Monday, November 29, 2010

New Study Reports Effects Of Endurance RunningI

Using a mobile MRI unit, researchers followed runners for two months along a 4,500-kilometer course to study how their bodies responded to the high-stress conditions of an ultra-long-distance race, according to a study presented at the annual meeting of the Radiological Society of North America (RSNA).

"Due to the exceptional setting of this study, we could acquire huge amounts of unique data regarding how endurance running affects the body's muscle and body fat," said Uwe Schütz, M.D., a specialist in orthopedics and trauma surgery in the Department of Diagnostic and Interventional Radiology at the University Hospital of Ulm in Germany. "Much of what we have learn
ed so far can also be applied to the average runner."

The TransEurope-FootRace 2009 took place from April 19 to June 21, 2009. It started in southern Italy and traversed approximately 4,488 kilometers to the North Cape in Norway. Forty-four of the runners (66 percent) agreed to participate in the study.

Urine and blood samples as well as biometric data were collected daily. The runners were also randomly assigned to other exams, including electrocardiograms, during the course of the study. Twenty-two of the runners in the study underwent a whole-body MRI exam approximately every three or four days during the race, totaling 15 to 17 exams over a period of 64 days. At the close of the race, researchers began to evaluate the data to determine, among other things, stress-induced changes in the legs and feet from running. Whole-body volume, body fat, visceral fat, abdominal subcutaneous adipose tissue (SCAT), and fat and skeletal muscle of the lower extremities were measured. Advanced MRI techniques allowed the researchers to quantify muscle tissue, fat and cartilage changes. According to Dr. Schütz, MRI is the gold standard for the evaluation of the musculoskeletal system of the runner.

The results showed that runners lost an average of 5.4 percent body volume during the course of the race, most of which was in the first 2,000 kilometers. They lost 40 percent of their body fat in the first half of the race and 50 percent over the duration of the race. Loss of muscle volume in the leg averaged
7 percent.

"One of the surprising things we found is that despite the daily running, the leg muscles of the athletes actually degenerated because of the immense energy consumption," Dr. Schütz said.

While most people do not run to this extreme, several of the study's other findings still have implications for the marathon runner and even the recreational runner, according to Dr. Schütz.

For example, the results showed that some leg injuries are safe to "run through." If a runner has intermuscular inflammation in the upper or lower legs, it is usually possible to continue running without risk of further tissue damage. Other overuse injuries, such as joint inflammation, carry more risk of progression, but not always with persistent damage.

"The rule that 'if there is pain, you should stop running' is not always correct," Dr. Schütz said.

Another key finding of the study was that the first tissue affected by running was fat tissue. More importantly, visceral fat loss (mean 70 percent) occurred much earlier in the running process than previously thought. Visceral fat is the most dangerous fat and is linked to cardiovascular disease. The findings also revealed that the greatest amount of overall fat loss appeared early in the process.

"When you just begin running, the effects of fat reduction are more pronounced than in athletes who have been running their whole life," Dr. Schütz said. "But you should do this sport constantly over the years. If you stop running for a long time, you need to reduce your caloric input or opt for other aerobic exercises to avoid experiencing weight gain."

Coauthors are Jürgen Machann, M.D., and Christian Billich, M.D.

Saturday, November 27, 2010

Landing techniques in volleyball

Landing techniques in volleyball

Authors: Roberto Lobiettia; Simon Colemanb; Eduardo Pizzichilloa; Franco Mernia


Knee injuries such as anterior cruciate ligament lesions and patellar tendonitis are very frequent in volleyball, and are often attributed to micro traumas that occur during the landing phase of airborne actions. The aim of the present study was to compare different jumping activities during official men's and women's volleyball games. Twelve top-level matches from the Italian men's and women's professional leagues were analysed. The jumps performed during the games were classified according to the landing technique used by the player (left or right foot or both feet together), court position, and ball trajectory. Chi-square analyses were performed to detect differences in landing techniques between the sexes, court positions, and trajectories when serving, attacking, blocking, and setting. Significant differences (P <>
Keywords: Volleyball; landings; differences between the sexes; block; attack; jump serve

Full text

Wednesday, November 24, 2010

Altered movement patterns but not muscle recruitment in moderately trained triathletes during running after cycling

Altered movement patterns but not muscle recruitment in moderately trained triathletes during running after cycling

Authors: Jason Bonacciab; Peter Blanchb; Andrew R. Chapmana; Bill Vicenzinoa


Previous studies have shown that cycling can directly influence neuromuscular control during subsequent running in some highly trained triathletes, despite these triathletes' years of practice of the cycle-run transition. The aim of this study was to determine whether cycling has the same direct influence on neuromuscular control during running in moderately trained triathletes. Fifteen moderately trained triathletes participated. Kinematics of the pelvis and lower limbs and recruitment of 11 leg and thigh muscles were compared between a control run (no prior exercise) and a 30 min run that was preceded by a 15 min cycle (transition run). Muscle recruitment was different between control and transition runs in only one of 15 triathletes (<7%).>
Keywords: Electromyography; triathlon; three-dimensional kinematics; motor control; transition

Full article

Tuesday, November 23, 2010

Whey protein isolate attenuates strength decline after eccentrically-induced muscle damage in healthy individuals

Reference:"Whey protein isolate attenuates strength decline after eccentrically-induced muscle damage in healthy individuals," Cooke MB, Hayes A, et al, J Int Soc Sports Nutr, 2010; 7(1): 30. (Address: Exercise Metabolism Unit, Institute for Sport, Exercise and Active Living, School of Biomedical and Health Sciences, Victoria University, Melbourne, Australia. E-mail: ).
Summary:In a randomized, placebo-controlled study involving 17 untrained men (mean age = 23 years), results indicate that supplementation with whey protein may attenuate exercise-induced muscle damage. The subjects were randomized to supplementation with whey protein isolate (1.5 g/ supplement (approximately 30 g consumed immediately, and then once with breakfast, lunch, in the afternoon and after the evening meal) or carbohydrate for a period of 14 days, following a unilateral eccentric contraction-based resistance exercise session. Significantly higher isometric knee extension strength, stronger tendencies for higher isokinetic forces (extension and flexion), and lower plasma LDH (lactate dehydrogenase) were observed in the whey protein group, compared with the placebo group. Thus, the authors of this study conclude, "The major finding of this investigation was that whey protein isolate supplementation attenuated the impairment in isometric and isokinetic muscle forces during recovery from exercise-induced muscle injury."

Full Article

Monday, November 22, 2010

Apolipoprotein E Genotype and Concussion in College Athletes

Clinical Journal of Sport Medicine:
November 2010 - Volume 20 - Issue 6 - pp 464-468
doi: 10.1097/JSM.0b013e3181fc0a81
Original Research

Apolipoprotein E Genotype and Concussion in College Athletes

Tierney, Ryan T PhD, ATC*; Mansell, Jamie L MEd†; Higgins, Michael PhD‡; McDevitt, Jane K MS*; Toone, Nieka MS*; Gaughan, John P PhD§; Mishra, Anarug PhD¶; Krynetskiy, Evgeny PhD¶

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Objective: To evaluate the association between apolipoprotein E (APOE) polymorphisms (E2, C/T Arg158Cys; E4, T/C Cys112Arg; and promoter, g-219t) and the history of concussion in college athletes. We hypothesized that carrying 1 or more APOE rare (or minor) allele assessed in this study would be associated with having a history of 1 or more concussions.

Design: Multicenter cross-sectional study.

Setting: University athletic facilities.

Participants: One hundred ninety-six male football (n = 163) and female soccer (n = 33) college athletes volunteered.

Interventions: Written concussion history questionnaire and saliva samples for genotyping.

Main Outcome Measures: Self-reported history of a documented concussion and rare APOE genotype (E2, E4, promoter).

Results: There was a significant association (Wald χ2 = 3.82; P = 0.05; odds ratio = 9.8) between carrying all APOE rare alleles and the history of a previous concussion. There was also a significant association (Wald χ2= 3.96, P = 0.04, odds ratio = 8.4) between carrying the APOE promoter minor allele and experiencing 2 or more concussions.

Conclusions: Carriers of all 3 APOE rare (or minor) alleles assessed in this study were nearly 10 times more likely to report a previous concussion and may be at a greater risk of concussion versus noncarriers. Promoter minor allele carriers were 8.4 times more likely to report multiple concussions and may be at a greater risk of multiple concussions versus noncarriers. Research involving larger samples of individuals with multiple concussions and carriers of multiple APOE rare alleles is warranted.

Friday, November 19, 2010

Concussion and Sports - Balance assessment another tool in Management of the Athlete

Concussion in sports is a hot topic today and the sports physician needs to be aware of how to mange these cases.

You should be aware of the American Academy of Neurology's position Statement. As well as the consensus statement on concussions from Zurich.

Here is one of the pieces to the puzzle and it involves balance assessment take a look at this abstract as well.

Balance Assessment in the Management of Sport-Related Concussion

Although neuropsychological testing has proven to be a valuable tool in concussion management, it is most useful when administered as part of a comprehensive assessment battery that includes grading of symptoms and clinical balance tests. A thorough sideline and clinical examination by the certified athletic trainer and team physician is considered an important first step in the management of concussion. The evaluation should be conducted in a systematic manner, whether on the field or in the clinical setting. The evaluation should include obtaining a history for specific details about the injury (eg, mechanism, symptomatology, concussion history), followed by assessing neurocognitive function and balance, which is the focus of this article. The objective measures from balance testing can provide clinicians with an additional piece of the concussion puzzle, remove some of the guesswork in uncovering less obvious symptoms, and assist in determining readiness to return safely to participation.

Tuesday, November 16, 2010

NFL study to find best management of middle third clavicle fractures

Small study size but interesting article on outcome from conservative and surgical repair of the middle third clavicle fractures take a look at the abstract

Evolving Management of Middle-Third Clavicle Fractures in the National Football League

  1. Robert J. Morgan, MD*,
  2. Larry S. Bankston Jr, MD,
  3. Michael P. Hoenig, MD§ and
  4. Patrick M. Connor, MD

+Author Affiliations

  1. Resurgens Orthopaedics, Atlanta, Georgia
  2. Baton Rouge Orthopaedic Clinic, Baton Rouge, Louisiana
  3. §Orthopaedics Associates, Spartanburg, South Carolina
  4. OrthoCarolina, Charlotte, North Carolina
  1. *Robert J. Morgan, MD, 3211 Iris Drive, Covington, GA 30016 (


Background: Clavicle fractures have historically been managed nonoperatively. Recent literature suggests a subset of clavicle fractures may be best treated with primary surgical treatment.

Purpose: To review the National Football League (NFL) experience in the management of middle-third clavicle fractures over a 5-year period.

Study Design: Case series; Level of evidence, 4.

Methods: A retrospective review of clavicle fractures that occurred during a 5-season period was obtained from the NFL Injury Surveillance System. A detailed questionnaire was also sent to the medical staff of all 32 NFL teams.

Results: Nineteen players sustained a middle-third clavicle fracture over the 5-year period. Six fractures were nondisplaced or minimally displaced. All 6 healed at an average time of 7.3 weeks. Thirteen fractures were 100% displaced. Six of the 13 underwent acute surgical fixation that resulted in fracture healing without complication at an average of 8.8 weeks. The remaining 7 players with a completely displaced fracture were initially treated nonoperatively. Three of these 7 healed clinically without sequela at an average of 13.3 weeks after injury; however, 4 players sustained a refracture within 1 year of the initial injury.

Conclusion: Over the past 5 years, nearly 50% of NFL players with a completely displaced middle-third clavicle fracture were treated successfully with acute surgical fixation without sequela and healed at an average of 8.8 weeks. Three of these players were able to return to play during the same season. In addition, 4 of 7 players initially treated nonoperatively for a completely displaced middle-third clavicle fracture refractured their clavicle within a 1-year period from their initial injury. The 4 players missed an average of 1.5 seasons because of their clavicle injury and subsequent clinical course. Based on this review, it may be reasonable to consider acute surgical treatment of this injury in the NFL player to enable a successful clinical outcome in a predictable time frame.


Monday, November 15, 2010

Study finds better early results with stretching vs. shockwave therapy for plantar fasciitis

Study finds better early results with stretching vs. shockwave therapy for plantar fasciitis.

File this under "Shocker" ......I have great success using Braces, orthotic, Graston Technique, laser therapy and of course stretching. I always find it strange how quick the patients are recommended this procedure. Take a look at the abstract.

J Bone Joint Surg Am. 2010 Nov;92(15):2514-22.

Plantar fascia-specific stretching versus radial shock-wave therapy as initial treatment of plantar fasciopathy.

Rompe JD, Cacchio A, Weil L Jr, Furia JP, Haist J, Reiners V, Schmitz C, Maffulli N.

OrthoTrauma Evaluation Center, Oppenheimer Strasse 70, D-55130 Mainz, Germany.


BACKGROUND: Whether plantar fascia-specific stretching or shock-wave therapy is effective as an initial treatment for proximal plantar fasciopathy remains unclear. The aim of this study was to test the null hypothesis of no difference in the effectiveness of these two forms of treatment for patients who had unilateral plantar fasciopathy for a maximum duration of six weeks and which had not been treated previously.

METHODS: One hundred and two patients with acute plantar fasciopathy were randomly assigned to perform an eight-week plantar fascia-specific stretching program (Group I, n = 54) or to receive repetitive low-energy radial shock-wave therapy without local anesthesia, administered weekly for three weeks (Group II, n = 48). All patients completed the seven-item pain subscale of the validated Foot Function Index and a patient-relevant outcome questionnaire. Patients were evaluated at baseline and at two, four, and fifteen months after baseline. The primary outcome measures were a mean change in the Foot Function Index sum score at two months after baseline, a mean change in item 2 (pain during the first few steps of walking in the morning) on this index, and satisfaction with treatment.

RESULTS: No difference in mean age, sex, weight, or duration of symptoms was found between the groups at baseline. At two months after baseline, the Foot Function Index sum score showed significantly greater changes for the patients managed with plantar fascia-specific stretching than for those managed with shock-wave therapy (p < p =" 0.002).">

CONCLUSIONS: A program of manual stretching exercises specific to the plantar fascia is superior to repetitive low-energy radial shock-wave therapy for the treatment of acute symptoms of proximal plantar fasciopathy.

LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence.+


Sunday, November 14, 2010

Cell Therapy in Tendon Disorders

What Is the Current Evidence?

  1. Haron Obaid, MBChB, FRCS, FRCR* and
  2. David Connell, MBBS, MMed, FRANZCR

+Author Affiliations

  1. Doncaster Royal Infirmary, Doncaster, United Kingdom
  2. Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, United Kingdom
  1. *Haron Obaid, MBChB, FRCS, FRCR, Mount Sinai Hospital, 600 University Avenue, Toronto, ON, M5G 1X5, Canada (e-mail:


Background: Various types of tissue-derived cells are being experimented with for the treatment of tendinopathy, tendon repair, and use in tissue engineering.

Purpose: The aim of this systematic review is to explore the current evidence with a view to evaluate the potential of this therapeutic intervention.

Study Design: Systematic review.

Methods: A review of the literature was conducted using PubMed. Search criteria included keywords “tendinopathy,” “tendinitis,” “tendinosis,” “epicondylitis,” “stem cell,” and “cell therapy.” Articles not written in English language were excluded.

Results: A total number of 379 articles were identified and a critical appraisal of the relevant articles was undertaken, which encompassed human and animal research. The review included articles related to various tissue-derived cells such as tendon progenitors, adipose tissue, synovium, muscle, bone marrow, and skin. The utility of cell therapy in tissue engineering and rotator cuff repair was also assessed.

Conclusion: With the limitation of the available evidence, the literature suggests that cell therapy is applicable and may be effective for the treatment of tendinopathy. However, further research into the precise biological mechanisms, long-term implications, and cost-effectiveness is needed.

Very interesting! Here is the link to the full article

Full Article