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Results of surgery for Achilles tendon overuse injuries
Abstracts trunk side bridge being significantly lower in those with poor single leg squat performance. doi:10.1016/j.jsams.2006.12.011 10 Scope of sports chiropractic required for the successful prevention of hamstring and other lower limb injury H. Pollard, W. Hoskins Macquarie Injury Management Group, Macquarie University, Australia Aim: To document the scope of sports chiropractic required for the successful prevention of hamstring and other lower limb injuries occurring in semielite Australian Rules footballers by identifying the type, location and reason for treatment provided in a season-long RCT. Methods: Treatment for the intervention group for the entirety of the study was continuously recorded and determined as being for symptomatic benefit for a self-reported complaint or asymptomatic functional/performance improvement. Treatment was classified as being joint based (manipulation/mobilisation) or soft tissue based (massage/stretching) and categorised into the regions of the body. Results: Four hundred and eighty-seven treatments were provided to 29 intervention players, 65.3% were delivered to asymptomatic regions and 34.7% symptomatic regions. Of the joint based therapy 73.5% was asymptomatic and 26.5% symptomatic. The most common asymptomatic joints treated were the thoracic spine (21.3%), knee (20.5%) and hip (19.0%) and symptomatic joints were the lumbar spine (24.3%), thoracic spine (16.7%) and hip (14.0%). Of the soft tissue based therapy 58.0% was asymptomatic and 42.0% symptomatic. The most common asymptomatic soft tissue regions treated were the gluteal region (22.0%), hip flexors (13.8%) and knee (13.0%) and symptomatic regions were the gluteal region (21.5%), lumbar region (14.2%) and thoracic region (7.6%). For joint based therapies 53.8% of treatment was directed at the spine with 46.2% directed at peripheral regions. Conclusion: Successful injury prevention in this cohort required an individualised full body sports chiropractic approach addressing soft and joint tissues in spinal and peripheral regions. doi:10.1016/j.jsams.2006.12.012
7 11 Factors associated with chronic plantar heel pain: A matched case—control study D. Irving, J. Cook, H. Menz Musculoskeletal Research Centre, La Trobe University, Melbourne, Australia Chronic plantar heel pain (CPHP) is one of the most common soft tissue disorders of the foot, yet its aetiology is poorly understood. The purpose of this matched case—control study was to examine the association between CPHP and a number of commonly hypothesized causative factors. Eighty subjects with CPHP were matched by age and sex (±2 years) to eighty control subjects. The two groups were then compared on measures of body mass index (BMI), foot posture index, calf strength, ankle dorsiflexion range of motion and occupational activity. The CPHP group was found to have significantly greater BMI, a more pronated foot posture, greater ankle dorsiflexion range of motion and during an average working day performed more squatting and carried heavier weights. No difference was identified between the groups for calf strength or mean occupational time spent sitting, standing, walking on uneven ground, climbing or lifting. Logistic regression revealed that obese individuals (BMI > 30 kg/m2 ) were 2.9 times more likely to have CPHP and those with pronated foot posture 3.7 times more likely. The findings of this study support previous evidence of an association between CPHP and both increased BMI and pronated foot posture. The association with increased ankle dorsiflexion is in contrast to previous evidence and questions the rationale for treatments aimed at increasing calf flexibility. doi:10.1016/j.jsams.2006.12.013 12 Results of surgery for Achilles tendon overuse injuries S. Orava, J. Hein¨ anen Mehilainen Hospital and Sports Clinic, Finland We wanted to see if the results of operative treatment of chronic Achilles tendon overuse injuries between two materials were different. The first series was from years 1986 to 1991 and the second from 2000 to 2004. There were 275 patients in the first series and 322 in the second series. The operations were done by the same orthopaedic surgeon and the same classification of diagnoses obtained from surgery were used. The mean age of
8
Abstracts
the patients was little higher in the second material. There were more retrocalcaneal ailments and chronic tendinosis in the second material. Good results with the follow-up time of 1.5 years (mean) were as follows (old material first): chronic peritendinitis 81% versus 84%, tendinosis 47% versus 69%, partial overuse tear 69% versus 72%, retrocalcaneal bursitis/Haglund’s heel 75% versus 76%, distal tendon calcification 77% (only in the second series). With increasing experience and avoidance of complications results seem to be somewhat better with time. All chronic Achilles tendon ailments do not respond well, results are only moderate and the symptoms may recur. Prevention and good basic conservative treatment before and after surgery may have positive effect on the final results. doi:10.1016/j.jsams.2006.12.014 13 The effects of SkinsTM compression garments on upper body strength S. Lambert 1 , F. Dongas 2 1 The
University of Sydney, Australia; of Western Sydney, Australia
2 University
Gradient compression garments (SkinsTM ) are frequently used during and after sport and exercise to reduce the effects of post-exercise muscle soreness. This study sought to determine whether upper body compression garments have a significant effect on upper body strength. Trained subjects (5 M:2 F) performed four consecutive isokinetic concentric and eccentric contractions against a fixed speed of 30 o/s, horizontal adduction of the shoulder, utilising the pectoralis muscles and rotator cuff group, on a KinComTM isokinetic dynamometry system. Compression garments used were SkinsTM long sleeve (LS) and SkinsTM sleeveless (SL) tops. After a warm-up/familiarisation set, subjects performed sets of four contractions whilst wearing SL, LS and normal training attire (C). Successive trials were conducted 3 min after the previous trial. The average values (±standard error) for eccentric contractions for SL, LS and C were 313.6 N m (53), 311.7 N m (51) and 296.0 N m (48) and for concentric contractions 268.1 N m (46) 263.3 N m (42) and 252 N m (39) respectively. There were significant differences between mean torques between (LS/SL) and C in both concentric and eccentric contractions (p < 0.0497 and 0.0253, respectively). However, there were no significant differences between the SL or LS for either concentric or eccentric contraction. This study clearly shows that upper
body compression garments significantly increase upper body strength (5% for both eccentric and concentric contraction). The mechanism may relate to muscle fibre recruitment which will be examined in planned future studies. doi:10.1016/j.jsams.2006.12.015 14 Investigation of the minor depolarisation disorders occured during the dynamic effort of performance athletes C. Musat, D. Firescu, M. Banu, V. Marinescu, C. Maier University Dunarea De Jos of Galati, Romania The target of the proposed work is to establish the origin of the minor depolarization disorders occured during dynamic effort conditions of performance athletes by investigation of EKG results. The following parameters of EKG have been monitored: flattening or inverting of the wave T in D2, inverting of the wave T in D3, slight depression of the segment ST in aVF with isoelectric T or inverted in V5 V6, recorded and analysed. One hundred and eighty 18-year-old athletes participated in this study. The parameters have been monitored during two stages of effort intensity: low intensity obtained by executing 20 genuflections in 40 s. (step S1) and an effort obtained by pedalling 6 min with an effort intensity of 2 W/kgc (step S2). The parameters have been measured during one year, at the same hour in the morning, before starting the effort, after S1 and S2 and in post-effort S3, in all three stages of training: T1, T2 and T3. The results show that in the first stage of measurement (T1, p = 0.08), disorders of EKG occur in S1, disappear in S2 and do not occur until the next training period. In T2, p < 0.05, disorders occur in S1, disappear in S2, re-occur in the post-effort period S3 and persist for a few hours, until the next training in some athletes’ cases. In T3, p = 0.009, the monitored EKG modifications disappear. The minor disorders recorded after S1 and S2 prove their noncoronarian origin, being a kind of neuro-circulatory asthenia (syndrome caused by the overstress), because these modifications disappear completely if the effort intensity decreases. The diagnostic of the benign origin of these minor depolarisation disorders is proved also by the absence of any other functional disorders of coronation type. The conclusion of the investigation underlines the possibility of installation of a temporary asthenia at the performance athletes under competition conditions which is caused by the over effort expressed by minor modifications of EKG
7 11 Factors associated with chronic plantar heel pain: A matched case—control study D. Irving, J. Cook, H. Menz Musculoskeletal Research Centre, La Trobe University, Melbourne, Australia Chronic plantar heel pain (CPHP) is one of the most common soft tissue disorders of the foot, yet its aetiology is poorly understood. The purpose of this matched case—control study was to examine the association between CPHP and a number of commonly hypothesized causative factors. Eighty subjects with CPHP were matched by age and sex (±2 years) to eighty control subjects. The two groups were then compared on measures of body mass index (BMI), foot posture index, calf strength, ankle dorsiflexion range of motion and occupational activity. The CPHP group was found to have significantly greater BMI, a more pronated foot posture, greater ankle dorsiflexion range of motion and during an average working day performed more squatting and carried heavier weights. No difference was identified between the groups for calf strength or mean occupational time spent sitting, standing, walking on uneven ground, climbing or lifting. Logistic regression revealed that obese individuals (BMI > 30 kg/m2 ) were 2.9 times more likely to have CPHP and those with pronated foot posture 3.7 times more likely. The findings of this study support previous evidence of an association between CPHP and both increased BMI and pronated foot posture. The association with increased ankle dorsiflexion is in contrast to previous evidence and questions the rationale for treatments aimed at increasing calf flexibility. doi:10.1016/j.jsams.2006.12.013 12 Results of surgery for Achilles tendon overuse injuries S. Orava, J. Hein¨ anen Mehilainen Hospital and Sports Clinic, Finland We wanted to see if the results of operative treatment of chronic Achilles tendon overuse injuries between two materials were different. The first series was from years 1986 to 1991 and the second from 2000 to 2004. There were 275 patients in the first series and 322 in the second series. The operations were done by the same orthopaedic surgeon and the same classification of diagnoses obtained from surgery were used. The mean age of
8
Abstracts
the patients was little higher in the second material. There were more retrocalcaneal ailments and chronic tendinosis in the second material. Good results with the follow-up time of 1.5 years (mean) were as follows (old material first): chronic peritendinitis 81% versus 84%, tendinosis 47% versus 69%, partial overuse tear 69% versus 72%, retrocalcaneal bursitis/Haglund’s heel 75% versus 76%, distal tendon calcification 77% (only in the second series). With increasing experience and avoidance of complications results seem to be somewhat better with time. All chronic Achilles tendon ailments do not respond well, results are only moderate and the symptoms may recur. Prevention and good basic conservative treatment before and after surgery may have positive effect on the final results. doi:10.1016/j.jsams.2006.12.014 13 The effects of SkinsTM compression garments on upper body strength S. Lambert 1 , F. Dongas 2 1 The
University of Sydney, Australia; of Western Sydney, Australia
2 University
Gradient compression garments (SkinsTM ) are frequently used during and after sport and exercise to reduce the effects of post-exercise muscle soreness. This study sought to determine whether upper body compression garments have a significant effect on upper body strength. Trained subjects (5 M:2 F) performed four consecutive isokinetic concentric and eccentric contractions against a fixed speed of 30 o/s, horizontal adduction of the shoulder, utilising the pectoralis muscles and rotator cuff group, on a KinComTM isokinetic dynamometry system. Compression garments used were SkinsTM long sleeve (LS) and SkinsTM sleeveless (SL) tops. After a warm-up/familiarisation set, subjects performed sets of four contractions whilst wearing SL, LS and normal training attire (C). Successive trials were conducted 3 min after the previous trial. The average values (±standard error) for eccentric contractions for SL, LS and C were 313.6 N m (53), 311.7 N m (51) and 296.0 N m (48) and for concentric contractions 268.1 N m (46) 263.3 N m (42) and 252 N m (39) respectively. There were significant differences between mean torques between (LS/SL) and C in both concentric and eccentric contractions (p < 0.0497 and 0.0253, respectively). However, there were no significant differences between the SL or LS for either concentric or eccentric contraction. This study clearly shows that upper
body compression garments significantly increase upper body strength (5% for both eccentric and concentric contraction). The mechanism may relate to muscle fibre recruitment which will be examined in planned future studies. doi:10.1016/j.jsams.2006.12.015 14 Investigation of the minor depolarisation disorders occured during the dynamic effort of performance athletes C. Musat, D. Firescu, M. Banu, V. Marinescu, C. Maier University Dunarea De Jos of Galati, Romania The target of the proposed work is to establish the origin of the minor depolarization disorders occured during dynamic effort conditions of performance athletes by investigation of EKG results. The following parameters of EKG have been monitored: flattening or inverting of the wave T in D2, inverting of the wave T in D3, slight depression of the segment ST in aVF with isoelectric T or inverted in V5 V6, recorded and analysed. One hundred and eighty 18-year-old athletes participated in this study. The parameters have been monitored during two stages of effort intensity: low intensity obtained by executing 20 genuflections in 40 s. (step S1) and an effort obtained by pedalling 6 min with an effort intensity of 2 W/kgc (step S2). The parameters have been measured during one year, at the same hour in the morning, before starting the effort, after S1 and S2 and in post-effort S3, in all three stages of training: T1, T2 and T3. The results show that in the first stage of measurement (T1, p = 0.08), disorders of EKG occur in S1, disappear in S2 and do not occur until the next training period. In T2, p < 0.05, disorders occur in S1, disappear in S2, re-occur in the post-effort period S3 and persist for a few hours, until the next training in some athletes’ cases. In T3, p = 0.009, the monitored EKG modifications disappear. The minor disorders recorded after S1 and S2 prove their noncoronarian origin, being a kind of neuro-circulatory asthenia (syndrome caused by the overstress), because these modifications disappear completely if the effort intensity decreases. The diagnostic of the benign origin of these minor depolarisation disorders is proved also by the absence of any other functional disorders of coronation type. The conclusion of the investigation underlines the possibility of installation of a temporary asthenia at the performance athletes under competition conditions which is caused by the over effort expressed by minor modifications of EKG