No Effect of Generalized Joint Hypermobility on Injury Risk in Elite Female Soccer Players: A Prospective Cohort Study.

BACKGROUND: Although it has been suggested that generalized joint hypermobility (GJH) is a risk factor for injury in soccer players, it remains unclear whether this applies to elite female soccer players. PURPOSE: To investigate whether GJH is a risk factor for injury in elite female soccer players. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: Elite female soccer players in the Netherlands were screened at the start of the 2014-2015 competitive season. GJH was assessed using the Beighton score. Soccer injuries and soccer exposure were registered throughout the entire season. Poisson regression was performed to calculate incidence risk ratios (IRRs) using different cutoff points of the Beighton score (≥3, ≥4, and ≥5) to indicate GJH. RESULTS: Of the 114 players included in the study, 20 were classified as hypermobile (Beighton score ≥4). The mean (±SD) injury incidence per player was 8.40 ± 9.17 injuries/1000 hours of soccer, with no significant difference between hypermobile and nonhypermobile players. GJH was not a risk factor for injuries when using Beighton score cutoff points of ≥3 (IRR = 1.06 [95% CI, 0.74-1.50]; P = .762), ≥4 (IRR = 1.10 [95% CI, 0.72-1.68]; P = .662), or ≥5 (IRR = 1.15 [95% CI, 0.68-1.95]; P = .602). Similarly, GJH was not a significant risk factor for thigh, knee, or ankle injuries evaluated separately. CONCLUSION: This study indicates that GJH is not a risk factor for injuries in elite female soccer players, irrespective of Beighton score cutoff point. Hypermobile players at this elite level might have improved their active stability and/or used braces to compensate for joint laxity.

Effectiveness of Shockwave Treatment Combined With Eccentric Training for Patellar Tendinopathy: A Double-Blinded Randomized Study.

OBJECTIVE: To evaluate the effectiveness of a combined treatment of focused shockwave therapy (ESWT) and eccentric training compared with sham-shockwave therapy (placebo) and eccentric training in participants with patellar tendinopathy (PT) after 24 weeks. DESIGN: Randomized controlled trial. SETTING: Sports medicine departments of a university hospital and a general hospital in the Netherlands. PARTICIPANTS: Fifty-two physically active male and female participants with a clinical diagnosis of PT (mean age: 28.6 years; range, 18-45) were randomly allocated to the ESWT (n = 22) or sham shockwave (n = 30). INTERVENTIONS: Extracorporeal shockwave therapy and sham shockwave were applied in 3 sessions at 1-week intervals with a piezoelectric device. All participants were instructed to perform eccentric exercises (3 sets of 15 repetitions twice a day) for 3 months on a decline board at home. MAIN OUTCOME MEASURES: The Victorian Institute of Sport Assessment-Patella (VISA-P) scores (primary), pain scores during functional knee loading tests, and Likert score (secondary) were registered at baseline and at 6, 12, and 24 weeks after the start with the ESWT or sham-shockwave treatment. RESULTS: No significant differences for the primary and secondary outcome measures were found between the groups. In the ESWT/eccentric group, the VISA-P increased from 54.5 ± 15.4 to 70.9 ± 17.8, whereas the VISA-P in the sham-shockwave/eccentric group increased from 58.9 ± 14.6 to 78.2 ± 15.8 (between-group change in VISA-P at 24 weeks -4.8; 95% confidence interval, -12.7 to 3.0, P = 0.150). CONCLUSIONS: This study showed no additional effect of 3 sessions ESWT in participants with PT treated with eccentric exercises. The results should be interpreted with caution because of small sample size and considerable loss to follow-up, particularly in the ESWT group.

Long-term prognosis of acute lateral ankle ligamentous sprains: high incidence of recurrences and residual symptoms.

BACKGROUND: Acute lateral ankle ligamentous sprains (ALALS) are common injuries. This injury does not always have a favourable long-term outcome. Studies reporting the prognosis of ALALS after functional treatment are scarce. OBJECTIVE: To determine the prognosis of functionally treated ALALS, in terms of recurrent ALALS and residual symptoms. STUDY DESIGN: Retrospective cohort study. SETTING: Patients were recruited from 20 family practices, nine physical therapy practices, the emergency departments of a regional hospital and a university hospital. PATIENTS: Adult patients with an ALALS caused by an inversion trauma were invited to participate in this study 2.5-5 years after their initial injury. INDEPENDENT VARIABLES: Functional treatment of the initial ALALS. MAIN OUTCOME MEASURES: Acute lateral ankle ligamentous sprain recurrences and residual symptoms. RESULTS: A total of 44 patients were included, with an average follow-up period after the initial ankle sprain of 204 weeks (range 150-274 weeks). Eight patients (18.1%) had reinjured their ankle. Explicit pain around the ankle joint at physical examination was experienced by 45.5%. Clinical symptoms of anterior ankle impingement were present in 25% (all athletes), with radiologically confirmed tibiotalar osteophyte bone formation in 82% of them. CONCLUSIONS: A large proportion of patients with ALALS experience recurrences and persistent symptoms after their initial ankle injury. The high percentage of patients with anterior ankle impingement syndromes illustrates the need for early assessment of this impairment in patients with persistent complaints.

Rehabilitation using high-intensity physical training and long-term return-to-work in cancer survivors.

INTRODUCTION: Due to large and increasing numbers of cancer survivors, long-term cancer-related health issues have become a major focus of attention. This study examined the relation between a high-intensity physical rehabilitation program and return-to-work in cancer survivors who had received chemotherapy. METHODS: The intervention group, consisting of 72 cancer survivors from one hospital (8 men and 64 women, mean age 49 years), followed an 18-weeks rehabilitation program including strength and interval training, and home-based activities. An age-matched control group, consisting of 38 cancer survivors (9 men and 29 women), was recruited from two other hospitals. They received only standard medical care. All subjects were evaluated during a telephone interview on employment issues, conducted at ±3 years after diagnosis. The main outcomes were change in working hours per week and time until return-to-work. RESULTS: Patients in the intervention group showed significant less reduction in working hours per week [-5.0 h/week vs. -10.8 h/week (P = .03)]. Multivariate analyses showed that the training intervention, the age of patients, and the number of working hours pre-diagnosis could explain the improvement in long-term participation at work. Time until (partial) return-to-work was 11.5 weeks for the intervention group versus 13.2 weeks for the control group (P = .40). On long-term follow-up, 78% of the participants from the intervention group versus 66% from the control group had returned to work on the pre-diagnosis level of working hours (P = .18). CONCLUSION: Rehabilitation using high-intensity physical training is useful for working patients to minimize the decreased ability to work resulting from cancer and its treatment.