Comparison of incidence, prevalence, severity and profile of health problems between male and female elite youth judokas: A 30-week prospective cohort study of 154 athletes.

OBJECTIVES: To describe and compare the incidence, prevalence, severity, and profile of injuries (acute and overuse) and illness between female and male youth elite judokas during 30 weeks of a sports season. DESIGN: Prospective cohort study. METHODS: A total of 154 elite youth judokas (83 males and 71 females) were assessed from January to August 2019 in a training period organized by the Brazilian Judo Confederation. We conducted a prospective 30-week follow-up study on acute and overuse injuries and illness among youth female and male judokas through the Oslo Sports Trauma Research Center questionnaire on health problems (OSTRC-H). Every week, the OSTRC-H was sent to all youth judokas electronically, starting in the first week of preseason. The incidence rate, prevalence, and severity of illnesses and acute and overuse injuries were compared between sexes using an independent t-test (variables with normal distribution) or Mann Whitney U test (variables with non-normal distribution) with α set a 0.05. RESULTS: Female and male judokas showed 16.96 and 16.57 injuries per 1000 athletic exposures, respectively (p = 0.383). Female judokas showed a higher average weekly prevalence of health problems (38.8%) than male judokas (29.0%). In addition, females had a greater prevalence of substantial health problems (p < 0.001), injuries (p < 0.001), and overuse injuries (p < 0.001) than males. CONCLUSION: There were no differences in the incidence rate of injuries between sexes. Youth female judokas showed a higher prevalence of all health problems than youth male judokas. For both sexes, the knee and shoulder were the most affected joints for acute and overuse injuries, respectively.

Prevalence of Vitamin D Insufficiency and Deficiency in Young, Female Patients With Lower Extremity Musculoskeletal Complaints.

BACKGROUND: Low levels of vitamin D have well-known impacts on bone health, but vitamin D also has a more global role throughout many tissues, including skeletal muscle. The high prevalence of hypovitaminosis D and the vast physiological features of vitamin D have led researchers to examine the influence of vitamin D on physical performance and injury. Because of the critical role of vitamin D in maintaining musculoskeletal health and function, a high rate of hypovitaminosis D among female patients with a variety of musculoskeletal issues could be of high clinical relevance. HYPOTHESIS: There is a high prevalence of low vitamin D in female patients with both acute and overuse sports-related issues of both soft tissue and bone. STUDY DESIGN: Prospective cohort study. LEVEL OF EVIDENCE: Level 3. METHODS: Female patients, aged 16 to 40 years, presenting with lower extremity injury diagnosed within the past 4 weeks, no use of multivitamin or vitamin D supplement, and no history of malabsorption syndrome met the inclusion criteria. Vitamin D levels were assessed and categorized as normal (≥32 ng/mL) and low, which includes insufficient (20.01-31.9 ng/mL) and deficient (≤20 ng/mL). RESULTS: Of the 105 patients enrolled, 65.7% had low vitamin D. Within the low vitamin D cohort, 40.6% were deficient and 59.4% were insufficient. Injuries were grouped into overuse or acute with 74 overuse injuries and 31 acute injuries, exhibiting low vitamin D prevalence of 60.8% and 77.4%, respectively. Patients with ligamentous/cartilaginous injuries exhibited the highest percentage of low vitamin D (76.5%), followed by those with patellofemoral-related complaints (71.0%), muscle/tendon injuries (54.6%), and bone stress injuries (45.5%). In univariable analysis, older age, non-White race, less physical activity, less high-intensity interval training days, less endurance training days, and more rest days showed an association with low vitamin D, but none showed an independent association in multivariable analysis. CONCLUSION: The prevalence of low vitamin D in female patients with various musculoskeletal complaints was high. Clinicians should evaluate for low vitamin D in both acute and overuse injuries. CLINICAL RELEVANCE: In addition to screening, this study suggests that clinicians should evaluate for low vitamin D levels beyond bone stress injuries in the setting of acute and overuse injuries.

Injury rates in martial arts athletes and predictive risk factors for lower limb injuries.

BACKGROUND: Previous studies attempted to identify possible risk factors for acute and overuse injuries in several sports disciplines such as running, gymnastics or team sports. Given the lack of scientific works focused on risk factors for lower limb injuries in martial arts, the present study was aimed to investigate foot anatomy, anthropometric measures, and other background information as possible risk factors of injury in barefoot athletes practicing judo, karate, kung fu, Thai boxing, or aikido. In addition, the injury rates were evaluated in relation with the different martial art styles. METHODS: One group of 130 martial artists was retrospectively evaluated. Data of three morphological variables of the foot were collected: navicular height (NH), navicular drop (ND), and the rear foot (RF). In addition, each participant filled an interview questionnaire providing the following information: age, sex, body weight, height, Body Mass Index, hours of training per week, the kind of injury occurred to the lower limbs in the preceding year. RESULTS: Of 130 subjects, 70 (53.8%) did not sustain injuries, 35 (27.0%) suffered an acute injury and the remaining 25 (19.2%) reported an overuse injury. No significant differences were observed in the injury rates in relation to style and kind of martial art. Age, training volume and BMI were found as significant predictors of injury, while NH, ND, and RF were not able to predict acute or overuse injury at lower limbs. CONCLUSIONS: The injury rates were similar in karate, judo, kung fu, aikido, and Thai boxing. The foot morphology variables were not related with the presence or absence of acute and overuse injuries. Conversely, older and heavier martial artists, performing more hours of barefoot training, are at higher risk of acute and overuse injury. Athletic trainers should strongly take into account the present information in order to develop more accurate and specific injury prevention programs for martial artists.

Prevalence rate of chronic overuse pain in taekwondo athletes.

BACKGROUND: The aim of this study was to estimate the prevalence of chronic overuse pain (COP) and to identify possible risk factors of COP in sport poomsae taekwondo. METHODS: This is a cross-sectional survey. A total of 263 sport-poomsae competitors (112 females; 151 males; aged between 12-44 years), who competed at the 2014 sport poomsae taekwondo competition, participated in this study. The prevalence rate of COP and possible risk factors associated with COP were analyzed by using Chi-square tests and independent t-tests. RESULTS: A total of 173 athletes reported that they experienced COP (65.8%; 95% confidence interval [CI]: 60.5-71.5). Female athletes showed a higher prevalence rate than their male counterparts (75.9% vs. 58.3%). Lower body (61.5%) and knee joints (26.4%) were the two primarily injured body part. A total of 101 athletes reported that they injured in the previous year. Among those, 81.2% were suffered from COP. The technique that caused pain most frequently was side-kick among females and front-kick among males. Prevalence rates of COP were significantly different by sex, education level, training hour, and a history of injury. CONCLUSIONS: The prevalence of COP is high among sport poomsae taekwondo athletes. Competitors who are female, have a history of injury, and train for extended hours were more likely to experience COP. To identify other potential risk factors of COP in sport poomsae taekwondo, more research is needed to build upon the findings.

Investigation of risk factors and characteristics of dance injuries.

OBJECTIVE: The aim of the present study was to identify risk factors for the occurrence of sport injuries in dancers related to anthropometric variables, training, and specific dance characteristics. DESIGN: One-year, retrospective, cross-sectional study. SETTING: 26th Dance Festival of Joinville (Brazil), 2008. PARTICIPANTS: Five hundred dancers (409 women and 91 men) with a mean age of 18.26 ± 4.55 years. ASSESSMENT OF RISK FACTORS: Dancers participating in the 26th Dance Festival of Joinville (Brazil) were interviewed using the Reported Condition Inquiry, which was previously validated and modified for dance. This questionnaire contains questions addressing the anthropometric data of the volunteers and characteristics of injuries that occurred in the past 12 months. MAIN OUTCOME MEASURES: The data were collected through interviews addressing the occurrence of injuries and respective characteristics. Injury was considered any pain or musculoskeletal condition resulting from training and competition sufficient to alter the normal training routine in terms of form, duration, intensity, or frequency. RESULTS: A total of 377 injuries (75.40%) of the interviewees reported injuries in the past 12 months. The most affected anatomic segments were the ankle/foot (92 injuries; 28.75%) and thigh/leg (88 injuries; 27.50%) in classical ballet, the thigh/leg (43 injuries; 27.92%) in jazz/contemporary dance, and the knee (22 injuries; 43.14%) in tap/folk dance. The most reported causal mechanisms were dynamic overload and excessive use. CONCLUSIONS: Age and body weight were associated with injury in jazz/contemporary dance. Height was associated with injury in classical ballet and tap/folk dance. Duration of practice was associated with injury in classical ballet and jazz/contemporary dance.

Athletic osteitis pubis.

Athletic osteitis pubis is a painful and chronic condition affecting the pubic symphysis and/or parasymphyseal bone that develops after athletic activity. Athletes with osteitis pubis commonly present with anterior and medial groin pain and, in some cases, may have pain centred directly over the pubic symphysis. Pain may also be felt in the adductor region, lower abdominal muscles, perineal region, inguinal region or scrotum. The pain is usually aggravated by running, cutting, hip adduction and flexion against resistance, and loading of the rectus abdominis. The pain can progress such that athletes are unable to sustain athletic activity at high levels. It is postulated that osteitis pubis is an overuse injury caused by biomechanical overloading of the pubic symphysis and adjacent parasymphyseal bone with subsequent bony stress reaction. The differential diagnosis for osteitis pubis is extensive and includes many other syndromes resulting in groin pain. Imaging, particularly in the form of MRI, may be helpful in making the diagnosis. Treatment is variable, but typically begins with conservative measures and may include injections and/or surgical procedures. Prolotherapy injections of dextrose, anti-inflammatory corticosteroids and a variety of surgical procedures have been reported in the literature with varying efficacies. Future studies of athletic osteitis pubis should attempt to define specific and reliable criteria to make the diagnosis of athletic osteitis pubis, empirically define standards of care and reduce the variability of proposed treatment regimens.

Long-term follow-up of hypothenar hammer syndrome: a series of 47 patients.

Hypothenar hammer syndrome (HHS) is an uncommon form of secondary Raynaud phenomenon, occurring mainly in subjects who use the hypothenar part of the hand as a hammer; the hook of the hamate strikes the superficial palmar branch of the ulnar artery in the Guyon space, leading to occlusion and/or aneurysm of the ulnar artery. In patients with HHS, such injuries of the palmar ulnar artery may lead to severe vascular insufficiency in the hand with occlusion of digital artery. To date, only a few series have analyzed the long-term outcome of patients with HHS. This prompted us to conduct the current retrospective study to 1) evaluate the prevalence of HHS in patients with Raynaud phenomenon and 2) assess the short-term and long-term outcome in patients with HHS. From 1990 to 2006, 4148 consecutive patients were referred to the Department of Internal Medicine at the University of Rouen medical center for evaluation of Raynaud phenomenon using nailfold capillaroscopy. HHS was diagnosed in 47 of these 4148 patients (1.13% of cases).Forty-three patients (91.5%) had occupational exposure to repetitive palmar trauma. The more common occupations were factory worker (21.3%), mason (12.8%), carpenter (10.6%), and metal worker (10.6%); the mean duration of occupational exposure to repetitive palmar trauma at HHS diagnosis was 21 years. One patient (2.1%) had recreational exposure (aikido training) to repetitive trauma of the palmar ulnar artery, and 3 other patients (6.4%) developed HHS related to a single direct injury to the hypothenar area. Clinical manifestations were more often unilateral (87.2%) involving the dominant hand (93%). HHS complications included digital ischemic symptoms (ischemia: n = 21, necrosis: n = 20) and irritation of the sensory branch of the ulnar nerve (n = 11). In HHS patients, angiography demonstrated occlusion of the ulnar artery in the area of the Guyon space (59.6%), aneurysm of the ulnar artery in the area of the Guyon space (40.4%), and embolic multiple occlusions of the digital arteries (57.4%). All patients were advised to change their occupational exposure. They were given vasodilators, including calcium channel blocker (n = 37) and buflomedil (n = 12); 36 patients (76.6%) also received oral platelet aggregation inhibitors. Twenty-one patients with digital ischemia/necrosis were further given hemodilution therapy to reduce the hematocrit level to 35%. In 3 patients with HHS-related digital necrosis who exhibited partial improvement with vasodilators, prostacyclin analog therapy (a 5-day regimen of intravenous prostacyclin analog) was instituted, resulting in complete healing of digital ulcer in these 3 patients. Other conservative treatment options included controlling risk factors (smoking cessation, low-lipid diet, therapy for arterial hypertension) and careful local wound care of fingers in the 20 patients with digital necrosis. Only 2 patients, exhibiting digital necrosis and multiple digital artery occlusions, with nonthrombotic ulnar artery aneurysm underwent reconstructive surgery, that is, resection of the aneurysm with end-to-end anastomosis of the ulnar artery. The median length of follow-up in patients with HHS was 15.9 months. Thirteen patients (27.7%) exhibited clinical recurrences of HHS; the median time of HHS recurrence onset was 11 months. Outcome of HHS relapse was favorable with conservative measures in all cases. Awareness of HHS is required to increase suspicion of the disorder so that further exposure to risk factors like repetitive hypothenar trauma can be avoided for these patients; this is of great importance for their overall prognosis. We found favorable outcomes in most patients after conservative measures were initiated; therefore we suggest that surgery may be undertaken in the subgroup of patients who exhibit partial improvement while receiving conservative therapy. Finally, because we observed recurrence of HHS in 27.7% of patients, we note that HHS patients require close follow-up, including both regular and systematic physical vascular examination.

Occupational and physical therapy for work-related upper extremity disorders: how we can influence outcomes.

Upper extremity disorders in the workplace continue to be an economic strain on society. Physical and occupational therapy plays a crucial role in the management of the disorders. Medical providers should use therapists whose treatments demonstrate improvement in function and provide superior outcomes. Skilled therapy intervention requires that a therapist be able to identify and treat an injured worker in a holistic manner by looking at the whole individual, including issues that involve mechanical dysfunctions, psychosocial issues that include job satisfaction, and other age-related organic comorbidities. Therapists who work with injured employees must be highly skilled in identifying behavioral and organic disorders and must be confident in communicating these findings to various members of the health care team to help facilitate further medical testing.

An interpreter's interpretation: sign language interpreters' view of musculoskeletal disorders.

INTRODUCTION: Sign language interpreters are at increased risk for musculoskeletal disorders associated with work. Previous studies have used survey techniques to identify potential risk factors and approaches to their medical management. Little is known about risk factors and management of symptoms in this group from the perspective of the interpreter. Such qualitative information should help inform future research related to this professional group. METHOD: One thousand ninety-two sign language interpreters recruited from the Registry of Interpreters for the Deaf completed an open-ended question that was a component of a national prevalence survey. Responses were evaluated using content analysis. Inter and intra rater reliability were high (.88 and .92, respectively). RESULTS: Risk factors for initiation and/or exacerbation of symptoms included: difficult job, interpreting setting (educational), interpreting style (e.g., posture, self generated force), and emotional and physical stressors. Exercise (e.g., stretching, aerobics) was a common prevention strategy. Conventional medical treatment was used as the first line approach to symptom control. Self-care methods such as exercise, diet and warm up prior to interpreting were also reported. While massage and chiropractic care was used as commonly as in the general population, acupuncture was found to be used more often. Coping strategies that were more active (e.g. exercise, diet, more control over work schedule) were also reported as useful. CONCLUSIONS: These findings provide a description of factors that interpreters view as important in the development and exacerbation of hand and wrist pain. The results also indicate that interpreters used many self-management approaches. Future research should carefully investigate the utility of such approaches using well-controlled designs. Also, because of its widespread use in this group the evaluation of acupuncture in the management of these symptoms appears warranted. The qualitative approach used in the present study permitted an analysis of the worker perspectives regarding risk and management of these work related symptoms. This information can be used to further inform future research.

Repetitive strain injury: causes, treatment and prevention.

Repetitive strain injury (RSI) has become increasingly prevalent with the growth of computer-based and automated occupations. While environmental factors such as work stations and repetitive tasks are primary causes, a number of secondary causes can increase a person's risk of RSI. Various treatments provide relief but the rate of recovery varies widely. Prevention involves adopting a range of measures that will also promote recovery in those with RSI.

Elbow injuries in golf.

Golf is not a sport known for its high injury level; however, injuries do occur. Such mishaps usually involve overuse-type injuries that are more common among amateur golfers than among professional golfers. This article attempts to provide an overview of golf injuries to the elbow, with a concentration on incidence, proper diagnosis, adequate treatment (including rehabilitation), and prevention strategies. After reading this article, primary care physicians should be able to manage most golfing injuries to the elbow.

Back & neck problems among dentists and dental auxiliaries.

In the practice of dentistry, stress, tension, and postural practices can contribute to back and neck problems. Two hundred and four dentists and dental auxiliary (87 males and 117 females) in Riyadh city, Saudi Arabia were surveyed to determine the prevalence of postural problems. The candidates were interviewed and observed during practice. The data obtained showed that 111 (54.4%) of the subjects complained of neck pain and 150 (73.5%) complained of back pain. Only 37% of those complaining of back pain sought medical help. Within the limitations of this study, it might be concluded that neck and back pain among dental personnel are not of a severe nature.

Before you touch that keyboard....

New technology often gives rise to new health and safety concerns. The Model-T didn't come equipped with a seatbelt; now it is standard equipment. For years, bike helmets were purely optional; now many jurisdictions legislate their use. We wear seatbelts and helmets to prevent injuries, yet we spend hours each day at a potentially hazardous activity--keyboarding--with absolutely no thought to our own health and safety. This is starting to take a toll.