LGBTQ+ disclosure: challenges and possibilities.

This paper uses Ambiguous Loss Theory to explore the anticipatory and ambiguous losses and stressors surrounding the decision to come out as Lesbian, Gay, Bisexual, Transgender or Queer. Purposive sampling was used to administer a survey to 429 individuals who identified as LGBTQ+ about their coming out decisions and experiences. Data were coded and three major themes were developed: (1) the need for psychosocial safety (fear of being disowned, shunned or abandoned); (2) experiences of anxiety, depression, emotional stress, and shame; and (3) the pursuit of authenticity, self-discovery and liberation. Findings from the study indicate that coming out for LGBTQ+ individuals in the twenty first century remains accompanied by challenges and fears, both before and after the process, which significantly affects individuals' health and safety. In the longer term, despite the challenges, stressors and losses identified by participants, most reported that disclosing their sexual orientation had greatly improved their health and mental well-being.

Single-Leg Heel Raise Capacity is Lower, and Perceived Ankle Instability is Greater, in Dancers and Athletes With Posterior Ankle Impingement Syndrome.

OBJECTIVE: To compare clinical assessment findings between elite athletic populations with and without a clinical diagnosis of posterior ankle impingement syndrome (PAIS). DESIGN: Cross-sectional case-control study. SETTING: Elite ballet and sport. PARTICIPANTS: Ten male and female professional ballet dancers and athletes with a clinical diagnosis of PAIS and were matched for age, sex, and activity to 10 professional ballet dancers and athletes without PAIS. INDEPENDENT VARIABLES: Posterior ankle pain on body chart and a positive ankle plantarflexion pain provocation test. MAIN OUTCOME MEASURES: Single-leg heel raise (SLHR) endurance test, range of motion testing for weight-bearing ankle dorsiflexion, passive ankle plantarflexion, and first metatarsophalangeal joint dorsiflexion, and Beighton score for generalized joint hypermobility. Participants also completed the Cumberland Ankle Instability Tool (CAIT) questionnaire. RESULTS: The group with PAIS achieved significantly fewer repetitions on SLHR capacity testing ( P = 0.02) and were more symptomatic for perceived ankle instability according to CAIT scores ( P = 0.004). CONCLUSIONS: Single-leg heel raise endurance capacity was lower, and perceived ankle instability was greater in participants with PAIS. The management of this presentation in elite dancers and athletes should include the assessment and management of functional deficits.

Women's preferences for pelvic floor screening in sport and exercise: a mixed-methods study integrating survey and interview data in Australian women.

OBJECTIVES: One in two women experiencing pelvic floor (PF) symptoms stop playing sport or exercising. The study examines the perspective of women with PF symptoms to inform acceptable screening practices within sport and exercise settings. METHODS: Explanatory, sequential, mixed-methods design. Phase 1: survey of 18-65 years, symptomatic, Australian women (n=4556). Phase 2: semistructured interviews with a subset of survey participants (n=23). Integration occurred through connection of phases (study design, sampling) and joint display of data. RESULTS: Findings are represented in three threads: (1) 'women (not) telling'; a majority of women had told no-one within a sport or exercise setting about their PF symptoms due to shame/embarrassment, lack of pelvic health knowledge and not wanting to initiate the conversation, (2) 'asking women (screening for PF symptoms)'; women endorsed including PF symptom questions within existing sport and exercise screening practices but only when conducted in a respectful and considered manner and (3) 'creating safety'; professionals can assist women to disclose by demonstrating expertise, trustworthiness and competency. If health and exercise professionals are provided with appropriate training, they could raise pelvic health awareness and promote a supportive and safe sport and exercise culture. CONCLUSION: Women with PF symptoms support health and exercise professionals initiating conversations about PF health to normalise the topic, and include PF symptoms among other pre-exercise screening questions. However, women should be informed on the relevance and potential benefits of PF screening prior to commencing. Safe screening practices require building trust by providing information, gaining consent, displaying comfort and genuine interest, and being knowledgeable within one's scope of practice to the provision of advice, exercise modifications and referral as appropriate.

Exploring the role of intratendinous pressure in the pathogenesis of tendon pathology: a narrative review and conceptual framework.

Despite the high prevalence of tendon pathology in athletes, the underlying pathogenesis is still poorly understood. Various aetiological theories have been presented and rejected in the past, but the tendon cell response model still holds true. This model describes how the tendon cell is the key regulator of the extracellular matrix and how pathology is induced by a failed adaptation to a disturbance of tissue homeostasis. Such failure has been attributed to various kinds of stressors (eg, mechanical, thermal and ischaemic), but crucial elements seem to be missing to fully understand the pathogenesis. Importantly, a disturbance of tissue pressure homeostasis has not yet been considered a possible factor, despite it being associated with numerous pathologies. Therefore, we conducted an extensive narrative literature review on the possible role of intratendinous pressure in the pathogenesis of tendon pathology. This review explores the current understanding of pressure dynamics and the role of tissue pressure in the pathogenesis of other disorders with structural similarities to tendons. By bridging these insights with known structural changes that occur in tendon pathology, a conceptual model was constituted. This model provides an overview of the possible mechanism of how an increase in intratendinous pressure might be involved in the development and progression of tendon pathology and contribute to tendon pain. In addition, some therapies that could reduce intratendinous pressure and accelerate tendon healing are proposed. Further experimental research is encouraged to investigate our hypotheses and to initiate debate on the relevance of intratendinous pressure in tendon pathology.

The VISA-A (sedentary) should be used for sedentary patients with Achilles tendinopathy: a modified version of the VISA-A developed and evaluated in accordance with the COSMIN checklist.

OBJECTIVE: To develop and evaluate a modified version of the Victorian Institute of Sport Assessment-Achilles (VISA-A) questionnaire, for use in sedentary patients with Achilles tendinopathy, using the Consensus-based Standards for the selection of health Measurement Instruments recommendations. METHODS: Twenty-two sedentary patients with Achilles tendinopathy completed the VISA-A and provided feedback regarding the relevance, comprehensiveness and comprehensibility of each item, response options and instructions. Patient and professional feedback was used to develop the VISA-A (sedentary) questionnaire. Reliability, validity and responsiveness of the VISA-A (sedentary) was evaluated in 51 sedentary patients with Achilles tendinopathy: 47.1% women, mean age 64.8 (SD 11.24). RESULTS: Factor analysis identified two dimensions (symptoms and activity) for the VISA-A (sedentary). Test-retest reliability was excellent for symptoms (intraclass correlation coefficient, ICC=0.991) and activity (ICC=0.999). Repeatability was 1.647 for symptoms and 0.549 for activity. There was a significant difference between the VISA-A and VISA-A (sedentary) scores both pretreatment and post-treatment. There was stronger correlation between the pretreatment to post-treatment change in the VISA-A (sedentary) scores (r=0.420 for symptoms, r=0.407 for activity) and the global rating of change than the VISA-A scores (r=0.253 for symptoms, r=0.186 for activity). CONCLUSION: The VISA-A (sedentary) demonstrates adequate reliability, validity and responsiveness in sedentary patients with Achilles tendinopathy. The VISA-A (sedentary) is a more appropriate measure than the VISA-A for this cohort and is recommended for clinical and research purposes.

Association Between COL5a1, COL11a1, and COL11a2 Gene Variations and Rotator Cuff Tendinopathy in Young Athletes.

OBJECTIVE: Tendinopathy is a prevalent condition in young athletes and in older nonathletic people. Recent tendinopathy research has shown a growing interest in the role played by genetic factors, basically genes involved in collagen synthesis and regulation, in view of collagen disorganization typically present in tendon pathologies. DESIGN: A case-control, genotype-phenotype association study. SETTING: La Ribera Hospital, Valencia, Spain. PARTICIPANTS: A group of 137 young athletes (49 with rotator cuff tendon pathology and 88 healthy counterparts) who played upper-limb-loading sports were clinically and ultrasound (US) assessed for rotator cuff tendinopathy were included. INTERVENTION: Genetic analysis was performed to determine whether there was a relationship between rotator cuff pathology and the genotype. MAIN OUTCOME MEASURES: We hypothesized that the following single nucleotide polymorphisms: COL5a1 rs12722, COL11a1 rs3753841, COL11a1 rs1676486, and COL11a2 rs1799907 would be associated with rotator cuff tendinopathy. RESULTS: A direct relationship between CC genotype and bilateral US pathological images was statistically significant (χ 2 = 0.0051) and confirmed by the Fisher test, with a correlation coefficient of 0.345 and a Cramer's v of 0.26. CONCLUSION: A significant association was found between COL5a1 rs12722 genotype and rotator cuff pathology, with the CC genotype conferring increased risk of tendon abnormalities and being associated with rotator cuff pathology.

Associations between clinical and imaging findings in posterior ankle impingement syndrome: a systematic review.

BACKGROUND: Posterior ankle impingement syndrome (PAIS) is a common and debilitating condition, commonly affecting people who participate in activities that involve repetitive ankle plantarflexion. The relationship between clinical and imaging findings in PAIS has not been established. PURPOSE: To investigate the relationship between clinical and imaging features in PAIS by reviewing the literature comparing symptomatic patients to asymptomatic controls. MATERIAL AND METHODS: A systematic literature search was performed to identify all English-language articles that compared imaging features in patients diagnosed with PAIS to imaging in an asymptomatic control group. RESULTS: A total of 8394 articles were evaluated by title and abstract, and 156 articles were read in full text. No articles compared imaging findings to an asymptomatic control group, thus no articles met the inclusion criteria. CONCLUSION: This systematic review found no published research that compared the imaging findings of people diagnosed with PAIS to asymptomatic people. Until this information is available, imaging features in people with posterior ankle impingement should be interpreted with caution.

Posterior Ankle Impingement Syndrome Clinical Features Are Not Associated With Imaging Findings in Elite Ballet Dancers and Athletes.

OBJECTIVE: To assess the association between clinical features and magnetic resonance imaging (MRI) findings in posterior ankle impingement syndrome (PAIS) and to compare the prevalence of imaging findings between participants with and without a clinical diagnosis of PAIS. DESIGN: Case-control study. SETTING: Elite ballet and sport. PARTICIPANTS: Eighty-two male (54%) and female participants comprising ballet dancers (n = 43), cricket fast bowlers (n = 24), and football (soccer) players (n = 15). INDEPENDENT VARIABLES: Clinical: posterior ankle pain on body chart, passive plantarflexion pain provocation test. Patient-reported outcome measures: Oslo Sports Trauma Research Center Overuse Injury Questionnaire, Foot and Ankle Ability Measure Sports subscale. MAIN OUTCOME MEASURES: Imaging findings including posterior ankle bone marrow edema, os trigonum (± bone marrow edema, and increased signal at synchondrosis), Stieda process (± bone marrow edema), talocrural and subtalar joint effusion-synovitis size, flexor hallucis longus tendinopathy, and tenosynovitis identified as present or absent on 3.0-Tesla MRI. RESULTS: Imaging findings were not associated with posterior ankle pain or a positive ankle plantarflexion pain provocation test. Imaging findings were not associated with patient-reported outcome measures. Imaging findings did not differ between PAIS-positive and PAIS-negative groups. Os trigonum and Stieda process were prevalent despite clinical status. CONCLUSIONS: The lack of association between imaging findings and clinical features questions the role of imaging in PAIS. Clinicians should rely primarily on clinical assessment in the diagnosis and management of patients with PAIS.

Implicit Motor Imagery of the Foot and Hand in People with Achilles Tendinopathy: A Left Right Judgement Study.

OBJECTIVE: To determine if impairment in motor imagery processes is present in Achilles tendinopathy (AT), as demonstrated by a reduced ability to quickly and accurately identify the laterality (left-right judgement) of a pictured limb. Additionally, this study aimed to use a novel data pooling approach to combine data collected at 3 different sites via meta-analytical techniques that allow exploration of heterogeneity. DESIGN: Multi-site case-control study. METHODS: Three independent studies with similar protocols were conducted by separate research groups. Each study-site evaluated left/right judgement performance for images of feet and hands using Recognise© software and compared performance between people with AT and healthy controls. Results from each study-site were independently collated, then combined in a meta-analysis. RESULTS: In total, 126 participants (40 unilateral, 22 bilateral AT cases, 61 controls) were included. There were no differences between AT cases and controls for hand image accuracy and reaction time. Contrary to the hypothesis, there were no differences in performance between those with AT and controls for foot image reaction time, however there were conflicting findings for foot accuracy, based on four separate analyses. There were no differences between the affected and unaffected sides in people with unilateral AT. CONCLUSIONS: Impairments in motor imagery performance for hands were not found in this study, and we found inconsistent results for foot accuracy. This contrasts to studies in persistent pain of limbs, face and knee osteoarthritis, and suggests that differences in pathoetiology or patient demographics may uniquely influence proprioceptive representation.

Magnetic resonance imaging findings associated with posterior ankle impingement syndrome are prevalent in elite ballet dancers and athletes.

OBJECTIVE: To report the prevalence of MRI features commonly associated with posterior ankle impingement syndrome in elite ballet dancers and athletes and to compare findings between groups. MATERIALS AND METHODS: Thirty-eight professional ballet dancers (47.4% women) were age- and sex-matched to 38 elite soccer or cricket fast bowler athletes. All participants were training, playing, and performing at full workload and underwent 3.0-T standardised magnetic resonance imaging of one ankle. De-identified images were assessed by one senior musculoskeletal radiologist for findings associated with posterior ankle impingement syndrome (os trigonum, Stieda process, posterior talocrural and subtalar joint effusion-synovitis, flexor hallucis longus tendon pathology and tenosynovitis, and posterior ankle bone marrow oedema). Imaging scoring reliability testing was performed. RESULTS: Posterior talocrural effusion-synovitis (90.8%) and subtalar joint effusion-synovitis (93.4%) were common in both groups, as well as the presence of either an os trigonum or Stieda process (61.8%). Athletes had a higher prevalence of either os trigonum or Stieda process than dancers (74%, 50% respectively, P = 0.03). Male athletes had a higher prevalence of either os trigonum or Stieda process than male dancers (90%, 50% respectively, P = 0.01), or female athletes (56%, P = 0.02). Posterior subtalar joint effusion-synovitis size was larger in dancers than athletes (P = 0.02). Male and female dancers had similar imaging findings. There was at least moderate interobserver and intraobserver agreement for most MRI findings. CONCLUSION: Imaging features associated with posterior impingement were prevalent in all groups. The high prevalence of os trigonum or Stieda process in male athletes suggests that this is a typical finding in this population.

Joint Hypermobility Does Not Increase the Risk of Developing Hip Pain, Cartilage Defects, or Retirement in Professional Ballet Dancers Over 5 years.

OBJECTIVE: This study aimed to evaluate the risk of developing hip pain, cartilage defects, and retirement in hypermobile ballet dancers over 5 years. DESIGN: Prospective cohort study. SETTING: Professional Ballet Company. PARTICIPANTS: Forty ballet dancers (57.5% women) were assessed at baseline and 21 dancers at 5 years. INDEPENDENT VARIABLE: Baseline evaluation of generalised joint hypermobility (GJH) (GJH = Beighton score ≥5/9). OUTCOME MEASURES: Cartilage defects on hip 3T magnetic resonance imaging and pain (the Copenhagen Hip and Groin Outcome Score: HAGOS) at baseline and follow-up, hip-related injury incidence, and retirement over 5 years. RESULTS: Twelve dancers retired by follow-up, none due to hip injury or GJH. At baseline, 17 (42.5%) dancers were hypermobile, 18 (45%) had cartilage defects, and 15 (37.5%) reported hip pain (HAGOS pain <100). Cartilage defect prevalence was lower in GJH (n = 1) than non-GJH dancers (n = 17, P < 0.001). Beighton scores <5/9 were predictive of cartilage defect presence at baseline, independent of age and sex (P = 0.006). At follow-up, cartilage defects progressed in 2 dancers, one was hypermobile. Baseline and follow-up HAGOS pain scores were similar in GJH and non-GJH dancers (P > 0.05 for all). Hip-related injury over 5 years was reported by a similar number of GJH (n = 7) and non-GJH dancers (n = 6, P = 0.7). Hypermobility was more prevalent in active dancers (n = 12) than dancers who retired (n = 2), independent of age, rank, and sex (P = 0.03). CONCLUSIONS: Hypermobile dancers are at no greater risk of reporting hip pain and injury or retirement over 5 years, and cartilage defect prevalence was much lower in GJH than non-GJH dancers.

Hip Joint Cartilage Defects in Professional Ballet Dancers: A 5-year Longitudinal Study.

OBJECTIVE: A causal link between ballet, hip pain, and pathology has not been established. Change in ballet dancers' hip pain and cartilage defect scores were investigated over 5 years. DESIGN: Longitudinal. SETTING: Professional ballet company. PARTICIPANTS: Twenty-one professional ballet dancers (52% men). INDEPENDENT VARIABLES: Baseline and follow-up Copenhagen Hip and Groin Outcome Score (HAGOS-pain subscale); incidence of hip-related pain and levels of dance participation collected daily over 5 years; bony morphology measured on baseline 3T magnetic resonance imaging (MRI). MAIN OUTCOME MEASURE: Change in cartilage defect score on MRI between baseline and 5-year follow-up. RESULTS: Cartilage scores did not increase in 19 (90%) dancers. There was one new cartilage defect and one progressed in severity. At follow-up, all 6 dancers with cartilage defects were men. Group HAGOS pain scores were high 97.5 (7.5) and not related to cartilage defects (P = 0.12). Five (83%) dancers with baseline cartilage defects reported HAGOS pain scores <100 at follow-up. There were no time-loss hip injuries over 5 years. Two (33%) dancers with cartilage defects recorded hip-related pain (one reported minor training modification). Femoral neck-shaft angles (NSAs) were lower in men with cartilage defects [129.3 degrees (3.4 degrees)] compared with those without cartilage defects [138.4 degrees (4.5 degrees); P = 0.004]. CONCLUSIONS: Elite level ballet did not negatively affect cartilage health over 5 years. Cartilage defects were related to low femoral NSAs. Most cartilage defects did not progress and there was minimal impact on dance participation and pain levels. Longer follow-up is required to determine the long-term sequelae for those with cartilage defects. LEVEL OF EVIDENCE: 1b.

Calf muscle strain injuries in elite Australian Football players: A descriptive epidemiological evaluation.

BACKGROUND: Calf muscle strain injuries (CMSI) show consistent rates of prevalence and re-injury in elite Australian Football players. An epidemiological evaluation is warranted to better understand the clinical presentation and recovery of CMSI. PURPOSE: First, to describe the epidemiology of CMSI in elite Australian Football players. Second, to determine if recovery following injury is different according to: (a) injury type (index vs re-injury); (b) muscle injured (soleus vs gastrocnemius); and (c) mechanism of injury (running-related activity vs non running-related activity). STUDY DESIGN: Descriptive epidemiological. METHODS: Data retrieved from the Soft Tissue injury Registry of the Australian Football League were analyzed. Sixteen clubs submitted data on CMSI from 2014 to 2017. Data included: player characteristics, training and match history at the time of injury, MRI, and the time to reach recovery milestones. RESULTS: One hundred and eighty-four CMSI were included (149 index injuries; 35 re-injuries). Soleus injuries were most prevalent (84.6%). Soleus injuries took 25.4 ± 16.2 days to return to play, whereas gastrocnemius injuries took 19.1 ± 14.1 days (P = .097). CMSI sustained during running-related activities took approximately 12 days longer to recover than injuries sustained during non running-related activities (P = .001). Compared to index injuries, re-injuries involved older players (P = .03) and significantly more time was taken to run at >90% of maximum speed, return to full training, and return to play (P ≤ .001). Almost all of the observed re-injuries involved soleus (91.4%). CONCLUSION: Soleus injuries are more prevalent than gastrocnemius injuries in elite Australian Football players. Prognosis appears to be influenced by clinical factors, with CMSI sustained during running-related activities and re-injuries needing more time to recover.

ICON PART-T 2019-International Scientific Tendinopathy Symposium Consensus: recommended standards for reporting participant characteristics in tendinopathy research (PART-T).

We aimed to establish consensus for reporting recommendations relating to participant characteristics in tendon research. A scoping literature review of tendinopathy studies (Achilles, patellar, hamstring, gluteal and elbow) was followed by an online survey and face-to-face consensus meeting with expert healthcare professionals (HCPs) at the International Scientific Tendon Symposium, Groningen 2018. We reviewed 263 papers to form statements for consensus and invited 30 HCPs from different disciplines and geographical locations; 28 completed the survey and 15 attended the meeting. There was consensus that the following data should be reported for cases and controls: sex, age, standing height, body mass, history of tendinopathy, whether imaging was used to confirm pathology, loading tests, pain location, symptom duration and severity, level of disability, comorbidities, physical activity level, recruitment source and strategies, and medication use history. Standardised reporting of participant characteristics aims to benefit patients and clinicians by guiding researchers in the conduct of their studies. We provide free resources to facilitate researchers adopting our recommendations.

ICON 2019-International Scientific Tendinopathy Symposium Consensus: There are nine core health-related domains for tendinopathy (CORE DOMAINS): Delphi study of healthcare professionals and patients.

BACKGROUND: The absence of any agreed-upon tendon health-related domains hampers advances in clinical tendinopathy research. This void means that researchers report a very wide range of outcome measures inconsistently. As a result, substantial synthesis/meta-analysis of tendon research findings is almost futile despite researchers publishing busily. We aimed to determine options for, and then define, core health-related domains for tendinopathy. METHODS: We conducted a Delphi study of healthcare professionals (HCP) and patients in a three-stage process. In stage 1, we extracted candidate domains from clinical trial reports and developed an online survey. Survey items took the form: 'The 'candidate domain' is important enough to be included as a core health-related domain of tendinopathy'; response options were: agree, disagree, or unsure. In stage 2, we administered the online survey and reported the findings. Stage 3 consisted of discussions of the findings of the survey at the ICON (International Scientific Tendinopathy Symposium Consensus) meeting. We set 70% participant agreement as the level required for a domain to be considered 'core'; similarly, 70% agreement was required for a domain to be relegated to 'not core' (see Results next). RESULTS: Twenty-eight HCP (92% of whom had >10 years of tendinopathy experience, 71% consulted >10 cases per month) and 32 patients completed the online survey. Fifteen HCP and two patients attended the consensus meeting. Of an original set of 24 candidate domains, the ICON group deemed nine domains to be core. These were: (1) patient rating of condition, (2) participation in life activities (day to day, work, sport), (3) pain on activity/loading, (4) function, (5) psychological factors, (6) physical function capacity, (7) disability, (8) quality of life and (9) pain over a specified time. Two of these (2, 6) were an amalgamation of five candidate domains. We agreed that seven other candidate domains were not core domains: range of motion, pain on clinician applied test, clinical examination, palpation, drop out, sensory modality pain and pain without other specification. We were undecided on the other five candidate domains of physical activity, structure, medication use, adverse effects and economic impact. CONCLUSION: Nine core domains for tendon research should guide reporting of outcomes in clinical trials. Further research should determine the best outcome measures for each specific tendinopathy (ie, core outcome sets).

Hip Joint Effusion-Synovitis Is Associated With Hip Pain and Sports/Recreation Function in Female Professional Ballet Dancers.

OBJECTIVE: To compare hip joint effusion-synovitis prevalence in professional ballet dancers with nondancing athletes and to evaluate the relationship between effusion-synovitis and clinical measures and cartilage defects. DESIGN: Case-control study. SETTING: Elite ballet and sport. PARTICIPANTS: Forty-nine professional ballet dancers and 49 age-matched and sex-matched athletes. INDEPENDENT VARIABLES: Group (dancers/athletes), sex, age, years of training, Copenhagen Hip and Groin Outcome Scores (HAGOSs), hip rotation range of motion (ROM), generalized joint hypermobility (GJH), and hip cartilage defect scores. MAIN OUTCOME MEASURES: Hip joint effusion-synovitis (absent, grade 1 = 2-4 mm, grade 2 = >4 mm) scored with 3-Tesla magnetic resonance imaging. RESULTS: Hip joint effusion-synovitis was found in 22 (45%) dancers and 13 (26.5%) athletes (P = 0.06). Grade 2 effusion-synovitis was only found in dancers (n = 8, r = 0.31, P = 0.009). The prevalence of effusion-synovitis was similar in men (n = 11, 26%) and women (n = 24, 43%, P = 0.09). Female dancers with effusion-synovitis had lower HAGOS pain (r = 0.63, P = 0.001) and sports/recreation scores (r = 0.66, P = 0.001) compared with those without effusion-synovitis. The HAGOS scores were not related to effusion-synovitis in male dancers or female and male athletes (P > 0.01 for all). Effusion-synovitis was not related to hip ROM, GJH, or cartilage defect scores (P > 0.05 for all). CONCLUSIONS: Hip joint effusion-synovitis was related to higher levels of pain and lower sports/recreation function in female ballet dancers. Effusion-synovitis was not related to hip rotation ROM, GJH or cartilage defects. Larger sized joint effusion-synovitis was exclusively found in dancers.

Reduced Levels of Aligned Fibrillar Structure Are Not Associated With Achilles and Patellar Tendon Symptoms.

OBJECTIVE: To investigate whether the mean cross-sectional area (mCSA) of aligned fibrillar structure (AFS) was associated with the presence and severity of symptoms. DESIGN: Prospective cohort study. PARTICIPANTS: One hundred seventy-five elite male Australian football players completed monthly Oslo Sports Trauma Research Center overuse injury questionnaires for both the Achilles and patellar tendon over the season to ascertain the presence and severity of symptoms. At the start of the preseason, participants underwent ultrasound tissue characterization (UTC) imaging of the Achilles and patellar tendon. MAIN OUTCOME MEASURES: Images were classified as normal or abnormal based on gray-scale ultrasound. Based on UTC quantification, the mCSA of AFS was compared between those with and without current symptoms. RESULTS: No difference in the mCSA of AFS was observed between those with or without tendon symptoms (P < 0.05). Similar to previous findings, 80% to 92% of abnormal tendons had similar amounts of mCSA of AFS compared with normal tendon. If reduced mCSA of AFS was present, it was not associated with the presence or severity of symptoms. CONCLUSIONS: The prevalence, development, or severity of symptoms was not associated with decreased levels of AFS in the Achilles or patellar tendon. This suggests that a lack of structural integrity is not linked to symptoms and questions the rationale behind regenerative medicine. Most tendons are able to compensate for areas of disorganization and maintain tissue homeostasis.

Muscle Size and Quality of the Gluteal Muscles and Tensor Fasciae Latae in Women with Greater Trochanteric Pain Syndrome.

Greater trochanteric pain syndrome (GTPS) is prevalent in women and severely impacts quality of life. A key muscle group demonstrating reduced strength are the hip abductors. An understanding of specific muscles affected will help guide targeted rehabilitation. Objectives of this case-control study were to compare gluteal and tensor fasciae latae (TFL) muscle size and quality (fatty infiltration) in women with symptomatic GTPS to asymptomatic age-matched female controls. Magnetic resonance imaging of 16 women with GTPS (mean age 55.75 years, range 23-69) and 15 asymptomatic controls (mean age 55.60 years, range 31-66) was undertaken. Muscle volumes of the gluteus maximus, gluteus medius, gluteus minimus, and TFL were calculated. Fatty infiltration was rated using the Goutallier classification system for all muscles in their entirety, as well as anterior and posterior segments of gluteus medius and minimus. Muscle volumes and fatty infiltration were compared between groups. Significantly smaller muscle volumes were identified in the symptomatic group for the upper (P = 0.01) and lower (P = 0.04) portions of gluteus maximus, gluteus medius (P = 0.03), and gluteus minimus (P = 0.02). There was no difference in TFL (P = 0.18). Symptomatic participants displayed significantly greater fatty infiltration in gluteus maximus upper (P = 0.021) and lower (P = 0.049) when adjusted for BMI, and gluteus minimus (P = 0.018), particularly in the posterior portion (P = 0.04). Anterior gluteus minimus demonstrated high amounts of fatty infiltration in both groups. Gluteal muscle atrophy and fatty infiltration in women with GTPS suggests gluteus maximus and minimus may be an important target for rehabilitation. Clin. Anat., 33:1082-1090, 2020. © 2019 Wiley Periodicals, Inc.

Three myeloproliferative neoplasms: An overview.

A group of rare hematologic cancers, myeloproliferative neoplasms (MPNs) evolve when bone marrow dysfunction causes overproduction of one or more blood cell types. This article explores the diagnosis, treatment, and nursing care of patients diagnosed with one of three classic MPNs: essential thrombocythemia, polycythemia vera, and primary myelofibrosis.

Self-Reported Wellness in Training and Performance: A Comparison of Professional Ballet Dancers and Professional Athletes.

OBJECTIVE: In high-performance sport, the use of self-report measures is expanding. The exploration of wellness states in response to training and performance requires further investigation for professional ballet dancers and athletes. This study therefore aimed to: compare wellness scores between professional ballet dancers and athletes in training and performance; report frequency of self-reported modified participation during training and performance; and report frequency of self-reported inability to participate due to pain and illness in dancers and athletes. METHODS: Fourteen professional ballet dancers (mean 26 yrs, SD 2.6) and 14 sex- and age-matched professional athletes (mean 27.7 yrs, SD 2.9) recorded daily wellness (fatigue, stress, sleep quality and quantity), participation (full, rest, modified, or unable to participate) and activity (performance, training) into a wellness application on their smart phone over a 4-month period. Mixed factorial ANOVAs were conducted to assess the interaction between group (ballet dancers and athletes) and activity (performance and training) on the dependent variables (stress, fatigue, sleep quality, and sleep quantity). RESULTS: Stress and fatigue levels were higher for both dancers and athletes during performance compared to training periods. Dancers recorded lower sleep quantity than athletes, with no difference in sleep quality. Modified participation appears more common in dancers compared to athletes. Dancers and athletes were rarely unable to train or perform/compete over the 4 months. CONCLUSION: Self-reported wellness scores appear sensitive to activity type and can provide valuable information to guide intervention and recovery strategies. Further research on the impact of poor wellness on performance, illness, and injury in professional ballet is warranted.