| 1. |
- Aasa, Ulrika, et al.
(författare)
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Injuries among weightlifters and powerlifters : a systematic review
- 2017
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Ingår i: British Journal of Sports Medicine. - : BMJ. - 0306-3674 .- 1473-0480. ; 51:4, s. 211-219
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Tidskriftsartikel (refereegranskat)abstract
- Background Olympic weightlifting and powerlifting are two sports that expose the body to great forces. Injury characteristics have not been systematically reviewed for these two growing sports.Objective The purpose of this study was to systematically review the literature regarding various definitions of injuries used, injury localisation, the prevalence and incidence of injuries and the associated risk factors for injuries in weightlifting and powerlifting.Design Systematic review.Data sources Five databases, PubMed, MEDLINE, SPORTDiscus, Scopus and Web of Science, were searched between 9 March and 6 April 2015.Eligibility criteria for selecting studies Studies assessing injury incidence and prevalence in Olympic weightlifting and powerlifting were included. The Quality assessment tool for observational cohort and cross-sectional studies was used to assess methodological quality.Results 9 studies were included in the review. Injury was defined fairly consistently across studies. Most studies were of low methodological quality. The spine, shoulder and the knee were the most common injury localisations in both sports. The injury incidence in weightlifting was 2.4–3.3 injuries/1000 hours of training and 1.0–4.4 injuries/1000 hours of training in powerlifting. Only one retrospective study had analysed possible risk factors.Summary/conclusions The risk of injury in both sports were similar to other non-contact sports also requiring strength/power, but low compared to contact sports. The severity of injuries differed in the included studies. Since little has been studied regarding possible risk factors to injuries, further research is therefore warranted to explain why athletes get injured and how to prevent injuries.Trial registration number PROSPERO CRD42015014805.
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| 5. |
- Alfredson, Håkan, et al.
(författare)
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A treatment algorithm for managing Achilles tendinopathy : new treatment options.
- 2007
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Ingår i: British Journal of Sports Medicine. - : BMJ. - 0306-3674 .- 1473-0480. ; 41:4, s. 211-216
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Forskningsöversikt (refereegranskat)abstract
- Achilles tendinopathy affects athletes, recreational exercisers and even inactive people. The pathology is not inflammatory; it is a failed healing response. The source of pain in tendinopathy could be related to the neurovascular ingrowth seen in the tendon's response to injury. The treatment of Achilles tendinopathy is primarily conservative with an array of effective treatment options now available to the primary care practitioner. If conservative treatment is not successful, then surgery relieves pain in the majority of cases. Directing a patient through the algorithm presented here will maximise positive treatment outcomes.
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| 6. |
- Alfredson, Håkan
(författare)
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Can specific treatment prevent progressive tendon degeneration?
- 2011
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Ingår i: British Journal of Sports Medicine. - : BMJ Journals. - 0306-3674 .- 1473-0480. ; 45:4, s. 334-
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Tidskriftsartikel (refereegranskat)abstract
- Background Tendon degeneration is generally believed to be irreversible.Objective To use ultrasound to study the Achilles midportion tendon structure and thickness before and after treatment of chronic painful tendinosis.Design Prospective study.Patients and interventions Middle aged patients on varying activity levels, having midportion chronic Achilles tendinosis, were followed with ultrasound examinations before and after treatment with eccentric training, sclerosing polidocanol injections and surgical scraping.Outcome measurements Tendon thickness and structure.Results 89 patients successfully treated (pain-free during tendon loading) with eccentric training (n=22), sclerosing polidocanol injections (n=38) and surgical scraping (n=29), had a significantly thinner Achilles midportion and a more normal tendon structure, after compared to before, treatment.Conclusion For the Achilles midportion, tendon degeneration might not be irreversible. The findings indicate a possible regeneration potential.
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| 7. |
- Alfredson, Håkan
(författare)
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Midportion Achilles tendinosis and the plantaris tendon
- 2011
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Ingår i: British Journal of Sports Medicine. - Loughborough : British Assoc. of Sport and Medicine. - 0306-3674 .- 1473-0480. ; 45:13, s. 1023-1025
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: When re-operating patients with midportion Achilles tendinosis, having had a poor effect of ultrasound (US) and Doppler-guided scraping, the author found the involvement of the plantaris tendon to be a likely reason for the poor result. The aim of this study was to investigate the occurrence of a plantaris tendon in close relation to the Achilles tendon in consecutive patients with midportion Achilles tendinosis undergoing treatment with US and Doppler-guided scraping. Material and methods: This study includes 73 consecutive tendons with chronic painful midportion Achilles tendinosis, where US+Doppler examination showed thickening, irregular tendon structure, hypo-echoic regions, and localised high blood flow outside and inside the ventral Achilles midportion. The tendons were treated with US+Doppler-guided scraping, via a medial incision. If there was a plantaris tendon located in close relation to the medial Achilles, it was extirpated. Results: An invaginated, or ‘close by located’, enlarged plantaris tendon was found in 58 of 73 (80%) tendons. Preliminary clinical results of the combined procedure, US + Doppler-guided surgical scraping and extirpation of the plantaris tendon, are very promising. Conclusions: A thickened plantaris tendon located in close relation to the medial Achilles seems common in patients with chronic painful midportion tendinosis. The role of the plantaris tendon in midportion Achilles tendinosis needs to be further evaluated and should be kept in mind when treating this condition.
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| 8. |
- Alfredson, Håkan, et al.
(författare)
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No normalisation of the tendon structure and thickness after intratendinous surgery for chronic painful midportion Achilles tendinosis.
- 2009
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Ingår i: British journal of sports medicine. - : BMJ. - 1473-0480 .- 0306-3674. ; 43:12, s. 948-9
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To characterise Achilles tendon structure and thickness a minimum of 8 years after intra-tendinous surgery. Material and METHODS: Fourteen patients (16 tendons; 9 men and 5 women, mean age 43 years, range 27-55) surgically treated (intra-tendinous surgery) for chronic painful midportion Achilles tendinosis, were followed with clinical examination and grey-scale ultrasonography for a minimum of 8 years (range 8-16 years, mean 13 years). RESULTS: All patients were satisfied with the result of surgery and were active in Achilles tendon loading activities without restrictions. In all operated tendons, structural abnormalities remained and tendons remained thicker than normal tendons. CONCLUSIONS: Resection of tendinosis is associated with persistent structural abnormalities and thickening of the tendon 13 years after surgery, despite successful clinical outcomes.
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| 9. |
- Alfredson, Håkan, et al.
(författare)
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Partial midportion Achilles tendon ruptures: new sonographic findings helpful for diagnosis.
- 2011
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Ingår i: British Journal of Sports Medicine. - : BMJ. - 0306-3674 .- 1473-0480. ; 45:5, s. 429-432
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Partial Achilles tendon ruptures are not always easy to diagnose. A history including a sudden onset of pain, and/or relative weakness in plantar flexion force, are indicators. The most loaded side of the Achilles tendon is the dorsal side (skin side). OBJECTIVE: To evaluate the ultrasound (US) and Doppler (CD) findings in patients with a suspected partial rupture in the Achilles tendon. Material and METHODS: Seventeen patients (16 men and 1 woman) with a mean age of 36 years (range 23-71) were examined clinically and by US+CD because of midportion Achilles tendon pain. There was an acute onset in 14/17 patients, and all had painful weakness during tendon loading activity. RESULTS: In all patients the US examination showed a partial Achilles tendon rupture, presented as a disrupted dorsal (skin side) tendon line and an irregular tendon structure mainly located in the dorsal and mid-tendon. The size of the rupture varied from 1/3 to 2/3 of the tendon thickness. In the dorsal part of the tendon, corresponding to the region with disrupted tendon line and irregular structure, CD examination showed high blood flow-most often of a longitudinal character. Six of the patients were surgically treated, and macroscopical examination verified the ultrasound findings, showing disruption on the dorsal side, and a partial rupture in the dorsal and mid- tendon. CONCLUSIONS: Ultrasound and Doppler examination can be helpful tools to diagnose partial midportion Achilles tendon ruptures. The characteristic findings of a disrupted dorsal tendon line, and high blood flow in the structurally abnormal dorsal tendon, indicate a partial rupture.
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| 11. |
- Alfredson, Håkan
(författare)
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Ultrasound and Doppler-guided mini-surgery to treat midportion Achilles tendinosis : results of a large material and a randomised study comparing two scraping techniques.
- 2011
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Ingår i: British Journal of Sports Medicine. - : BMJ. - 0306-3674 .- 1473-0480. ; 45:5, s. 407-410
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Treatment based on ultrasound (US) and colour Doppler (CD) findings in midportion Achilles tendinosis has shown promising results. In a randomised study on a small patient material, similar short-term clinical results were demonstrated with surgery outside the tendon and sclerosing polidocanol injections, but surgical treatment led to a faster return to activity.OBJECTIVE: To evaluate the clinical results of US and CD-guided mini-surgery (scraping) outside the ventral tendon in a larger patient material and, in a randomised study, compare two different techniques for surgical scraping.MATERIAL AND METHODS: 103 patients (66 men, 37 women), mean age 43 years (range 24-77), with midportion tendinosis in 125 Achilles tendons were included. Patients from a large group (88 tendons), and a randomised study (37 tendons), were in local anaesthesia treated with a US and CD-guided new surgical approach outside the ventral tendon. All patients in the large group, and one arm of the randomised study, were treated open with a scalpel, while the other arm of the randomised study were treated percutaneously. Pain during Achilles tendon loading activity (Visual Analogue Scale (VAS)), and satisfaction with treatment, were evaluated.RESULTS: Before surgery, the mean VAS was 73. After surgery (follow-up mean 18 months, range 6-33), the mean VAS was 3 in 111 tendons (89%) from satisfied patients back in full Achilles tendon loading activity. In the randomised study, there were no significant differences in the results between open treatment with a scalpel and percutaneous treatment with a needle.CONCLUSIONS: US and CD-guided scraping show good short-term results in midportion Achilles tendinosis.
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| 12. |
- Alfredson, Håkan, et al.
(författare)
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Unilateral surgical treatment for patients with midportion Achilles tendinopathy may result in bilateral recovery
- 2014
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Ingår i: British Journal of Sports Medicine. - : BMJ Publishing Group. - 0306-3674 .- 1473-0480. ; 48:19, s. 1421-1424
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Bilateral midportion Achilles tendinopathy/tendinosis is not unusual, and treatment of both sides is often carried out. Experiments in animals suggest of the potential involvement of central neuronal mechanisms in Achilles tendinosis. OBJECTIVES: To evaluate the outcome of surgery for Achilles tendinopathy. METHODS: This observational study included 13 patients (7 men and 6 women, mean age 53 years) with a long duration (6-120 months) of chronic painful bilateral midportion Achilles tendinopathy. The most painful side at the time for investigation was selected to be operated on first. Treatment was ultrasound-guided and Doppler-guided scraping procedure outside the ventral part of the tendon under local anaesthetic. The patients started walking on the first day after surgery. Follow-ups were conducted and the primary outcome was pain by visual analogue scale. In an additional part of the study, specimens from Achilles and plantaris tendons in three patients with bilateral Achilles tendinosis were examined. RESULTS: Short-term follow-ups showed postoperative improvement on the non-operated side as well as the operated side in 11 of 13 patients. Final follow-up after 37 (mean) months showed significant pain relief and patient satisfaction on both sides for these 11 patients. In 2 of 13 patients operation on the other, initially non-operated side, was instituted due to persisting pain. Morphologically, it was found that there were similar morphological effects, and immunohistochemical patterns of enzyme involved in signal substance production, bilaterally. CONCLUSION: Unilateral treatment with a scraping operation can have benefits contralaterally; the clinical implication is that unilateral surgery may be a logical first treatment in cases of bilateral Achilles tendinopathy.
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| 13. |
- Alfredson, Håkan
(författare)
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Where to now with Achilles tendon treatment?
- 2011
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Ingår i: British Journal of Sports Medicine. - : BMJ Publishing Group. - 0306-3674 .- 1473-0480. ; 45:5, s. 386-386
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Tidskriftsartikel (refereegranskat)
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| 14. |
- Alonso, Juan-Manuel, et al.
(författare)
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Preparticipation injury complaint is a risk factor for injury : a prospective study of the Moscow 2013 IAAF Championships.
- 2015
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Ingår i: British Journal of Sports Medicine. - : BMJ Publishing Group. - 0306-3674 .- 1473-0480. ; 49:17, s. 1118-U45
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To determine the health status of athletes before the start of an international athletics championship and to determine whether preparticipation risk factors predicted in-championship injuries.METHODS: At the beginning of the 2013 International Association of Athletics Federations (IAAF) World Championships, all registered athletes (n=1784) were invited to complete a preparticipation health questionnaire (PHQ) on health status during the month preceding the championships. New injuries that occurred at the championships were prospectively recorded.RESULTS: The PHQ was completed by 698 (39%) athletes; 204 (29.2%) reported an injury complaint during the month before the championships. The most common mode of onset of preparticipation injury complaints was gradual (43.6%). Forty-nine athletes in the study reported at least one injury during the championships. Athletes who reported a preparticipation injury complaint were at twofold increased risk for an in-championship injury (OR=2.09; 95% CI 1.16 to 3.77); p=0.014). Those who reported a preparticipation gradual-onset injury complaint were at an almost fourfold increased risk for an in-championship time-loss injury (OR=3.92; 95% CI 1.69 to 9.08); p=0.001). Importantly, the preparticipation injury complaint severity score was associated with the risk of sustaining an in-championship injury (OR=1.14; 95% CI 1.06 to 1.22); p=0.001).SUMMARY AND CONCLUSIONS: About one-third of the athletes participating in the study reported an injury complaint during the month before the championships, which represented a risk factor for sustaining an injury during the championship. This study emphasises the importance of the PHQ as a screening tool to identify athletes at risk of injuries before international championships.
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| 16. |
- Andersson, Gustav, et al.
(författare)
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Substance P accelerates hypercellularity and angiogenesis in tendon tissue and enhances paratendinitis in response to Achilles tendon overuse in a tendinopathy model
- 2011
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Ingår i: British Journal of Sports Medicine. - Loughborough : British Assoc. of Sport and Medicine. - 0306-3674 .- 1473-0480. ; 45:13, s. 1017-1022
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Tidskriftsartikel (refereegranskat)abstract
- Background Tenocytes produce substance P (SP) and its receptor (neurokinin-1 receptor (NK-1R) is expressed throughout the tendon tissue, expecially in patients with tendinopathy and tissue changes (tendinosis) including hypercellularity and vascular proliferation. Considering the known effects of SP, one might ask whether SP contributes to these canges.Objectives To test whether development of tendinosislike changes (hypercellularity and angiogenesis) is accelerated during a 1-week course of ecercise with local administration of SP in an establish Achilles tendinopathy model.Methods Rabbits were subjected to a protocol of Achilles tendon overuse for 1 week, in conjunction with SP injections in the paratenon. Exercised control animals received NaCl injections or no injections, and unexercised, uninjected controls were also used. Tenocyte number and vascular density, as well as paratendinous inflammation, were evaluated. Immunohistochemistry and in sity hybridisation to detect NK-1R were conducted.Results There was a significant increase in tenocyte number in the SP-injected and NaCl-injected groups compared with both unexercised and exercised, uninjected controls. Tendon blood vessels increased in number in the SP-injected group compared with unexercised controls, a finding not seen in NaCl-injected controls or in uninjected, exercised animals. Paratendinous inflammation was more pronounced in the SP-injected group than in the NaCl controls. NK-1R was detected in blood vessel walls, nerves, inflammatory cells and tenocytes.Conclusions SP accelerated the development of tendinosis-like changes in the rabbit. Achilles tendon, which supports theories of a potential role of SP in tendinosis development; a fact of clinical interest since SP effects can be effectively blocked. The angiogenic response to SP injections seems related to parateninitis.
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| 17. |
- Andersson, Gustav, 1983-, et al.
(författare)
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Tenocyte hypercellularity and vascular proliferation in a rabbit model of tendinopathy : contralateral effects suggest the involvement of central neuronal mechanisms
- 2011
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Ingår i: British Journal of Sports Medicine. - : BMJ. - 0306-3674 .- 1473-0480. ; 45:5, s. 399-406
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Tidskriftsartikel (refereegranskat)abstract
- Objective To determine whether there are objective findings of tendinosis in a rabbit tendinopathy model on exercised and contralateral (non-exercised) Achilles tendons. Design Four groups of six New Zealand white rabbits per group were used. The animals of one (control) group were not subjected to exercise/stimulation. Interventions Animals were subjected to a protocol of electrical stimulation and passive flexion-extension of the right triceps surae muscle every second day for 1, 3 or 6 weeks. Main Outcome Measures Tenocyte number and vascular density were calculated. Morphological evaluations were also performed as well as in-situ hybridisation for vascular endothelial growth factor (VEGF) messenger RNA. Results There was a significant increase in the tenocyte number after 3 and 6 weeks of exercise, but not after 1 week, in comparison with the control group. This was seen in the Achilles tendons of both legs in experimental animals, including the unexercised limb. The pattern of vascularity showed an increase in the number of tendon blood vessels in rabbits that had exercised for 3 weeks or more, compared with those who had exercised for 1 week or not at all. VEGF-mRNA was detected in the investigated tissue, with the reactions being more clearly detected in the tendon tissue with tendinosis-like changes (6-week rabbits) than in the normal tendon tissue (control rabbits). Conclusions There were bilateral tendinosis-like changes in the Achilles tendons of rabbits in the current model after 3 weeks of training, suggesting that central neuronal mechanisms may be involved and that the contralateral side is not appropriate as a control.
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| 19. |
- Ardern, Clare, 1985-, et al.
(författare)
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2016 Consensus statement on return to sport from the First World Congress in Sports Physical Therapy, Bern
- 2016
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Ingår i: British Journal of Sports Medicine. - : BMJ PUBLISHING GROUP. - 0306-3674 .- 1473-0480. ; 50:14, s. 853-864
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Tidskriftsartikel (refereegranskat)abstract
- Deciding when to return to sport after injury is complex and multifactorial-an exercise in risk management. Return to sport decisions are made every day by clinicians, athletes and coaches, ideally in a collaborative way. The purpose of this consensus statement was to present and synthesise current evidence to make recommendations for return to sport decision-making, clinical practice and future research directions related to returning athletes to sport. A half day meeting was held in Bern, Switzerland, after the First World Congress in Sports Physical Therapy. 17 expert clinicians participated. 4 main sections were initially agreed upon, then participants elected to join 1 of the 4 groups-each group focused on 1 section of the consensus statement. Participants in each group discussed and summarised the key issues for their section before the 17-member group met again for discussion to reach consensus on the content of the 4 sections. Return to sport is not a decision taken in isolation at the end of the recovery and rehabilitation process. Instead, return to sport should be viewed as a continuum, paralleled with recovery and rehabilitation. Biopsychosocial models may help the clinician make sense of individual factors that may influence the athletes return to sport, and the Strategic Assessment of Risk and Risk Tolerance framework may help decision-makers synthesise information to make an optimal return to sport decision. Research evidence to support return to sport decisions in clinical practice is scarce. Future research should focus on a standardised approach to defining, measuring and reporting return to sport outcomes, and identifying valuable prognostic factors for returning to sport.
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| 20. |
- Ardern, Clare, et al.
(författare)
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2018 International Olympic Committee consensus statement on prevention, diagnosis and management of paediatric anterior cruciate ligament (ACL) injuries
- 2018
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Ingår i: British Journal of Sports Medicine. - : BMJ. - 0306-3674 .- 1473-0480. ; 52:7, s. 422-438
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Tidskriftsartikel (refereegranskat)abstract
- In October 2017, the International Olympic Committee hosted an international expert group of physiotherapists and orthopaedic surgeons who specialise in treating and researching paediatric ACL injuries. Representatives from the American Orthopaedic Society for Sports Medicine, European Paediatric Orthopaedic Society, European Society for Sports Traumatology, Knee Surgery & Arthroscopy, International Society of Arthroscopy Knee Surgery and Orthopaedic Sports Medicine, Pediatric Orthopaedic Society of North America and Sociedad Latinoamericana de Artroscopia, Rodilla y Deporte attended. Physiotherapists and orthopaedic surgeons with clinical and research experience in the field, and an ethics expert with substantial experience in the area of sports injuries also participated. Injury management is challenging in the current landscape of clinical uncertainty and limited scientific knowledge. Injury management decisions also occur against the backdrop of the complexity of shared decision-making with children and the potential long-term ramifications of the injury. This consensus statement addresses six fundamental clinical questions regarding the prevention, diagnosis and management of paediatric ACL injuries. The aim of this consensus statement is to provide a comprehensive, evidence-informed summary to support the clinician, and help children with ACL injury and their parents/guardians make the best possible decisions.
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