General sports medicine

Loading recommendations for resistance training are typically prescribed along what has come to be known as the "repetition continuum", which proposes that the number of repetitions performed at a given magnitude of load will result in specific adaptations. Specifically, the theory postulates that heavy load training optimizes increases maximal strength, moderate load training optimizes increases muscle hypertrophy, and low-load training optimizes increases local muscular endurance. However, despite the widespread acceptance of this theory, current research fails to support some of its underlying presumptions...

BACKGROUND: A return to running after anterior cruciate ligament reconstruction (ACL-R) is critical to the clinical success of any cutting and pivoting athlete who wishes to return to sport. Knowledge of specific alterations during running after ACL-R is required to optimise rehabilitation for improving outcomes and long-term disability. OBJECTIVE: The objective of this systematic review was to summarise kinematic, kinetic and muscle activation data during running after ACL-R and the intrinsic factors (e...

INTRODUCTION: Knee osteoarthritis (KOA) is a chronic disease with symptoms of persistent pain or resting pain, joint stiffness, numbness, limitation of activity and even disability, with significant associated costs and effects on individuals' life quality. The use of acupuncture for the management of chronic pain is receiving increasing recognition from both the public and professionals. The aim of this study is to identify the effects of three commonly used acupuncture treatments for KOA...

The results of anterior cruciate ligament repair are not satisfactory. While some cohort studies reported optimistic outcomes, even using augmentation and modern rehabilitation procedures, repair of anterior cruciate ligament ruptures should not be done outside well-designed studies as the overwhelming literature is quite negative on short-term results. The steps from basic science through animal surgery to clinical studies have still not resulted in techniques for daily use.

BACKGROUND: There is no agreement about or understanding of what rehabilitation is; those who pay for it, those who provide it, and those who receive it all have different interpretations. Furthermore, within each group, there will be a variety of opinions. Definitions based on authority or on theory also vary and do not give a clear description of what someone buying, providing, or receiving rehabilitation can actually expect. METHOD: This editorial extracts information from systematic reviews that find rehabilitation to be effective, to discover the key features and to develop an empirical definition...

Myofascial pain syndrome is a pain condition characterized by the presence of trigger points. Current evidence, mostly experimental studies, clearly supports a role of trigger points on peripheral and central sensitization since they are able to contribute to sensitization of peripheral nociceptors, spinal dorsal horn neurons, and the brainstem. Several interventions are proposed for treating trigger points, dry needling being one of the most commonly used by clinicians. There is no consensus on the clinical application of trigger point dry needling: some authors propose that local twitch responses should be elicited during the needling intervention to be effective, whereas others do not...

BACKGROUND: Patellofemoral pain (PFP) affects 7% of adolescents, especially those who are highly active. Exercise-focused treatments show limited effect and overlook activity modification and load management. As many adolescents continue at high levels of sports despite pain, a new strategy addressing this problem is warranted. PURPOSE: To investigate the effects of a treatment strategy for adolescents that focuses on activity modification and load management. STUDY DESIGN: Cohort study; Level of evidence, 2...

Around 20% of patients undergoing surgery for lumbar radiculopathy develop chronic pain after surgery, leading to high socioeconomic burden. Current perioperative interventions, including education and rehabilitation, are not always effective in preventing prolonged or chronic postoperative pain and disability. Here, a shift in educational intervention from a biomedical towards a biopsychosocial approach for people scheduled for lumbar surgery is proposed. Pain neuroscience education (PNE) is a biopsychosocial approach that aims to decrease the threat value of pain by reconceptualizing pain and increasing the patient's knowledge about pain...

Outcomes following long-term injuries such as anterior cruciate ligament rupture are unsatisfactory. To improve outcomes, we must improve rehabilitation practices. One aspect of the return-to-sport process that has received limited attention is on-field rehabilitation. This article is part 1 of a 2-part series aimed at discussing the important elements of on-field rehabilitation and illustrating how they can be applied across a 5-stage on-field rehabilitation program following anterior cruciate ligament reconstruction...

PURPOSE: To compare the symptomatic hip muscle cross-sectional area (CSA) in patients with unilateral femoroacetabular impingement syndrome (FAIS) with the asymptomatic-side hip muscle CSA and to determine whether correlations exist between the hip muscle CSA and preoperative pain level, preoperative symptom duration, and postoperative function. METHODS: We performed a retrospective review of magnetic resonance imaging data of patients who underwent hip arthroscopy from January 2012 through June 2015 for the treatment of unilateral FAIS and who had a minimum of 2 years' follow-up after hip arthroscopy for FAIS...

PURPOSE: To compare femoral nerve blockade (FNB) versus adductor canal nerve blockade (ACB) for postoperative pain control and quadriceps muscle function in patients undergoing anterior cruciate ligament (ACL) reconstruction with patellar tendon autograft. METHODS: A randomized therapeutic trial of 90 patients undergoing ACL reconstruction with patellar tendon autograft was conducted comparing ACB versus FNB at 24 hours, 2 and 4 weeks, and 6 months postsurgery...

Concussion is a challenging and controversial medical diagnosis that can test even the most seasoned practitioner. Knowledge on this topic is ever evolving. It was not so long ago that grading guidelines were based on loss of consciousness and amnesia. Medicine has seen a renaissance of discovery over the past 20 years in concussion evaluation and management. A PubMed search for "concussion" between 1990 and 2000 produced just over 1000 articles and that same search including the last 18 years expands to over 10,000 publications...

Failed back surgery syndrome (FBSS) is a major, worldwide health problem that generates considerable expense for healthcare systems. A number of controversial issues concerning the management of FBSS are regularly debated, but no clear consensus has been reached. This pitfall is the result of lack of a standardized care pathway due to insufficient characterization of underlying pathophysiological mechanisms, which are essential to identify in order to offer appropriate treatment, and the paucity of evidence of treatment outcomes...

Background: Younger athletes have high rates of second anterior cruciate ligament (ACL) injury. Return-to-sport criteria have been proposed to enable athletes to make a safe return, but they frequently lack validation. It is unclear whether commonly recorded clinical measures can help to identify high-risk athletes. Purpose: To explore the association between commonly recorded clinical outcome measures and second ACL injury in a young, active patient group. Study Design: Cohort study; Level of evidence, 2...

PURPOSE: Multimodal analgesia has become an important concept in current pain management following total knee arthroplasty (TKA). However, controversy remains over what is the most accepted combination. In this study, the additional benefits of local infiltration of analgesia to femoral nerve block were evaluated. METHODS: Forty patients were randomly allocated into a combined local infiltration of analgesia and femoral nerve block or femoral nerve block alone group...

OBJECTIVE: To determine if commonly used knee radiofrequency ablation (RFA) techniques would be able to completely denervate the knee joint. METHODS: A comprehensive search of the literature on knee joint innervation was conducted using the databases Medline, Embase, and PubMed from inception through February 1, 2019. Google Scholar was also searched. Data on the origin, number of articular branches, course, distribution, and frequency of each nerve innervating the knee joint were extracted from the included studies and compared in order to identify variations...

Herrington, L, Ghulam, H, and Comfort, P. Quadriceps strength and functional performance after anterior cruciate ligament reconstruction in professional soccer players, at time of return to sport. J Strength Cond Res 35(3): 769-775, 2021-Poor quadriceps strength has been associated with poor outcome after anterior cruciate ligament (ACL) reconstruction (ACLR). This study aims to assess quadriceps strength, muscle inhibition, and hop test performance in professional soccer players after ACLR. Fifteen professional soccer players (age 22...

Aberrant motor cortex plasticity is hypothesized to contribute to chronic musculoskeletal pain, but evidence is limited. Critically, studies have not considered individual differences in motor plasticity or how this relates to pain susceptibility. Here we examined the relationship between corticomotor excitability and an individual's susceptibility to pain as pain developed, was sustained and resolved over 21 days. Nerve growth factor was injected into the right extensor carpi radialis brevis muscle of 20 healthy individuals on day 0, 2, and 4...

Objectives: We investigated whether patient demographics, 4-month patient-reported outcomes (PRO) and muscle function predicted young athletes regaining symmetrical muscle function in five tests of muscle function 1 year after ACL reconstruction. Methods: We extracted data on patient demographics, PROs and the results of five tests of muscle function from a rehabilitation-specific register. Athletes were 15-30 years of age, involved in knee-strenuous sport and had undergone a primary ACL reconstruction...

BACKGROUND: To investigate the association between cardiorespiratory fitness and risk of cardiovascular disease, cancer, and all-cause mortality in men with musculoskeletal conditions. METHODS: Participants were 12,728 men (mean age 47.0 [9.3] y) with a history of musculoskeletal conditions (including joint pain, low back pain, stiff joints, arthritis, osteoporosis, or gout) and were followed for all-cause mortality to December 31, 2003. Fitness was quantified by maximal treadmill exercise test and was categorized for analysis as low, moderate, and high performance...