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Patterns of platelet rich plasma use among Australasian Sports Physicians
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Thursday 22 October Posters / Journal of Science and Medicine in Sport 19S (2015) e33–e56
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111
Classification of sports injuries in Japanese university judo players and analysis of associated physical fitness characteristics
Effectiveness of a single Platelet Rich Plasma (PRP) injection to promote recovery in rugby players with ankle syndesmosis injury
Kasahara 1,2,∗ , D. Martin 1 , C. Humberstone 1 , T. Yamamoto 2 , T. Nakamura 3
D. Samra 1,2,∗ , C. Hiller 2 , A. Sman 4 , K. Rae 1 , J. Linklater 3 , K. Refshauge 2
1
The Sports Clinic, Sydney University, Australia Arthritis and Musculoskeletal Research Group, Sydney University, Australia 3 Castlereagh Imaging Sydney, Australia 4 Institute for Neuroscience and Muscle Research, The Children’s Hospital at West, Australia
Australian Institute of Sport, Australia International Budo University, Australia 3 Judo Federation of Australia, Australia 2
Background: In Judo, injuries are frequent and can be severe to the extent where athletes miss practice for long periods of time. Consequently, sport injury prevention for judo athletes is crucial. The aim of this study was to gather basic information that may assist in preventing sport injuries in judo, including physical fitness data collected from judo athletes when entering university as well as the rate and site of injuries during their collegiate careers. Methods: The period of this study was ten years, and the subjects consisted of 373 male judo athletes at a Japanese University. When entering the university, athletes completed a series of physical tests, including body composition (body fat percentage was derived from height, body mass and 3-site skinfold assessment using the calculations from Nagamine et al., 1979), isometric knee extension strength (calculated relative to body mass), muscular flexibility (hamstring, quadriceps, around shoulder girdle using the finger vertebral distance, gastrocnemius), joint laxity (knee hyperextension), and limb alignment (quadriceps-angle, varus and valgus knee alignment, foot pronation/supination). Throughout the athletes’ collegiate careers, the number of injuries resulting in missing practice for a period of over one month was recorded and they were classified by site. Additionally, sport injuries with the highest numbers were divided into an injured group and a non-injured group, and their physical strength test data were compared for statistical difference. ‘here were a total of 53 sport injuries: knee joint injuries (56%), foot joint injuries (13%), shoulder joint injuries (11%), elbow joint injuries (9%), back injuries (5%), finger injuries (4%), and neck injuries (2%). The subjects with knee joint injuries (n = 25) had significantly weaker knee extension muscle strength in the injured leg (77.7 ± 22.2% relative to body weight) when compared to the non-injured group (89.7 ± 22.2%, p < 0.01, n = 348). There were no significant differences between the ‘knee-injured’ and ‘no injury’ groups for any other physical testing results. Discussion: These results indicate that it is important to pay close attention to mainly knee joint injuries among judo athletes, and that knee extension muscle strength is crucial for its prevention. In Judo, this factor may be particularly vital due to the high frequency of situations when athletes must carry their own and their opponent’s weight. As more data is collected about foot, shoulder, elbow and back injuries, it may be possible to perform similar analyses to establish links between other physical fitness characteristics and injury incidence. http://dx.doi.org/10.1016/j.jsams.2015.12.495
1
2
Introduction: To determine whether a single ultrasoundguided platelet rich plasma (PRP) injection into the anterior inferior tibiofibular ligament (AITFL) reduces the time for rugby athletes to return to function and match-play following MRI confirmed ankle syndesmosis injury. Methods: Cohort controlled pilot study. Ten rugby union players were recruited during the 2014 season, and consented to receive a single autologous PRP injection into the AITFL within 14 days of MRI confirmed ankle syndesmosis injury. An historical control group included 11 rugby players between 2011 and 2013 who were treated conservatively with the same inclusion criteria and rehabilitation protocol as the intervention group. Participants followed a standardised rehabilitation protocol involving simple milestones for progression. Early functional tests were performed 2 weeks after the removal of the CAM-boot. Time to return to play was recorded. Repeat functional testing occurred within 1 week of return to play. Results: Groups were comparable in anthropometrics and MRI injury severity. Time to return to play was significantly less in the intervention group (p = 0.048). Following return to play, athletes in the intervention group showed higher agility (p = 0.002) and vertical jump (p = 0.001). There was a lower level of fear avoidance associated with rugby in the intervention than the control group (p = 0.014). Discussion: This study shows that following ankle syndesmosis injury, a single autologous PRP injection may reduce fear avoidance, improve functional capacity and accelerate safe and successful return to rugby. http://dx.doi.org/10.1016/j.jsams.2015.12.496 112 Patterns of platelet rich plasma use among Australasian Sports Physicians D. Samra The Sports Clinic, University of Sydney, Australia Background: We hypothesised that the application, production and administration of platelet rich plasma (PRP) varies widely among Sports Physicians, bringing into question the validity and consistency of PRP described in research and clinical use. The current study allows an evaluation of current practice of Australasian Sports physicians with current evidence for the effectiveness of PRP. Methods: We conducted an anonymous 23 question online survey of 153 current Fellows of the Australasian College of Sports Physicians (ACSP), using an emailed link. It was opened from April 2014 until August 2014. Results: There was a 73% response rate, and 87% completion rate. The survey confirmed that although most Sports Physicians either provide PRP themselves or refer for it, there is wide variation
Thursday 22 October Posters / Journal of Science and Medicine in Sport 19S (2015) e33–e56
in the application, production and administration of PRP. We found that only 37.5% of Sports Physicians perform platelet-rich plasma injections themselves. Forty nine percent of clinicians do not provide the service themselves, and only refer for PRP injections. The remaining 13.4% of clinicians do not inject PRP or refer for PRP injections at all. Clinicians who perform their own PRP injections vary from an average of 0 to 500 injections per month, with a median of 12 times per month. Forty percent of clinicians who perform PRP injections themselves use commercial kits (not exclusively), and 28.5% use activating techniques. For Sports Physicians who use or refer for PRP injections, tendinopathy was overwhelmingly cited (n = 63) as the condition for which clinicians thought PRP was most effective. Based on clinical experience, those clinicians thought PRP was effective for lateral epicondylalgia (n = 30), hamstring origin tendinopathy (n = 17) and patella tendinopathy (n = 17). Thirty respondents cited effectiveness for osteoarthritis, especially osteoarthritis of the knee. Australian Sports Physicians are far more likely to use PRP than their New Zealand counterparts (p = 001). Forty-five percent of Australian clinicians perform PRP injections compared with 6% of New Zealand clinicians. Discussion: This study shows there is wide variability in the practices employed by Sports Physicians to produce and administer platelet rich plasma. There is a poor correlation between the best available evidence and the beliefs of Sports Physicians regarding clinical conditions responding best to PRP. There is a clear need for validation of clinic-based methods of producing platelet rich plasma. Future clinical research must consider real world practice and help develop guidelines that allow increased consistency between clinicians for this service. http://dx.doi.org/10.1016/j.jsams.2015.12.497 113 Association between fat percent and the basic physical capacities of children of 7-11 years at school stage of an educational institution in Bogotá – Colombia M. Ocampo Plazas ∗ , J.F. Correa, C.A. Guzman David, J.C. Correa Morales Universidad Nacional De Colombia, Sede Bogotá, Colombia Introduction: Obesity is a disease that progresses rapidly and generated chronic diseases both adults and children that are costly and difficult to treat. The decline of physical performance associated with obesity is an issue that has been addressed by several studies in which the alteration of aerobic capacity as the causal agent is disclosed, but is less addressed the decline in physical performance associated with other physical qualities. This work is developed as part of the academic field practice in education sector undergraduates’ physical therapy from the National University of Colombia, the purpose of this study is to establish what is the degree of association between the percentage of fat and basic physical capacities (strength, flexibility and endurance) in children of second childhood. Methods: Students of elementary school, between 7 and 11 years; who performed the FITNESSGRAM® . This is a correlational study to determine the strength of association between the percentage of fat and physical qualities as flexibility, strength and endurance. Results: It was found significant association between fat percentage and PACER level (p = 0.0001), push up (p < 0.0001), abdominal strength (p = 0.0148) and left shoulder flexibility
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(p = 0.03186). It was not found association between vertical jump Sargent and fat percentage. Discussion: The negative association between PACER level and fat percentage is significant, which is consistent with other studies that have shown that disproportionately increased weight at school age has an inversely proportional relationship with aerobic endurance. This weight gain is associated with sedentary lifestyles, which promotes obesity and increased energy expenditure and the need to mobilize more weight for oxidative activity that promotes faster reach the threshold that produces a higher glycolytic acidosis and speeds fatigue. Fat percentage is n’t related to vertical jump, although there are some studies in athletes (not children) that show that using an additional weight of body affects jump significantly, decreasing altitude and flight time, increasing-off time. Moreover, if we consider children are in full swing and jump is one of the fundamental patterns whose maturation stimulates the development of certain motor skills, it’s necessary to consider this result and the negative impact that a high percentage of fat can generate on motor development. Conclusion: The fat percentage has high influence on physical performance in general, demonstrating once again the need to develop strategies to offset overweight, obesity and promote physical activity for minimizing the deleterious effects the health. http://dx.doi.org/10.1016/j.jsams.2015.12.498 114 Unhealthy imbalance; decreased exercise and poor knowledge of exercise as medicine in Australian Medical Students the MEDx study D. Lipman ∗ , C. Bell, S. McCoombe School of Medicine, Deakin University, Geelong Waurn Ponds Campus, Australia Introduction: Physical activity is important for medical student health and wellbeing. Furthermore, having the knowledge and skills to prescribe exercise for patients will help address the imminent burden of non-communicable diseases that these students will most certainly face. Evaluating these important areas is the goal of “MEDx”, a study spanning 2 years exploring the perceptions and knowledge levels of postgraduate medical students towards exercise as medicine as well as investigating their physical activity levels. This is particularly pertinent as a growing body of evidence indicates that role-modeling and physicians’ exercise habits greatly influence their exercise prescription. This study adds to the growing body of evidence supporting the inclusion of exercise prescription and physical activity in medical curricula. Methods: An anonymous online quantitative and qualitative survey of Deakin University postgraduate medical students was undertaken regarding their exercise habits as well as their perceptions and beliefs surrounding exercise. Also assessed was students’ knowledge of exercise as medicine. Subjects were recruited from the entire 4-year cohort biannually. Ethics approval was obtained from Deakin University Human research ethics. Results: Response rates were consistently 1 in 4 (total n = 436) throughout the 2 years of this study. 32.45% (SD 10.4) of surveyed students met or exceeded current physical activity guidelines, despite the majority believing that practitioners exercise prescription is affected by exercise habits and that practitioner health influences patient health. Of concern is that 50.26% (SD 5.85) of participating students believe medical school hinders their exercise and indeed exercise levels dropped between preclinical and clinical years. Furthermore >85% of student participants believe exercise counselling is important for their future field and even
Thursday 22 October Posters / Journal of Science and Medicine in Sport 19S (2015) e33–e56
110
111
Classification of sports injuries in Japanese university judo players and analysis of associated physical fitness characteristics
Effectiveness of a single Platelet Rich Plasma (PRP) injection to promote recovery in rugby players with ankle syndesmosis injury
Kasahara 1,2,∗ , D. Martin 1 , C. Humberstone 1 , T. Yamamoto 2 , T. Nakamura 3
D. Samra 1,2,∗ , C. Hiller 2 , A. Sman 4 , K. Rae 1 , J. Linklater 3 , K. Refshauge 2
1
The Sports Clinic, Sydney University, Australia Arthritis and Musculoskeletal Research Group, Sydney University, Australia 3 Castlereagh Imaging Sydney, Australia 4 Institute for Neuroscience and Muscle Research, The Children’s Hospital at West, Australia
Australian Institute of Sport, Australia International Budo University, Australia 3 Judo Federation of Australia, Australia 2
Background: In Judo, injuries are frequent and can be severe to the extent where athletes miss practice for long periods of time. Consequently, sport injury prevention for judo athletes is crucial. The aim of this study was to gather basic information that may assist in preventing sport injuries in judo, including physical fitness data collected from judo athletes when entering university as well as the rate and site of injuries during their collegiate careers. Methods: The period of this study was ten years, and the subjects consisted of 373 male judo athletes at a Japanese University. When entering the university, athletes completed a series of physical tests, including body composition (body fat percentage was derived from height, body mass and 3-site skinfold assessment using the calculations from Nagamine et al., 1979), isometric knee extension strength (calculated relative to body mass), muscular flexibility (hamstring, quadriceps, around shoulder girdle using the finger vertebral distance, gastrocnemius), joint laxity (knee hyperextension), and limb alignment (quadriceps-angle, varus and valgus knee alignment, foot pronation/supination). Throughout the athletes’ collegiate careers, the number of injuries resulting in missing practice for a period of over one month was recorded and they were classified by site. Additionally, sport injuries with the highest numbers were divided into an injured group and a non-injured group, and their physical strength test data were compared for statistical difference. ‘here were a total of 53 sport injuries: knee joint injuries (56%), foot joint injuries (13%), shoulder joint injuries (11%), elbow joint injuries (9%), back injuries (5%), finger injuries (4%), and neck injuries (2%). The subjects with knee joint injuries (n = 25) had significantly weaker knee extension muscle strength in the injured leg (77.7 ± 22.2% relative to body weight) when compared to the non-injured group (89.7 ± 22.2%, p < 0.01, n = 348). There were no significant differences between the ‘knee-injured’ and ‘no injury’ groups for any other physical testing results. Discussion: These results indicate that it is important to pay close attention to mainly knee joint injuries among judo athletes, and that knee extension muscle strength is crucial for its prevention. In Judo, this factor may be particularly vital due to the high frequency of situations when athletes must carry their own and their opponent’s weight. As more data is collected about foot, shoulder, elbow and back injuries, it may be possible to perform similar analyses to establish links between other physical fitness characteristics and injury incidence. http://dx.doi.org/10.1016/j.jsams.2015.12.495
1
2
Introduction: To determine whether a single ultrasoundguided platelet rich plasma (PRP) injection into the anterior inferior tibiofibular ligament (AITFL) reduces the time for rugby athletes to return to function and match-play following MRI confirmed ankle syndesmosis injury. Methods: Cohort controlled pilot study. Ten rugby union players were recruited during the 2014 season, and consented to receive a single autologous PRP injection into the AITFL within 14 days of MRI confirmed ankle syndesmosis injury. An historical control group included 11 rugby players between 2011 and 2013 who were treated conservatively with the same inclusion criteria and rehabilitation protocol as the intervention group. Participants followed a standardised rehabilitation protocol involving simple milestones for progression. Early functional tests were performed 2 weeks after the removal of the CAM-boot. Time to return to play was recorded. Repeat functional testing occurred within 1 week of return to play. Results: Groups were comparable in anthropometrics and MRI injury severity. Time to return to play was significantly less in the intervention group (p = 0.048). Following return to play, athletes in the intervention group showed higher agility (p = 0.002) and vertical jump (p = 0.001). There was a lower level of fear avoidance associated with rugby in the intervention than the control group (p = 0.014). Discussion: This study shows that following ankle syndesmosis injury, a single autologous PRP injection may reduce fear avoidance, improve functional capacity and accelerate safe and successful return to rugby. http://dx.doi.org/10.1016/j.jsams.2015.12.496 112 Patterns of platelet rich plasma use among Australasian Sports Physicians D. Samra The Sports Clinic, University of Sydney, Australia Background: We hypothesised that the application, production and administration of platelet rich plasma (PRP) varies widely among Sports Physicians, bringing into question the validity and consistency of PRP described in research and clinical use. The current study allows an evaluation of current practice of Australasian Sports physicians with current evidence for the effectiveness of PRP. Methods: We conducted an anonymous 23 question online survey of 153 current Fellows of the Australasian College of Sports Physicians (ACSP), using an emailed link. It was opened from April 2014 until August 2014. Results: There was a 73% response rate, and 87% completion rate. The survey confirmed that although most Sports Physicians either provide PRP themselves or refer for it, there is wide variation
Thursday 22 October Posters / Journal of Science and Medicine in Sport 19S (2015) e33–e56
in the application, production and administration of PRP. We found that only 37.5% of Sports Physicians perform platelet-rich plasma injections themselves. Forty nine percent of clinicians do not provide the service themselves, and only refer for PRP injections. The remaining 13.4% of clinicians do not inject PRP or refer for PRP injections at all. Clinicians who perform their own PRP injections vary from an average of 0 to 500 injections per month, with a median of 12 times per month. Forty percent of clinicians who perform PRP injections themselves use commercial kits (not exclusively), and 28.5% use activating techniques. For Sports Physicians who use or refer for PRP injections, tendinopathy was overwhelmingly cited (n = 63) as the condition for which clinicians thought PRP was most effective. Based on clinical experience, those clinicians thought PRP was effective for lateral epicondylalgia (n = 30), hamstring origin tendinopathy (n = 17) and patella tendinopathy (n = 17). Thirty respondents cited effectiveness for osteoarthritis, especially osteoarthritis of the knee. Australian Sports Physicians are far more likely to use PRP than their New Zealand counterparts (p = 001). Forty-five percent of Australian clinicians perform PRP injections compared with 6% of New Zealand clinicians. Discussion: This study shows there is wide variability in the practices employed by Sports Physicians to produce and administer platelet rich plasma. There is a poor correlation between the best available evidence and the beliefs of Sports Physicians regarding clinical conditions responding best to PRP. There is a clear need for validation of clinic-based methods of producing platelet rich plasma. Future clinical research must consider real world practice and help develop guidelines that allow increased consistency between clinicians for this service. http://dx.doi.org/10.1016/j.jsams.2015.12.497 113 Association between fat percent and the basic physical capacities of children of 7-11 years at school stage of an educational institution in Bogotá – Colombia M. Ocampo Plazas ∗ , J.F. Correa, C.A. Guzman David, J.C. Correa Morales Universidad Nacional De Colombia, Sede Bogotá, Colombia Introduction: Obesity is a disease that progresses rapidly and generated chronic diseases both adults and children that are costly and difficult to treat. The decline of physical performance associated with obesity is an issue that has been addressed by several studies in which the alteration of aerobic capacity as the causal agent is disclosed, but is less addressed the decline in physical performance associated with other physical qualities. This work is developed as part of the academic field practice in education sector undergraduates’ physical therapy from the National University of Colombia, the purpose of this study is to establish what is the degree of association between the percentage of fat and basic physical capacities (strength, flexibility and endurance) in children of second childhood. Methods: Students of elementary school, between 7 and 11 years; who performed the FITNESSGRAM® . This is a correlational study to determine the strength of association between the percentage of fat and physical qualities as flexibility, strength and endurance. Results: It was found significant association between fat percentage and PACER level (p = 0.0001), push up (p < 0.0001), abdominal strength (p = 0.0148) and left shoulder flexibility
e51
(p = 0.03186). It was not found association between vertical jump Sargent and fat percentage. Discussion: The negative association between PACER level and fat percentage is significant, which is consistent with other studies that have shown that disproportionately increased weight at school age has an inversely proportional relationship with aerobic endurance. This weight gain is associated with sedentary lifestyles, which promotes obesity and increased energy expenditure and the need to mobilize more weight for oxidative activity that promotes faster reach the threshold that produces a higher glycolytic acidosis and speeds fatigue. Fat percentage is n’t related to vertical jump, although there are some studies in athletes (not children) that show that using an additional weight of body affects jump significantly, decreasing altitude and flight time, increasing-off time. Moreover, if we consider children are in full swing and jump is one of the fundamental patterns whose maturation stimulates the development of certain motor skills, it’s necessary to consider this result and the negative impact that a high percentage of fat can generate on motor development. Conclusion: The fat percentage has high influence on physical performance in general, demonstrating once again the need to develop strategies to offset overweight, obesity and promote physical activity for minimizing the deleterious effects the health. http://dx.doi.org/10.1016/j.jsams.2015.12.498 114 Unhealthy imbalance; decreased exercise and poor knowledge of exercise as medicine in Australian Medical Students the MEDx study D. Lipman ∗ , C. Bell, S. McCoombe School of Medicine, Deakin University, Geelong Waurn Ponds Campus, Australia Introduction: Physical activity is important for medical student health and wellbeing. Furthermore, having the knowledge and skills to prescribe exercise for patients will help address the imminent burden of non-communicable diseases that these students will most certainly face. Evaluating these important areas is the goal of “MEDx”, a study spanning 2 years exploring the perceptions and knowledge levels of postgraduate medical students towards exercise as medicine as well as investigating their physical activity levels. This is particularly pertinent as a growing body of evidence indicates that role-modeling and physicians’ exercise habits greatly influence their exercise prescription. This study adds to the growing body of evidence supporting the inclusion of exercise prescription and physical activity in medical curricula. Methods: An anonymous online quantitative and qualitative survey of Deakin University postgraduate medical students was undertaken regarding their exercise habits as well as their perceptions and beliefs surrounding exercise. Also assessed was students’ knowledge of exercise as medicine. Subjects were recruited from the entire 4-year cohort biannually. Ethics approval was obtained from Deakin University Human research ethics. Results: Response rates were consistently 1 in 4 (total n = 436) throughout the 2 years of this study. 32.45% (SD 10.4) of surveyed students met or exceeded current physical activity guidelines, despite the majority believing that practitioners exercise prescription is affected by exercise habits and that practitioner health influences patient health. Of concern is that 50.26% (SD 5.85) of participating students believe medical school hinders their exercise and indeed exercise levels dropped between preclinical and clinical years. Furthermore >85% of student participants believe exercise counselling is important for their future field and even