Exercise may be the long-term key for improving gluteal tendinopathy patient outcomes

Education plus exercise versus corticosteroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy: prospective, single blinded, randomised clinical trial

Mellor R, Bennell K, Grimaldi A, Nicolson P, Kasza J, Hodges P, Wajswelner H, Vincenzino B. Br J Sports Med. 2018 Nov;52(22):1464-1472. doi: 10.1136/bjsports-2018-k1662rep.

https://www.ncbi.nlm.nih.gov/pubmed/30385462

Take Home Message: Exercise with education or a corticosteroid injection led to superior patient-reported outcomes among people with gluteal tendinopathy compared to a wait-and-see approach. Exercise and education resulted in the greatest perceived improvements and is a viable choice for treating these patients.

Gluteal tendinopathies are often treated either conservatively with hip strengthening and stabilizing exercises or with corticosteroid injections. Though previous studies have compared injections with “wait and see” approaches, the authors were interested in looking at how education with exercise would influence patient-reported outcome measures. Therefore, the authors conducted a randomized controlled trial to compare 204 patients’ global and pain outcomes up to 52 weeks following one of 3 treatment strategies: 1) education plus exercise, 2) a corticosteroid injection, and 3) “wait and see”.

Fascial tissue research in sports medicine: from molecules to tissue adaptation, injury and diagnostics: consensus statement

Fascial tissue research in sports medicine: from molecules to tissue adaptation, injury and diagnostics: consensus statement

Zügel M, Maganaris CN, Wilke J, Jurkat-Rott K, Klingler W, Wearing SC, Findley T, Barbe MF, Steinacker JM, Vleeming A, Bloch W, Schleip R, Hodges PW. Br J Sports Med. 2018 Dec;52(23):1497. doi: 10.1136/bjsports-2018-099308. Epub 2018 Aug 2.

Full Text Freely Available

After the Second International CONNECT Conference in 2017, conference speakers and other field-related experts discussed and found consensus regarding the role of fascial tissue in the field of sports medicine. “This paper aims to summarise the contemporary state of knowledge regarding the fascial system from the microlevel

(molecular and cellular responses) to the macrolevel (mechanical properties), and the responses of the fascial system to altered loading (physical exercise), to injury and

other physiological challenges including ageing, methods available to study the fascial system, and the contemporary view of interventions that target fascial tissue in sports medicine”

View 178 other recent position statements, consensus statements, guidelines, and recommendations related to sports medicine.

Public Perception of Youth Contact Sports

Public attitudes and knowledge about youth sports participation and concussion risk in an urban area

Taranto E, Fishman M, Garvey K, Perlman M, Benjamin HJ, and Ross LF. J Natl Med Assoc. 2018. [Epub Ahead of Print].
https://www.ncbi.nlm.nih.gov/pubmed/30376961

Take Home Message: Seventy-four percent of a surveyed people in an urban area reported that it is proper for physicians to counsel against youth participation in full-contact sports. Furthermore, 46% would still allow their child to participate in football.

As youth participation in sports increases, so to have the number of sports-related concussions in the youth population. Authors of a recent study of parents with children in youth sports showed that while overall about 70% of parents felt children should start playing contact sports under 10 years of age, only 37% of parents with kids in noncontact sports agreed. An important limitation of this study was that it failed to include all adults, which may include parents who decided that their child should not participate in sports. Understanding people’s knowledge and attitudes of concussion is a critical step in understanding how to promote physical activity and best intervene and protect youth sports participants from sustaining a concussion. To address this knowledge gap, Taranto and colleagues completed a survey study to examine the attitudes and knowledge of adults in the Chicago area about full-contact youth sports, concussions, and the role of physicians.

Ankle Surgery Patients Should “Get Up and Walk” to a More Functional Life After Surgery

Weight-bearing or Non-Weight-Bearing after Surgical Treatment of Ankle Fractures: A Multicenter Randomized Controlled Trial

Smeeing DPJ, Houwert RM, Briet JP, Groenwold RHH, Lansick KWW, Leenen LPH, van der Zwaal P, Hoogendoorn JM, van Heijl M, Verliesdonk EJ, Segers MJM, Heitbrink F. Eur J Trauma Emerg Surg. 2018 Sep 24. doi: 10.1007/s00068-018-1016-6. [Epub ahead of print]
Text Freely Available

Take Home Message: Patients with an ankle fracture who followed an unprotected weight-bearing postoperative care protocol reported less disability and returned to work and sport quicker than patients who followed a protocol limiting their weight-bearing following surgery.

Postoperative care after an ankle fracture ranges from complete non-weight-bearing with immobilization cast to full weight-bearing as tolerated with no protective equipment. It remains unclear which approach is associated with less complications, quicker return to functional activity, and better health-related quality of life after an internal fixation surgery for a supination-external rotation Lauge-Hansen classification fracture. Therefore, the authors conducted a multicenter randomized controlled trial among patients who received surgical treatment of an ankle fracture to determine the effects of three postoperative care protocols: 

• unprotected non-weight-bearing mobilization with crutches and active ankle exercises,
• protected weight-bearing with a below knee cast for 6 weeks, or
• unprotected weight-bearing with functional weight-bearing as tolerated.

Head Impact Exposures Prior to a Concussion

Comparison of Head Impact Exposure Between Concussed Football Athletes and Matched Controls: Evidence for a Possible Second Mechanism of Sport-Related Concussion.

Stemper BD, Shah A, Harezlak J, Rowson S, Mihalik JP, Duma SM, Riggen LD, Brooks A, Cameron KL, Campbell D, DiFiori JP, Giza CC, Guskiewicz KM, Jackson J, McGinty GT, Svoboda SJ, McAllister TW, Broglio SP, McCrea M; CARE Consortium Investigators. Ann Biomed Eng. 2018. [Epub ahead of print]

Full Text Freely Available

Take Home Message: Athletes with a concussion had greater exposure to head impacts on either the day of injury or in the season leading up to the injury compared to peers matched on the same team and playing the same position.

Authors conducting biomechanical concussion research have suggested that repetitive head impact exposure (lifelong or recent) may increase a player’s risk for concussion due to a decrease in concussive tolerance. However, much of this prior research involved no control group, a small cohort of athletes with a concussion, or only one competitive season. Therefore, the authors collected head impact data from the 2015-2017 fall and spring seasons at 6 institutions (part of the NCAA CARE Consortium) to determine differences in repetitive head impact exposure between 50 college football athletes with a concussion compared to healthy peers (~4 per concussed).

Two Peas in a Pediatric Pod: Brain Injury and Other Related Health Conditions

Prevalence of parent-reported traumatic brain injury in children and associated health conditions.

Haarbauer-Krupa J, Lee AH, Bitsko RH, Zhang, X, and Kresnow-Sedacca K. JAMA Pediatrics. 2018. [Epub Ahead of Print].

https://jamanetwork.com/journals/jamapediatrics/article-abstract/2703481

Take Home Message: Children who are diagnosed with traumatic brain injuries (TBIs) are more likely to have a reported additional health concern (e.g., epilepsy/seizure disorder, intellectual disability, musculoskeletal problem, vision problem). TBIs are also more widely reported in states where estimates of private health insurance policies are higher.

Traumatic brain injuries (TBIs) are common among children and may be related to sport participation or other activities of daily living. Understanding how many children have a history of a TBI is the first step in the process of developing appropriate measures to safeguard children; however, no comprehensive data on TBI among children existed. Therefore, Haarbauer-Krupa and colleagues completed a study to estimate the national and state-specific prevalence of TBI based on a self-report by parents.

AOFAS Position Statement Regarding Patient-Reported Outcome Measures

AOFAS Position Statement Regarding Patient-Reported Outcome Measures.

Kitaoka HB, Meeker JE, Phisitkul P, Adams SB Jr, Kaplan JR, Wagner E. Foot Ankle Int. 2018 Oct 31:1071100718809066. doi: 10.1177/1071100718809066. [Epub ahead of print]

Full Text Not Freely Available

The American Orthopaedic Foot & Ankle Society (AOFAS) released a position statement on patient-reported outcomes to assess patient general health, functional status, and outcomes of treatment. The authors note “It is not possible to recommend a single instrument to collect quality orthopedic data as the selection is dependent on the population being examined and the question being asked. We support the use of the PROMIS Physical Function Computerized Adaptive Test (PF CAT) or Lower Extremity Computerized Adaptive Test (LE CAT), which can be assessed with other domains such as Pain Interference. In addition, a disease-specific measure can be used when available.”

View 177 other recent position statements, consensus statements, guidelines, and recommendations related to sports medicine.