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Andrea Bailey, Nicola Goodstone, Sharon Roberts, Jane Hughes, Simon Roberts, Louw van Niekerk, James Richardson and Dai Rees

Objective:

To develop a postoperative rehabilitation protocol for patients receiving autologous-chondrocyte implantation (ACI) to repair articular-cartilage defects of the knee.

Data Sources:

careful review of both basic science and clinical literature, personal communication with colleagues dealing with similar cases, and the authors’ experience and expertise in rehabilitating numerous patients with knee pathologies, injuries, and trauma.

Data Synthesis:

Postoperative rehabilitation of the ACI patient plays a critical role in the outcome of the procedure. The goals are to improve function and reduce discomfort by focusing on 3 key elements: weight bearing, range of motion, and strengthening.

Conclusions:

The authors present 2 flexible postoperative protocols to rehabilitate patients after an ACI procedure to the knee.

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Gregoire P. Millet, David J. Bentley and Veronica E. Vleck

The relationships between sport sciences and sports are complex and changeable, and it is not clear how they reciprocally influence each other. By looking at the relationship between sport sciences and the “new” (~30-year-old) sport of triathlon, together with changes in scientific fields or topics that have occurred between 1984 and 2006 (278 publications), one observes that the change in the sport itself (eg, distance of the events, wetsuit, and drafting) can influence the specific focus of investigation. The sport-scientific fraternity has successfully used triathlon as a model of prolonged strenuous competition to investigate acute physiological adaptations and trauma, as support for better understanding cross-training effects, and, more recently, as a competitive sport with specific demands and physiological features. This commentary discusses the evolution of the scientific study of triathlon and how the development of the sport has affected the nature of scientific investigation directly related to triathlon and endurance sport in general.

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Kelsey Timm, Cindra Kamphoff, Nick Galli and Stephen P. Gonzalez

The historic Boston Marathon was struck by tragedy in 2013 when two bombs exploded near the finish line during the race. This tragedy provided the opportunity to study resilience in marathon runners, whose experience overcoming minor adversities may help them respond resiliently to trauma (Dyer & Crouch, 1988). The purpose of this study was to employ qualitative methods to examine the role of resilience in helping runners overcome their experience at the 2013 Boston Marathon. The researchers used Galli and Vealey’s (2008) Conceptual Model of Sport Resilience as a guide. Sixteen 2013 Boston Marathon runners were interviewed. Participants reported experiencing a confusing, unpleasant race day, followed by months of mixed emotions and coping strategies, which were mediated by personal resources and ultimately led to positive outcomes including increased motivation, strength, new perspectives, and a greater sense of closeness in the running community.

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Daniel Fulham O’Neill

Season-ending injuries, particularly those to the anterior cruciate ligament (ACL), continue to occur at a high rate in many sports. Although multiple factors are thought to contribute to this injury rate, no study has looked at possible psychological influences. Therefore, the present hypothesis suggests that there exists an emotional trauma that affects athletes after seeing someone in their own sport sustain a serious injury. This traumatic response could result in a change in performance tactics that could result in injury to oneself (“injury contagion”). Students numbering 459 (N= 459; 277 males and 182 females) from four ski academies were studied. Results from psychological testing showed an increase in the use of fear words and phrases after injury to a teammate. As a result, it is recommended that coaches and other personnel maintain a heightened awareness of teammates’ emotions after a team member sustains a significant injury.

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Hawley Chase Almstedt and Zakkoyya H. Lewis

Context:

Intermittent pneumatic compression (IPC) is a common therapeutic modality used to reduce swelling after trauma and prevent thrombosis due to postsurgical immobilization. Limited evidence suggests that IPC may decrease the time needed to rehabilitate skeletal fractures and increase bone remodeling.

Objective:

To establish feasibility and explore the novel use of a common therapeutic modality, IPC, on bone mineral density (BMD) at the hip of noninjured volunteers.

Design:

Within-subjects intervention.

Setting:

University research laboratory.

Participants:

Noninjured participants (3 male, 6 female) completed IPC treatment on 1 leg 1 h/d, 5 d/wk for 10 wk. Pressure was set to 60 mm Hg when using the PresSsion and Flowtron Hydroven compression units.

Main Outcome Measures:

Dual-energy X-ray absorptiometry was used to assess BMD of the hip in treated and nontreated legs before and after the intervention. Anthropometrics, regular physical activity, and nutrient intake were also assessed.

Results:

The average number of completed intervention sessions was 43.4 (± 3.8) at an average duration of 9.6 (± 0.8) wk. Repeated-measures analysis of variance indicated a significant time-by-treatment effect at the femoral neck (P = .023), trochanter (P = .027), and total hip (P = .008). On average, the treated hip increased 0.5–1.0%, while the nontreated hip displayed a 0.7–1.9% decrease, depending on the bone site.

Conclusion:

Results of this exploratory investigation suggest that IPC is a therapeutic modality that is safe and feasible for further investigation on its novel use in optimizing bone health.

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John J. Nicholas, Margaret Reidy and Denise M. Oleske

In order to supplement the literature that describes individual injuries of the shoulder, carpal tunnel, and back in golfers, we administered a survey to demonstrate the incidence of golfers' injuries and describe the most frequent types. A questionnaire was administered to 1,790 members of the New York State Golf Association (amateur) under age 21. Three hundred sixty-eight players responded. Half of those responding had been struck by a golf ball at least on one occasion (47.6%), and 23% of the injuries were to the head or neck. Male golfers were 2.66 times more likely to be struck by a golf ball than females. Women and golfers with a higher handicap were at an increased risk for upper extremity problems, whereas younger and overweight golfers were more likely to have golf-related back problems. We concluded that golf is associated with a significant morbidity. Repetitious trunk and upper limb motions probably contribute to musculoskeletal disorders. However, an unexpectedly high incidence of trauma from projectile golf balls leads to the conclusion that no amount of stretching or muscular exercise is as important as increased alertness by golfers to decrease this hazard.

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Daniel Martínez-Silván, Jaime Díaz-Ocejo and Andrew Murray

Purpose:

To analyze the influence of training exposure and the utility of self-report questionnaires on predicting overuse injuries in adolescent endurance athletes.

Methods:

Five adolescent male endurance athletes (15.7 ± 1.4 y) from a full-time sports academy answered 2 questionnaires (Recovery Cue; RC-q and Oslo Sports Trauma Research questionnaire; OSTRC-q) on a weekly basis for 1 season (37 wk) to detect signs of overtraining and underrecovery (RC-q) and early symptoms of lower-limb injuries (OSTRC-q). All overuse injuries were retrospectively analyzed to detect which variations in the questionnaires in the weeks preceding injury were best associated. Overuse incidence rates were calculated based on training exposure.

Results:

Lower-limb overuse injuries accounted for 73% of total injuries. The incidence rate for overuse training-related injuries was 10 injuries/1000 h. Strong correlations were observed between individual running exposure and overuse injury incidence (r 2 = .66), number of overuse injuries (r 2 = .69), and days lost (r 2 = .66). A change of 20% or more in the RC-q score in the preceding week was associated with 67% of the lower-limb overuse injuries. Musculoskeletal symptoms were only detected in advance by the OSTRC-q in 27% of the episodes.

Conclusion:

Training exposure (especially running exposure) was shown to be related to overuse injuries, suggesting that monitoring training load is a key factor for injury prevention. Worsening scores in the RC-q (but not the OSTRC) may be an indicator of overuse injury in adolescent endurance runners when used longitudinally.

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Dwight E. Waddell, Craig Wyvill and Robert J. Gregor

A field study was performed using a new data collection system looking at upper extremity kinetics during two different cutting tasks, wing vs. tender cuts, in three poultry plants. The Ergonomic Work Assessment System (EWAS) was designed to simultaneously record knife forces (Fx, Fy, and Fz), electromyographic (EMG) activity (forearm flexors/extensors), and goniometric data (wrist flexion/extension), all of which may represent risk factors associated with cumulative trauma disorders, specifically carpal tunnel syndrome (CTS). The objective of this study was to monitor workers in an unencumbered fashion as they performed two different poultry cutting tasks. It was assumed that the variables measured by EWAS would be able to discriminate between the two cuts and quantify possible differences between the two. The results confirmed that EWAS successfully showed significant differences in knife forces between the wing and tender cuts. Knife force differences were also observed between plants for the same cut. Differences in the two cuts were also identified in the EMG and wrist angles. EWAS successfully quantified variables that may represent risk factors associated with CTS in three poultry plants. Knowledge of a better quantitatively described external work environment may enable plants to better design rotation schedules for their deboners.

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Kyle Southall, Matt Price and Courtney Wisler

A 20-year-old male collegiate football athlete reported a remarkably swollen elbow after direct contact with the ground. Initial radiographs and magnetic resonance imaging were negative for a fracture and soft tissue structural damage. After 2 weeks of conservative treatment, the athlete had no decrease in swelling and associated symptoms. He was diagnosed with a Morel-Lavallée lesion, later confirmed by diagnostic ultrasound imaging. The lesion was initially treated with compression therapy and cryotherapy to reduce swelling. Upon the final diagnosis the lesion was eventually incised, drained, and packed with iodoform sterile strips. It is hypothesized that many minor Morel-Lavallée cases are under- or misdiagnosed due to overlapping of signs and symptoms with other soft tissue traumas common in athletic populations. The procedures of this case can be utilized to optimize outcomes in future cases. While rare, Morel-Lavallée lesions can occur in athletic activities involving the upper extremity, and not solely crush injuries or traumatic and high-intensity accidents. This knowledge, along with the presented signs and symptoms, can give future healthcare professionals knowledge to include this diagnosis in their working differential diagnosis of injuries with similar presentations.

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Kaitlyn J. Weiss, Sian V. Allen, Mike R. McGuigan and Chris S. Whatman

Purpose:

To establish the relationship between the acute:chronic workload ratio and lower-extremity overuse injuries in professional basketball players over the course of a competitive season.

Methods:

The acute:chronic workload ratio was determined by calculating the sum of the current week’s session rating of perceived exertion of training load (acute load) and dividing it by the average weekly training load over the previous 4 wk (chronic load). All injuries were recorded weekly using a self-report injury questionnaire (Oslo Sports Trauma Research Center Injury Questionnaire20). Workload ratios were modeled against injury data using a logistic-regression model with unique intercepts for each player.

Results:

Substantially fewer team members were injured after workload ratios of 1 to 1.49 (36%) than with very low (≤0.5; 54%), low (0.5–0.99; 51%), or high (≥1.5; 59%) workload ratios. The regression model provided unique workload–injury trends for each player, but all mean differences in likelihood of being injured between workload ratios were unclear.

Conclusions:

Maintaining workload ratios of 1 to 1.5 may be optimal for athlete preparation in professional basketball. An individualized approach to modeling and monitoring the training load–injury relationship, along with a symptom-based injury-surveillance method, should help coaches and performance staff with individualized training-load planning and prescription and with developing athlete-specific recovery and rehabilitation strategies.