| 1. |
- Alfredson, Håkan, et al.
(author)
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Achilles tendinosis and calf muscle strength : the effect of short-term immobilization after surgical treatment
- 1998
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In: American Journal of Sports Medicine. - 0363-5465 .- 1552-3365. ; 26:2, s. 166-71
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Journal article (peer-reviewed)abstract
- We prospectively studied calf muscle strength in 7 men and 4 women (mean age, 40.9 +/- 10.1 years) who had surgical treatment for chronic Achilles tendinosis. Surgery was followed by immobilization in a weightbearing below-the-knee plaster cast for 2 weeks followed by a stepwise increasing strength training program. Strength measurements (peak torque and total work) were done preoperatively (Week 0) and at 16, 26, and 52 weeks postoperatively. We measured isokinetic concentric plantar flexion strength at 90 and 225 deg/sec and eccentric flexion strength at 90 deg/sec on both the injured and noninjured sides. Preoperatively, concentric and eccentric strength were significantly lower on the injured side at 90 and 225 deg/sec. Postoperatively, concentric peak torque on the injured side decreased significantly between Weeks 0 and 16 and increased significantly between Weeks 26 and 52 at 90 deg/sec but was significantly lower than that on the noninjured side at all periods and at both velocities. The eccentric strength was significantly lower on the injured side at Week 26 but increased significantly until at Week 52 no significant differences between the sides could be demonstrated. It seems, therefore, that the recovery in concentric and eccentric calf muscle strength after surgery for Achilles tendinosis is slow. We saw no obvious advantages in recovery of muscle strength with a short immobilization time (2 weeks) versus a longer (6 weeks) period used in a previous study.
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| 2. |
- Alfredson, Håkan, et al.
(author)
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Concentric and eccentric shoulder and elbow muscle strength in female volleyball players and non-active females
- 1998
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In: Scandinavian Journal of Medicine and Science in Sports. - : Wiley. - 0905-7188 .- 1600-0838. ; 8:5 Pt 1, s. 265-270
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Journal article (peer-reviewed)abstract
- Maximal isokinetic concentric (60 degrees/s and 180 degrees/s) and eccentric (60 degrees/s) muscle strength of the external and internal rotator muscles of the shoulder and the flexor and extensor muscles of the elbow was measured in a position resembling spiking and serving in volleyball, on 11 non-injured female volleyball players (first division) and 11 non-active females. In the dominant arm, the volleyball players had significantly higher concentric peak torque of the internal and external rotators and elbow extensors at both velocities, and significantly higher eccentric peak torque of the shoulder internal and external rotators and elbow flexors and extensors, than the controls. In the volleyball group, the concentric internal rotation peak torque at 60 degrees/s was significantly higher in the dominant than in the non-dominant arm. The external/internal strength ratio was significantly lower at 60 degrees/s, but not at 180 degrees/s, in the dominant arm. CONCLUSION: The female volleyball players had a higher concentric and eccentric strength in the rotator muscles of the shoulder and in the extensor muscles of the elbow compared to untrained controls in this special test position. There were signs of rotator muscle imbalance at the low test speed, but no signs of weakness of the external rotators, in the dominant arm of the volleyball players.
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| 3. |
- Alfredson, Håkan, et al.
(author)
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Heavy-load eccentric calf muscle training for the treatment of chronic Achilles tendinosis
- 1998
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In: American Journal of Sports Medicine. - : Sage. - 0363-5465 .- 1552-3365. ; 26:3, s. 360-366
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Journal article (peer-reviewed)abstract
- We prospectively studied the effect of heavy-load eccentric calf muscle training in 15 recreational athletes (12 men and 3 women; mean age, 44.3 +/- 7.0 years) who had the diagnosis of chronic Achilles tendinosis (degenerative changes) with a long duration of symptoms despite conventional nonsurgical treatment. Calf muscle strength and the amount of pain during activity (recorded on a visual analog scale) were measured before onset of training and after 12 weeks of eccentric training. At week 0, all patients had Achilles tendon pain not allowing running activity, and there was significantly lower eccentric and concentric calf muscle strength on the injured compared with the noninjured side. After the 12-week training period, all 15 patients were back at their preinjury levels with full running activity. There was a significant decrease in pain during activity, and the calf muscle strength on the injured side had increased significantly and did not differ significantly from that of the noninjured side. A comparison group of 15 recreational athletes with the same diagnosis and a long duration of symptoms had been treated conventionally, i.e., rest, nonsteroidal antiinflammatory drugs, changes of shoes or orthoses, physical therapy, and in all cases also with ordinary training programs. In no case was the conventional treatment successful, and all patients were ultimately treated surgically. Our treatment model with heavy-load eccentric calf muscle training has a very good short-term effect on athletes in their early forties.
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| 4. |
- Alfredson, Håkan, et al.
(author)
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High thigh muscle strength but not bone mass in young horseback-riding females
- 1998
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In: Calcified Tissue International. - : Springer. - 0171-967X .- 1432-0827. ; 62:6, s. 497-501
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Journal article (peer-reviewed)abstract
- To evaluate whether the type of weight-bearing loading subjected to the skeleton during horseback-riding was associated with differences in bone mass and muscle strength of the thigh, we investigated bone mass and isokinetic muscle strength in 20 female horse riders (age 17.9 +/- 0.6 years) who were riding 7.0 +/- 3.4 hours/week, and 20 nonactive females (age 17.8 +/- 1.1 years). The groups were matched according to age, weight, and height. Areal bone mineral density was measured in total body, head, lumbar spine, right femoral neck, Ward's triangle, and trochanter, the whole dominant and nondominant humerus, and in specific sites in the right femur diaphysis, distal femur, proximal tibia, and tibia diaphysis using dual X-ray absorptiometry. Isokinetic concentric and eccentric peak torque of the quadricep and hamstring muscles were measured using an isokinetic dynamometer. There were no significant differences in bone mass between the horseback riders and nonactives at any site measured. The horse riders were significantly (P < 0.05-0.01) stronger in concentric hamstrings strength at 90 degrees/second and 225 degrees/second and in eccentric quadricep and hamstring strength at 90 degrees/second. Horseback riding in young females is associated with a high muscle strength of the thigh, but not with a high bone mass.
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| 5. |
- Alfredson, Håkan, et al.
(author)
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Long-term loading and regional bone mass of the arm in female volleyball players
- 1998
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In: Calcified Tissue International. - : Springer Science and Business Media LLC. - 0171-967X .- 1432-0827. ; 62:4, s. 303-308
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Journal article (peer-reviewed)abstract
- In the present study, we compared the bone mineral content (BMC) and bone mineral density (BMD) in the arms of 11 female volleyball players (mean age 22.0 +/- 2.6 years) training for about 8 hours/week, and 11 nonactive females aged 24.6 +/- 3.1 years (mean +/- SD) not participating in regular or organized sport activity. Using dual X-ray absorptiometry (DXA), BMC was measured in the proximal and distal humerus, and BMD in the distal radius. Isokinetic concentric peak torque (highest value attained during 5 or 10 repetitions) of the rotator muscles of the shoulder and flexor and extensor muscles of the elbow were measured using an isokinetic dynamometer. The volleyball players had significantly higher BMC (P < 0.05) at the proximal humerus of the dominant arm compared with the nonactive group, but there were no differences between the groups in BMC of the distal humerus and BMD of the distal radius. In the volleyball players, BMC was significantly higher at the proximal humerus, at the distal humerus, and at the distal radius in the dominant compared with the nondominant arm. In the nonactive group, there were no significant differences in BMC and BMD between the dominant and nondominant arm at any site measured. Except for shoulder internal rotation strength and elbow flexion strength at 90 degrees/second that was higher in the dominant arm in the volleyball players, there were no significant differences in muscle strength of the rotator muscles of the shoulder and flexor and extensor muscles of the elbow between the dominant and nondominant arm in the volleyball players and nonactive controls. In the volleyball players, but not in the nonactive controls, there were several significant relationships between shoulder and elbow strength and BMC at the distal humerus of the dominant and especially the nondominant arm. These results show that young female volleyball players have a higher bone mass in the proximal humerus, distal humerus, and distal radius in the dominant compared with the nondominant arm, and a higher bone mass in the proximal humerus compared with nonactive controls. Muscle strength of the rotator muscles of the shoulder is not related to the higher bone mass in the proximal humerus of the dominant arm. Theoretically, the observed differences in bone mass can be related to the type of loading the skeleton undergoes when playing volleyball.
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| 6. |
- Alfredson, Håkan, et al.
(author)
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Prolonged progressive calcaneal bone loss despite early weightbearing rehabilitation in patients surgically treated for Achilles tendinosis
- 1998
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In: Calcified Tissue International. - : Springer. - 0171-967X .- 1432-0827. ; 62:2, s. 166-171
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Journal article (peer-reviewed)abstract
- We prospectively evaluated areal bone mineral density (BMD) of the calcaneus and calf-muscle strength (concentric and eccentric plantar flexion peak torque in Nm) in 10 recreational athletes (5 males and 5 females), mean age 40.9 years (range 26-55), who were selected to undergo surgical treatment for chronic Achilles tendinosis localized at the 2-6 cm level. Surgery was followed by immobilization in a plaster cast for 2 weeks, followed by flexibility training and slowly progressing strength training and weight-bearing activity. One patient was excluded after week 0 because of a new injury. Seven patients were back to their preinjury activity at the 26-week control, and eight patients at the 52-week control postoperatively. BMD in the calcaneus and calf-muscle strength on the injured and noninjured side was measured preoperatively (week 0) and postoperatively (weeks 2, 6, 16, 26, and 52). There were no significant differences in BMD between the injured and noninjured side at weeks 0, 2, and 6, but at weeks 16, 26, and 52, BMD was significantly (P < 0.05) lower (11.5%, 18.4%, and 16.4%, respectively) in the calcaneus of the injured side. Concentric and eccentric plantar flexion strength were significantly lower on the injured side preoperatively. Eccentric, but not concentric plantar flexion strength had recovered compared with the noninjured side 1 year postoperatively. Calf-muscle strength was not related to bone mass in the calcaneus. As a comparison, we used a group of 11 recreational athletes (10 males and 1 female), with a mean age of 46.1 years (range 28.9-58.5) who had been surgically treated for chronic Achilles tendinosis at the 2-6 cm level 39.5 +/- 11.8 months ago. In this group, there was no significant difference in BMD of the calcaneus between the injured and noninjured side. It seems that there was a delayed and prolonged calcaneal bone loss despite early weightbearing loading in patients surgically treated for chronic Achilles tendinosis at the 2-6 cm level. Around that time, when the Achilles tendon had healed (4-6 months) and the athletes returned to their sports, the calcaneal bone had a relatively low BMD and might possibly be vulnerable to heavy loadings. There were no signs of recovery 1 year postoperatively, but in a comparison group there were no significant side-to-side differences 39.5 months postoperatively.
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| 7. |
- Fahlström, Martin, et al.
(author)
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Acute Achilles tendon rupture in badminton players
- 1998
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In: American Journal of Sports Medicine. - : Sage. - 0363-5465 .- 1552-3365. ; 26:3, s. 467-470
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Journal article (peer-reviewed)abstract
- All patients with badminton-related acute Achilles tendon ruptures registered during 1990 to 1994 at the University Hospital of Umeå were retrospectively followed up using a questionnaire. Thirty-one patients (mean age, 36.0 years), 27 men and 4 women, were included. Thirty patients (97%) described themselves as recreational players or beginners. The majority of the injuries (29 of 31, 94%) happened at the middle or end of the planned game. Previous local symptoms had been noticed by five patients (16%). Long-term results showed that patients treated with surgery had a significantly shorter sick leave absence than patients treated without surgery (50 versus 75 days). There was no obvious selection favoring any treatment modality. None of the surgically treated patients had reruptures, but two reruptures occurred in the nonsurgically treated group. There seemed to be fewer remaining symptoms and a higher sports activity level after the injury in the surgically treated group. Our results indicate that local muscle fatigue may interfere with strength and coordination. Preventive measures such as specific treatment of minor injuries and adequate training of strength, endurance, and coordination are important. Our findings also indicate that surgical treatment and careful postoperative rehabilitation is of great importance among badminton players of any age or sports level with Achilles tendon rupture.
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| 8. |
- Fahlström, Martin, et al.
(author)
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Acute badminton injuries
- 1998
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In: Scandinavian Journal of Medicine and Science in Sports. - : Wiley. - 0905-7188 .- 1600-0838. ; 8:3, s. 145-148
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Journal article (peer-reviewed)abstract
- During 1990-1994, 1.2% of all sports injuries that required emergency care at the University Hospital of Umeå were caused by badminton. In 90.7% of the cases the patients described themselves as recreational players or beginners. There were 51.3% minor injuries (AIS 1) and 48.7% moderate injuries (AIS 2). The lower extremities were affected in 92.3% of the cases. Achilles tendon ruptures (34.6%) and ankle sprains and fractures (29.5%) were the most frequent. By the time of the follow-up (10-69 months), 52.6% of the players still had symptoms from the injuries and 39.5% had not been able to return to playing badminton. Our data indicate the importance of adequate treatment and rehabilitation after acute badminton injuries.
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| 9. |
- Lorentzon, Ronny, et al.
(author)
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Treatment of deep cartilage defects of the patella with periosteal transplantation
- 1998
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In: Knee Surgery, Sports Traumatology, Arthroscopy. - : Springer. - 0942-2056 .- 1433-7347. ; 6:4, s. 202-208
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Journal article (peer-reviewed)abstract
- Twenty-six consecutive patients (19 men and 7 women) with a mean age of 31.5 years (range 19-52 years) who suffered from an isolated full-thickness cartilage defect of the patella (area ranged from 0.75 to 20.0 cm2) and disabling knee pain were treated with autologous periosteal transplantation (without any chondrocytes). The duration of symptoms was 59 months (range 11-144 months). During the first 5 postoperative days all patients were treated with continuous passive motion (CPM). This was followed by active motion, slowly progressive strength training, and slowly progressive weight-bearing. After a mean follow-up of 42 months (range 24-76 months), 17 patients (65%) were graded as excellent (were painfree), 8 patients (31%) as good (had pain with strenuous knee-loading activities), and 1 patient as poor (had pain at rest). Twenty-two patients (85%) had returned to their previous occupation. Twelve patients (46%) had resumed sports or recreational activities at their former level. Repeated magnetic resonance imaging (MRI) investigations showed progressive, and finally complete, filling of the articular defects. Biopsies taken in five randomly selected cases showed hyaline-like cartilage. Patients with full-thickness cartilage defects of the patella and disabling knee pain can be treated with autologous periosteal transplantation (without any chondrocytes), followed by CPM, and slowly progressive strength training and weight-bearing. We believe this is a good method to accomplish regeneration of articular cartilage and satisfactory clinical results.
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| 10. |
- Nordström, Peter, et al.
(author)
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Type of physical activity, muscle strength, and pubertal stage as determinants of bone mineral density and bone area in adolescent boys.
- 1998
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In: Journal of Bone and Mineral Research. - : Wiley. - 0884-0431 .- 1523-4681. ; 13:7, s. 1141-8
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Journal article (peer-reviewed)abstract
- The present study was conducted to evaluate the influence of different types of weight-bearing physical activity, muscle strength, and puberty on bone mineral density (BMD, g/cm2) and bone area in adolescent boys. Three different groups were investigated. The first group consisted of 12 adolescent badminton players (age 17.0 +/- 0.8 years) training for 5.2 +/- 1.9 h/week. The second group consisted of 28 ice hockey players (age 16.9 +/- 0.3 years) training for 8.5 +/- 2.2 h/week. The third group consisted of 24 controls (age 16.8 +/- 0.3 years) training for 1.4 +/- 1.4h/week. The groups were matched for age, height, and pubertal stage. BMD, bone mineral content (BMC, g), and the bone area of the total body, lumbar spine, hip, femur and tibia diaphyses, distal femur, proximal tibia, and humerus were measured using dual-energy X-absorptiometry. When adjusting for the difference in body weight between the groups, the badminton players were found to have significantly higher BMD (p < 0.05) of the trochanter and distal femur compared with the ice hockey players despite a significantly lower weekly average training. The badminton players had higher BMD compared with the control with the control group at all weight-bearing BMD sites, except at the diaphyses of the femur and tibia and lumbar spine. The independent predictors of bone density were estimated by adjusting BMC for the bone area in a multivariate analysis among all subjects (n = 64). Accordingly, the bone density of all sites except the spine was significantly related to muscle strength and height, and the bone density of the total body, neck, trochanter, distal femur, and proximal tibia was significantly related to type of physical activity (beta = 0.09-0.33, p < 0.05). The bone area values at different sites were strongly related to muscle strength and height and less strongly related to the type of physical activity and pubertal stage. In conclusion, it seems that during late puberty in adolescent boys the type of weight-bearing physical activity is an important determinant of bone density, while the bone area is largely determined by parameters related to body size. The higher BMD at weight-bearing sites in badminton players compared with ice hockey players, despite significantly less average weekly training, indicates that physical activity including jumps in unusual directions has a great osteogenic potential.
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