Sports Medicine Research: In the Lab & In the Field (Sports Med Res)
Friday, October 24, 2014

Who is at Risk for Medial Tibial Stress Syndrome?

Risk factors for medial tibial stress syndrome in physically active individuals such as runners and military personnel: a systematic review and meta-analysis

Hamstra-Wright KI, Huxel Bliven KC, Bay C. British Journal of Sports Medicine. 2014;0:1-9. Doi:10.1136/bjsports-2014-093462

Take Home Message: Risk of medial tibial stress syndrome (MTSS) is associated with increased body mass index, navicular drop, ankle plantarflexion range of motion (ROM) and hip external rotation ROM.

Medial tibial stress syndrome, often referred to as “shin splints”, is a very common problem in active individuals. The exact cause of MTSS is unknown, but it is thought to be related to overuse of the extensor muscles in the front of the shin, which pulls on the tibia and ultimately causes pain. If we could identify the key risk factors for MTSS then we may be able to develop prevention programs. The authors of this systematic review evaluated which key factors put physically active individuals at risk for MTSS.
Wednesday, October 22, 2014

Knee Cartilage Changes Following ACL Rupture

Five-year follow-up of knee joint cartilage thickness changes after acute anterior cruciate ligament rupture.

Eckstein F, Wirth W, Lohmander LS, Hudelmaier MI, and Frobell RB. Arthritis Rheum. [Epub Ahead of Print].

Take Home Message:  Following an anterior cruciate ligament (ACL) rupture overall cartilage thickness in the tibiofemoral joint increased at an average of 0.4% per year. Patients under 25 years of age showed greater cartilage thickening than older patients.

In addition to immediate physical limitations, a patient who experiences an ACL rupture also has an increased risk of long-term disability due to structural adaptations within the joint. If clinicians could identify early changes in the joint then clinicians may eventually be able to implement pharmacological and rehabilitation protocols to limit joint cartilage changes and other structural changes that may lead to osteoarthritis. Therefore, Eckstein and college completed a prospective study to quantify tibiofemoral cartilage thickness changes in patients with an ACL rupture.
Monday, October 20, 2014

Novel NSAID has Differential Tissue Effects in the Treatment of Chronic Rotator Cuff Repairs

Inhibition of 5-LOX, COX-1, and COX-2 Increases Tendon Healing and Reduces Muscle Fibrosis and Lipid Accumulation After Rotator Cuff Repair

Oak NR, Gumucio JP, Flood MD, Saripalli AL, Davis ME, Harning JA, Lynch EB, Roche SM, Bedi A, Mendias CL. Am J Sport Med. 2014 [Epub ahead of print]

Take-Home Message: Licofelone, a non-steroidal anti-inflammatory treatment, has tissue-specific effects. In a rotator cuff repair rat model, this drug reduces functional muscle regeneration but improves tendon healing.

Rotator cuff tears are often associated with muscle atrophy and fatty degeneration, which can impair tendon repairs. The arachidonic acid cascade, in which arachidonic acid is converted to prostaglandins by cyclooxygenases-1 and -2 (COX-1 and COX-2) or leukotrienes by 5-lipoxygenase (5-LOX), may contribute to the development of fatty infiltration and unfavorable conditions for tissue repair. Licofelone is an anti-inflammatory drug (not yet FDA-approved) that simultaneously inhibits 5-LOX, COX-1, and COX-2. This drug enhanced cartilage and bone regeneration, but its effects have not been tested in other musculoskeletal tissues.  The authors of this study were interested in the effects of licofelone on rotator cuff tendon healing in an animal model.
Wednesday, October 15, 2014

ACL Reconstruction Provides Not So Good Long-Term Outcomes

Osteoarthritis Prevalence Following Anterior Cruciate Ligament Reconstruction: A Systematic Review and Numbers-Needed-to-Treat Analysis

Luc B, Gribble PA, & Pietrosimone B. Journal of Athletic Training. 40(3) Published online first June 2014. doi: 10.4085/1062-6050-49.3.35

Take Home Message:  There is very little evidence that an anterior cruciate ligament (ACL) reconstruction can reduce the risk of knee osteoarthritis (OA).     

The primary goal of an ACL reconstruction is to restore stability and return a patient to a physically active life in the short term.  While many patients successfully return to physical activity, it remains less clear whether an ACL reconstruction can help prevent a patient from developing knee OA.  This systematic review aimed to determine if patients who underwent ACL reconstruction had lower knee OA prevalence than patients who tore their ACL but remained ACL deficient.
Monday, October 13, 2014

Fatigue Does Not Have A Leg To Stand On

Fatigue-induced balance impairments in young soccer players

Pau M., Ibba G., Attene G. Journal of Athletic Training. 2014;49(4):454-461

Take Home Message: Soccer players have impaired postural control after a fatigue-inducing task. The single-leg balance impairment was related to repeated sprint ability performance, which suggests that an athlete who was less fatigued by a sprinting task had less balance impairment.

When an athlete becomes fatigued his/her balance may be compromised; however, we don’t know how much fatigue influences balance among young soccer players and if changes in balance influence performance. Therefore, the authors investigated the effect of fatigue on changes in balance during unipedal and bipedal static stances as well as whether there is a relationship between performance in a fatiguing activity and balance among young soccer athletes.
Wednesday, October 8, 2014

Stronger May not be Better in Decreasing the Risk of High Magnitude Head Impacts in Football

The Influence of Cervical Muscle Characteristics on Head Impact Biomechanics in Football

Schmidt JD, Guskiewicz KM, Blackburn JT, Mihalik JP, Siegmund GP, and Marshall SW. Am J Sport Med. 42 (9). 2014.

Take Home Message: Football players with greater cervical neck muscle strength and size were as likely to sustain larger head impacts as their peers. Football players who had greater cervical stiffness and an ability to decrease the displacement of their head following perturbation were less likely to sustain a moderate and severe head impacts.

While many believe that strengthening cervical muscles may reduce head acceleration after an impact, and thus reduce the risk of concussions, there is very little evidence to verify this concept. If athletes with stronger, larger, or stiffer cervical muscles are less likely to suffer higher magnetic head impacts compared with their peers then this could provide more justification for targeting cervical muscles in a concussion prevention program. Therefore Schmidt and colleagues completed a prospective cohort study to compare the risk of, “sustaining higher magnitude in-season head impacts between athletes with higher and lower preseason performance on cervical muscle characteristics.”
Wednesday, October 1, 2014

Painful Arc in Flexion and Forward Scapular Posture = SLAP Surgery Recommendation

Preliminary Development of a Clinical Prediction Rule for Treatment of Patients with Suspected SLAP Tears

Moore-Read SD, Kibler WB, Sciascia AD, & Uhl T. Arthroscopy.  Published online first August 14, 2014. doi: 10.1016/j.arthro.2014.06.015 

Take Home Message:  The presence of a painful flexion arc and forward scapular posture seem to be relatively accurate in predicting who will need surgery for a SLAP tear after trying 6 weeks of rehabilitation.  While this rule seems promising, more investigation is needed, and clinical decisions should be made on an individual basis.

Shoulder injury diagnosis and management is often a very complicated process.  Even once a SLAP tear diagnosis is made, it can be difficult to decide whether an athlete should have surgery or not, as outcomes vary by individual.  The purpose of this prospective study was to examine whether there are initial examination findings among 58 patients with a diagnosed SLAP tear that accurately predict whether a patient needs surgery after trying 6 weeks of rehabilitation.