Functional knee brace use by non-injured subjects while performing an anaerobic capacity task: preliminary study.

AIM: The objective of this paper was to investigate if performance was hindered in non-injured braced athletes during an anaerobic task. If performance was affected, could accommodation to wearing a knee brace occur and thus decreasing performance hindrance concern while using a functional knee brace (FKB). METHODS: A 2x3 non-braced (NBr) and braced repeated measure factorial design. Five healthy athletes completed all testing. Subjects performed the Repeated High Intensity Shuttle Test (RHIST) over six days (three days NBr and three days braced). Running times were recorded each testing day to determine performance measures and percent fatigue levels while using a FKB and if accommodation to FKB use was possible. RESULTS: Non significant (F1,4=1.42, P=0.299) faster group mean performance time, was recorded for braced subjects relative to the non-braced condition. Although relatively faster performance levels were noted during the braced testing conditions during days 1 and 3 compared to the non-braced condition, these results were also not significant (F2,8=2.82, P=0.118). Lower percent fatigue level was recorded during all three braced days compared to non-braced days. Further, a tendency for accommodation to knee brace trend use was noted as the percentage performance difference between the two conditions had decreased by the last day of testing. CONCLUSION: Use of a knee brace did not hinder performance once accommodation to using the knee brace occurred and fatigue was not a factor while using a knee brace. Additional research, using a larger sample size and longer testing duration, is required to confirm the potential accommodation trend.

University men's ice hockey: rates and risk of injuries over 6-years.

AIM: The aim of this study was to determine the injury rates of a Men's Varsity Ice Hockey team over six-years. Data on ice hockey injury rates and profile continue to increase in the hope of assisting with injury prevention. METHODS: The University of British Columbia Men's Varsity team has been followed prospectively over a six-year period. All student-athletes completed a preseason medical examinations and physiological assessments. The team physician evaluated each injury and the team therapist completed the injury report forms and the attendance records for each player. RESULTS: A total of 46215 player exposures were recorded. The combined injury rate was 3.70 injuries/1000 player game and practice exposures. A statistically significantly higher risk of injury was observed during games and the greatest risk of injury was observed during the second period. Forwards sustained greater percentage of injuries compared to defensemen and goalies. Sprains and strains accounted for 40% of all injuries, followed by concussions (13%). Non-contact injuries were most common, while the anatomy sustaining the most injuries was the head/neck/face region. A high percentage of the recorded injuries required less than seven days to return to full activity. CONCLUSIONS: The risk of injury for university ice hockey players is greater during games and is dependant on playing position. Players are prone to sprains and strains, which may not involve any contact. Concussion and knee joint injury rates continue to cause concern.

Exercise-induced stress injuries to the femur.

Seventy-one athletes with 74 stress injuries to the femur were studied using a case-controlled design. Forty-three were females (26.6 yrs) and 28 were males (31.2 yrs). Each patient had exercise-induced pain in the hip, groin or thigh and a Tec-99m-MDP bone scan showing focal uptake of radionuclide in the femur. Running was the most common activity at the time of injury (89.2%) followed by triathlon (4.6%) and aerobic dance (4.6%). Thirty per cent of the runners had increased their training duration immediately prior to their first symptom. Anterior thigh pain was the most frequent site of exercise-induced pain (45.9%) followed by hip pain (27%) and groin pain (8.1%). During the clinical examination, when asked to hop on the affected limb, 70.3% of the patients had pain reproduced in the hip, groin or anterior thigh. There were 39 cases (53%) involving focal uptake of radionuclide in the femoral shaft, 15 (20%) in the lesser trochanter, 11 (15%) in the intertrochanteric region between the femoral neck and the greater trochanter, 8 (11%) in the femoral neck and 1 (1%) in the greater trochanter. Two patients suffered displaced fractures, one at the femoral neck and the other in the shaft of the femur. Neither patient had previously sought medical attention for their leg pain. Of 46 plain radiographs taken, only 11 (24%) were abnormal. The mean time to diagnosis and recovery were 6.6 and 10.4 weeks respectively. Substitution of cycling and water exercise for running were the most common therapeutic interventions.

Osteochondral lesions of the talus.

We report demographic, clinical, and imaging data on 92 patients with osteochondral lesions of the talus collected in one center between 1981 and 1992. All patients reported pain as their primary symptom. Ninety-four percent of the patients reported pain with activity. Physical examination was unhelpful. Using newer imaging techniques (bone scan and computed tomography) and with increased awareness, we have observed a sevenfold increase in the diagnostic frequency of osteochondral lesions of the talus between the years 1981 to 1986 and 1987 to 1992. Bone scan is an excellent screening tool for patients with chronic ankle pain and has 99% sensitivity in depicting osteochondral lesions. Computed tomography demonstrated a previously unclassified lesion, the radiolucent defect, which accounts for 77% of the lesions in this series. We have therefore modified the Berndt and Harty classification system, basing it on radiographic appearance (principally computed tomography) and adding the radiolucent lesion. Fifty-eight patients were treated surgically. Anterior and midtalar lesions are now approached arthroscopically. Surgical treatment of the radiolucent lesion, consisting of curettage and drilling, gives 42% excellent and 32% good results. Pain relief often occurs within months of surgery, but healing of the lesion requires years, and some may persist indefinitely.

Musculoskeletal injuries associated with physical activity in older adults.

In order to compare the clinical presentation of overuse injuries in older and younger athletes, retrospective patient chart data were obtained from cases which had been referred to an outpatient sports medicine clinic over a 5-yr period. A total of 1,407 cases were studied comprising two populations separated by significantly (P less than 0.001) different ages: 685 "old" (mean age = 56.9 +/- 6.1 yr) and 722 "young" (mean age = 30.4 +/- 8.1 yr). Although the two subpopulations demonstrated modest differences in sport activity at the time of injury, specific diagnoses, and anatomic location of injury, many similarities existed between the groups. Running, fitness classes, and field sports were more commonly associated with injury in the younger group, while racquet sports, walking, and low intensity sports were more commonly associated with injury in the older group. The frequency of tendinitis was similar in both age groups, while metatarsalgia, plantar fasciitis, and meniscal injury were more common in the older population, and patellofemoral pain syndrome (PFPS) and stress fracture/periostitis were more common in the younger population. Anatomically, injury sites in the foot were more frequent in the older group, while injury sites in the knee were more frequent in the younger group. In the older population, the prevalence of osteoarthritis was 2.5 times higher than the frequency of osteoarthritis as the source of activity-related pain. In the older group, 85% of the diagnoses were overuse injuries known to respond to conservative treatment, 14.4% of the cases required consultative referral, and only 4.1% required surgery.

A Survey of Overuse and Traumatic Hip and Pelvic Injuries in Athletes.

In brief: Two hundred and twenty-two hip and pelvic injuries in 204 patients (114 men and 90 women) were retrospectively assessed at a general sports medicine clinic over a two-year period. The three most common bone injuries were sacroiliitis, pelvic and femoral neck stress fractures, and osteitis pubis. The three most common soft-tissue injuries were gluteus medius strain/tendinitis, trochanteric bursitis, and hamstring strain. Running, fitness classes, and racket sports were the most commonly involved activities. Overuse accounted for 82.4% of injuries and trauma 17.6%. Treatment consisted of modified activity, local muscle rehabilitation, physiotherapy, oral anti-inflammatory medication, infrequent corticosteroid injection, orthoses and/or heel lifts, change of footwear, and gradual reintroduction of the specific sport.

Pre-ski season preparation: conditioning and equipment.

Skiing-either downhill or cross-country-is one of the most popular winter sports. Because the skiing season is short, a pre-ski conditioning program is particularly important to enhance enjoyment and minimize the risk of injury. Aerobic and anaerobic training and abdominal, quadriceps, and hamstring strength and flexibility drills are advised for those planning to downhill ski. Aerobic training and paraspinal, shoulder girdle, abdominal, quadriceps, hamstring, gastrocsoleus and anterior tibial strengths and flexibility drills are advised for cross-country skiers. An equipment check by a qualified technician is mandatory. Cants or skiboot orthotics are useful for skiers whose leg and/or foot alignment is abnormal.