Sports Medicine Research: In the Lab & In the Field: March 2016 (Sports Med Res)

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Wednesday, March 30, 2016

Pay Now, or Pay Later…ACL Reconstruction Costs are Similar Whether Early or Delayed

No economic benefit of early knee reconstruction over optional delayed reconstruction for ACL tears: registry enriched randomized controlled trial data

Kiadarliri AA, Engulnd M,Lohmander LS, Carlsson KS, & Frobell RB.  Br J Sports Med. Published Online First: March 2, 2016; DOI: 10.1136/bjsports-2015-095308

Take Home Message: An early anterior cruciate ligament reconstruction fails to provide improved quality-of-life years and costs compared with people who are provided an optional delayed reconstruction treatment strategy. 

There is a lingering debate about whether or not a patient should have an anterior cruciate ligament (ACL) reconstruction as well as when to have surgery.  The KANON trial (randomized controlled trial of young active adults with an ACL injury) failed to identify any differences in patient-reported outcomes or radiographic outcomes between those who were randomized to early reconstruction or an optional delayed surgery.  Given the lack of differences, the authors of this study aimed to analyze the same data to determine if there were any differences in costs or quality-of-life years.
Monday, March 28, 2016

9-Point Survey to Determine Risk of Persistent Postconcusison Symptoms in Pediatric Population

Clinical Risk Score for Persistent Postconcusison Symptoms Among Children with Acute Concussion in ED

Zemek R, Barrowman N, Freedman SB, Gravel J, Gagnon I, McGahern C, Aglipay M, Sangha G, Boutis K, Beer D, Craig W, Burns E, Farion KJ, Mikrogianakis A, Barlow K, Dubrovsky AS, Meeuwisse W, Gioia G, Meehan WP, Beauchamp MH, Kamil Y, Grool AM, Hoshizaki B, Anderson P, Brooks BL, Yeates KO, Vassilyadi M, Klassen T, Keightley M, Richer L, DeMatteo C, Osmond MH; Pediatric Emergency Research Canada (PERC) Concussion Team. JAMA. 2016 Mar 8;315(10):1014-25.

Take Home Message: A novel clinical risk score developed for the acutely concussed pediatric population has a modest ability to discriminate between those at low, medium, or high risk for persistent postconcussion symptoms at 28 days.

After a concussion, nearly a third of pediatric patients experience somatic, cognitive, psychological, and behavioral symptoms for longer than 28 days, which is often referred to as persistent postconcussion symptoms (PPCS). Unfortunately, medical professionals lack a validated tool to identify a young athlete at risk for PPCS. Therefore, the authors of this multi-center prospective cohort study aimed to derive and validate a clinical risk score for PPCS among children presenting to an emergency department.
Wednesday, March 23, 2016

Finding Who Will Develop Chronic Ankle Instability

Recovery from a first-time lateral ankle sprain and the predictors of chronic ankle instability: A Prospective Cohort Analysis.

Doherty C, Bleakley C, Hertel J, Caulfield B, Ryan J, and Delahunt E. Am J Sports Med. 2016; [Epub ahead of print].

Take Home Message: Following a first-time lateral ankle sprain, a patient who was unable to complete the single-leg drop landing and drop vertical jump at 2 weeks post injury was more likely to be classified as having chronic ankle instability. Patient-reported outcomes at 6 months was also associated with onset of chronic ankle instability.

Lateral ankle sprains are a common injury in sports and are the gateway to chronic ankle instability. No study has tracked people after their first lateral ankle sprain to identify early motor control impairments that may predict chronic ankle instability. By finding ways to identify patients who may be susceptible to chronic ankle instability, clinicians can begin to develop effective interventions that could halt the progression of chronic ankle instability. Therefore, Doherty and colleagues completed a cohort study of people with a first time lateral ankle sprain to identify motor control deficits that predict chronic ankle stability.
Monday, March 21, 2016

Scapular Rehabilitation: Inside Info to Help Choose the Right Exercises

Superficial and Deep Scapulothoracic Muscle EMG Activity During Different Types of Elevation Exercises in the Scapular Plane

Castelein B, Cools A, Bostyn E, Delemarre J, Lemahieu T, Cagnie B. J Orthop Sports Phys Ther. 2016 Mar;46(3):184-93

Take Home Message: Different humeral elevation exercises result in different levels of scapulothoracic muscle activity.  Knowledge of muscle activity levels for different exercises could help clinicians optimize rehabilitation protocols.

The scapulothoracic joint has minimal bony stabilization and is primarily dynamically stabilized by multiple muscle attachments.  It plays an important role in shoulder function by providing a stable base for glenohumeral motion. Glenohumeral elevation exercises are commonly used in scapular rehabilitation training.  However, the level of activation in the scapulothoracic muscles between different types of elevation exercises has not been fully defined.  Knowledge of muscle activity levels for different exercises could help clinicians develop appropriate rehabilitation programs.  Therefore, the objective of this study was to evaluate scapulothoracic muscle activity during different types of elevation exercise in the scapular plane.
Wednesday, March 16, 2016

Quadriceps Inactivation? Shake It Off

Immediate effect of vibratory stimuli on quadriceps function in healthy adults

Pamukoff DN, Pietrosimone B, Lewek MD, Ryan ED, Weinhold PS, Lee DR, & Blackburn T.  Muscle & Nerve. Published Online First: February 13, 2016; DOI: 10.1002/mus.25081

Take Home Message: Local or whole body vibration treatments increase quadriceps function similarly.  Vibration therapy can be a tool to facilitate strengthening protocols.

Vibration techniques (local and whole body) increase quadriceps function immediately after application.  However, it is unclear how long these improvements last among healthy individuals.  It would be ideal if these benefits lasted long enough to allow someone to complete an exercise program. The authors of this study compared the effects of whole body and local muscle vibration on quadriceps function in healthy individuals and assessed how long changes would persist.
Wednesday, March 9, 2016

Knowing the Symptoms of Sudden Cardiac Death May be the First Step in the Right Direction

Symptoms before sudden arrhythmic death syndrome: A nationwide study among the young in Demark.

Glinge C, Jabbari R, Rigsgaard B, Lynge TH, Engstrom T, Albert CM, Haunso S, Winkel BG, and Tfelt-Hansen J. J Cardiovasc Electrophysiol. 2015. 26(7):761-7.

Cardiac symptoms before sudden cardiac death caused by hypertrophic cardiomyopathy: a nationwide study among the young in Denmark.

Lynge TH, Risgaard B, Jabbari R, Glinge C, Bundgaard H, Maron B4 Haunsø S, Winkel BG, Tfelt-Hansen J. Europace. 2016 Jan 27. pii: euv403. [Epub ahead of print]

Take Home Message: Patients who suffered sudden cardiac death reported experiencing more cardiac symptoms prior to death compared with control patients.

Sudden cardiac death is a major cause of death among the young individuals. Hypertrophic cardiomyopathy is a leading cause of sudden cardiac death in athletes and sudden arrhythmic death syndrome (SADS) is defined as a sudden cardiac death that remains unexplained. If more is understood about the signs and symptoms that precede these deaths, then it could help clinicians educate patients and recognize patients at risk for death. Therefore, Glinge and Lynge and colleagues completed two studies to investigate and describe the medical history and symptoms that precede sudden cardiac death due to hypertrophic cardiomyopathy and SADS.
Monday, March 7, 2016

The National Strength And Conditioning Association Position Statement On Long-Term Athletic Development

The National Strength And Conditioning Association Position Statement On Long-Term Athletic Development

Lloyd RS, Cronin JB, Faigenbaum AD, Haff GG, Howard R, Kraemer WJ, Micheli LJ, Myer GD, Oliver JL. Journal of Strength & Conditioning Research: 2016 Feb 29 [Epub ahead of print] doi: 10.1519/JSC.0000000000001387

The National Strength and Conditioning Association (NSCA) has released a position statement about long-term athletic development for youth. The document discusses “10 pillars of successful long-term athletic development, which summarize the key recommendations detailed within the consensus statement. With these pillars in place, it is believed that the NSCA can (i) help foster a more unified and holistic approach to youth physical development, (ii) promote the benefits of a lifetime of healthy physical activity, and (iii) prevent and/or minimize injuries from sports participation for all boys and girls.”



Wednesday, March 2, 2016

Movement Screen Not Terribly Predictive

The Functional Movement Screen and Injury Risk: Association and Predictive Value in Active Men

Bushman TT, Grier TL, Canham-Chervak M, Anderson MK, North WJ, & Jones BH. Am J Sports Med. Published Online First: February 1, 2016; DOI: 10.1177/0363546515614815

Take Home Message: The Functional Movement Screen poorly predicts injury within 6 months after an assessment.  A score less than 14 is a risk factor for injury, but more research is needed. 

Injury screening helps to assess and identify injury risk in physically active people.  There are many options for injury screening; however, the Functional Movement Screen (FMS) is becoming more widely used.  Three prior studies have indicated that the FMS could identify individuals at risk for injury but other studies have questioned its validity. The authors of this study wanted to determine the association between FMS and injury risk, the effectiveness of the FMS for injury prediction, and an optimal cut point for FMS scores in young physically active male soldiers.