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Resume Le sport de haut niveau a un impact considerable sur l’appareil locomoteur mais egalement sur l’ensemble du corps des athletes. Les principales structures concernees sont les os, les muscles, les articulations mais egalement le systeme endocrinien. Les consequences sur celles-ci sont decrites et analysees afin de mieux comprendre les phenomenes biophysiologiques induits par la pratique sportive. Nous avons egalement mis l’accent sur les risques et les moyens de prevention de certaines lesions osteoarticulaires et musculaires. L’influence hormonale de l’activite sportive a aussi ete developpee, que ce soit en condition d’effort ou au repos. Enfin, un paragraphe a ete consacre a l’usage des produits dopants, les effets recherches mais egalement les risques engendres chez les athletes par l’utilisation de ceux-ci.

Muscle strength imbalances and poor flexibility are frequently described as risk factors for hamstring injury. Preventive strategies include eccentric exercises, but the influence of field eccentric exercises on these risk factors remains unclear. We investigated the influence of a field hamstring eccentric program on hamstring strength and flexibility. Twenty-seven amateur athletes were randomly assigned to an intervention (n=13) or control group (n=14). In the intervention group, participants were involved in 15 sessions of four eccentric exercises. Peak torque, hamstring-to-quadriceps ratios, passive and active flexibility were analyzed. No significant modifications of strength, passive or active flexibility were observed in the control group (p>0.05). Hamstring eccentric peak torque (+7.1%) and functional hamstring-to-quadriceps ratios (9.3%) were significantly increased (p0.05). In conclusion, a 6-week eccentric program, including four field exercises for hamstring muscles, is an effective method of improving eccentric strength, functional ratios and, especially, passive flexibility. As this program may be easily implemented in a real-world context, this association of multiple eccentric exercises might be useful in an injury prevention strategy.

IntroductionStandard care for anterior cruciate ligament (ACL) injuries includes surgical reconstruction of the ACL. However, two randomised controlled trials (RCTs) concluded that conservative treatment does not result in inferior clinical outcomes compared with immediate ACL reconstruction. More research is needed to in the first place verify these results, and second to assess whether patient-specific parameters determine whether a patient would benefit from one treatment option over the other. However, before running a full RCT, it seems necessary to perform a pilot study that assesses the feasibility of recruiting patients with ACL for such a RCT. This is because recruitment may be challenging as many patients have strong treatment beliefs. Therefore, this pilot study will assess whether a large RCT is feasible with regard to participant recruitment, adherence to the allocated treatment arm and protocol feasibility. These pilot findings will help deciding about progressing to a future full RCT.Methods and analysisThis is a pragmatic, multicentre, randomised controlled pilot trial with two parallel groups. Patients with an acute ACL injury will be recruited from two Belgian hospitals. Patients will be randomised to either conservative treatment or surgical treatment. Patients will be followed-up at 3, 6 and 12 months postrandomisation. Recruitment feasibility will be evaluated by calculating the recruitment rate 4 months after the two sites have been initiated. Clear criteria for progression to a full trial are defined. Adherence to the protocol will be assessed by calculating the proportion of patients who complete the assessments. Furthermore the proportion of patients who cross-over between treatment arms during the follow-up period will be assessed.Ethics and disseminationThe study was approved by the ethical committees: Ethische Commissie Onderzoek UZ/KU Leuven (S62004) and Comité d’Ethique Hospitalo-Facultaire Universitaire de Liège (2020212). Results will be made available to caregivers, researchers and funder.Trial registration numberThis trial is registered on ClinicalTrials.gov (NCT04408690) on 29 May 2020.

Resume Bien que la litterature scientifique relative a la prevention de blessures dans le triathlon soit globalement pauvre, des lignes de conduite directement applicables sur le terrain peuvent etre proposees. Les principales blessures du triathlete etant des lesions de surcharge des membres inferieurs (tendinopathies, fractures de fatigue, periostites), leurs facteurs de risque principaux sont un premier episode lesionnel et une charge de travail inadaptee. Concretement, les mesures preventives peuvent etre regroupees selon differents axes : realiser un bilan medical de pre-saison pour recenser tout element susceptible de predisposer a la survenue d’une blessure ulterieure ; monitorer et gerer la charge de travail ; prevoir une preparation physique incluant notamment un travail de core stability et de renforcement musculaire afin de preparer les organismes aux contraintes ; insister sur une qualite de gestuelles techniques dans chacune des trois disciplines ; ne pas negliger d’eventuels autres facteurs de risque modifiables comme l’hygiene de vie ou la pratique d’echauffement de qualite. Cependant, il apparait necessaire de disposer de plus d’etudes sur le sujet pour pouvoir repondre encore plus efficacement aux besoins fondamentaux de la prevention lesionnelle dans le triathlon.

Resume La recherche sur la thematique de la prevention lesionnelle a connu ces dernieres annees, et toujours actuellement, un developpement important. Plusieurs modeles theoriques ont ete decrits afin d’optimiser l’efficacite des strategies preventives qui, si elles sont creees et pratiquees de maniere rigoureuse, peuvent s’averer particulierement efficaces. Parmi ces modeles, nous pouvons notamment pointer les tres recents « sports injury risk management approaches » qui pourraient s’averer pertinents dans le futur mais qui doivent etre confirmes par des etudes. Pour etre efficace, une strategie preventive devrait notamment inclure divers elements tels que : un bilan medico-sportif de pre-saison, une action coordonnee sur plusieurs facteurs de risque, une compliance maximale des participants ainsi que du staff, et une quantification/gestion de la charge de travail.

Context: Few researchers have identified intrinsic risk factors for shoulder injury in team handball players by analyzing measurements of maximal isokinetic rotator muscle strength. Objective: To identify possible intrinsic risk factors for shoulder injury by analyzing measurements of maximal isokinetic rotator muscle strength. Design: Cross-sectional study. Setting: Male team handball senior divisions (the highest level) in France and Belgium. Patients or Other Participants: A total of 108 male high-level handball players (age = 24 ± 4 years, height = 189 ± 6 cm, mass = 87 ± 11 kg) were enrolled. Main Outcome Measure(s): All players completed a preseason questionnaire and performed a bilateral isokinetic assessment of the shoulder rotator muscles. On a monthly questionnaire, players reported any shoulder injury that they sustained during the season. Results: On the preseason questionnaire, 51 of 108 (47%) participants reported a history of dominant-shoulder injury. A total of 106 participants completed the in-season questionnaire, with 22% (n = 23) reporting a shoulder injury on their dominant side during the subsequent season. Fourteen percent (n = 15) sustained microtraumatic injuries, and 8% (n = 8) described a traumatic injury. Backcourt players had a 3.5-times increased risk of injury during the new season compared with players in other positions. Among the isokinetic results, no risk factor for further injury was identified in handball players with microtraumatic injuries. For traumatic injuries, the concentric maximal strength developed by the internal rotators at high speed (240°/s) in the dominant shoulder was a protective factor against the risk of further injury. Conclusions: These results can potentially identify intrinsic risk factors for shoulder injury and may be used to determine potential interventions for reducing this risk in handball players.

Resume Objectifs L’incidence des lesions musculaires est elevee dans les sports ou la vitesse de mouvement, l’explosivite ou les changements brusques de direction sont determinants. Cet article a pour objectifs d’analyser : (1) les facteurs de risque des principales lesions musculaires des membres inferieurs (ischiojambiers, quadriceps, adducteurs et triceps sural) ; (2) l’efficacite des principales strategies preventives de ce type de blessures. Actualites Ces dernieres annees, un nombre significatif d’etudes prospectives a permis d’identifier plusieurs facteurs de risque de lesions musculaires. Parmi ceux-ci, un premier episode lesionnel represente le seul facteur de risque intrinseque retrouve pour l’ensemble des quatre grands groupes musculaires. L’âge et la presence d’un desequilibre musculaire interviennent plus specifiquement dans la lesion des ischiojambiers ; la dominance dans la lesion du quadriceps ; un desequilibre musculaire et un manque de souplesse dans la lesion des adducteurs, et enfin l’âge ainsi qu’un manque de souplesse dans la lesion du triceps sural. Les facteurs de risque extrinseques apparaissent plus difficiles a associer a une localisation precise et sont principalement le type de sport pratique (sports collectifs et athletisme notamment), un echauffement inadapte, une charge de travail mal repartie, ainsi que la pratique de l’activite en competition. D’un point de vue preventif, il apparait essentiel de favoriser la pratique reguliere d’exercices de renforcement a haute intensite en mode excentrique et de corriger les eventuels desequilibres musculaires. Perspectives et projets L’influence de certains facteurs de risque comme le manque de souplesse dans les lesions des ischiojambiers et du quadriceps, la fatigue ou encore le moment de la saison meriterait d’etre approfondie. La realisation d’etirements, largement repandue sur les terrains de sport, ne devrait pas etre remise en cause mais l’evidence scientifique de l’efficacite preventive de toute lesion musculaire reste a demontrer, et des precisions concernant les modalites pratiques des etirements (duree, type d’etirement…) sont souhaitables. Des etudes ulterieures sont egalement necessaires pour confirmer l’interet preventif, dans les lesions des ischiojambiers et du quadriceps, de la therapie manuelle ou d’exercices de gainage. Conclusion Un premier episode de blessure musculaire represente le principal facteur de risque de lesions musculaires aux membres inferieurs, et chaque groupe musculaire semble presenter des facteurs de risque specifiques a leur localisation. Pour les quadriceps et surtout pour les ischiojambiers, l’incidence lesionnelle peut etre reduite de maniere consequente grâce a l’implementation de certaines mesures comme la realisation reguliere d’exercices a haute intensite en mode excentrique.

Objective To compare blood gas results obtained from 4 point-of-care (POC) blood gas analyzers under routine working conditions in order to determine their interchangeability. Design Prospective study. Setting University teaching hospital. Animals Arterial blood samples from 34 dogs, 22 presented for cardiorespiratory disease and 12 healthy experimental Beagles. Measurements Each sample was analyzed by 4 POC blood gas analyzers in a random order: Cobas b-123 POC system, IRMA TruPoint, Idexx VetStat, and ABL80 FLEX. Values obtained for pH, partial pressure of oxygen (PO2), and partial pressure of carbon dioxide (PCO2) were compared between analyzers using a statistical mixed linear model and the Bland–Altman method; P < 0.05 was set as the level of significance. One sample was also repeatedly measured 5 times on each machine to calculate and compare intra-analyzer variance for each measured variable using Fisher-statistics. Results PO2 and PCO2 values were significantly higher when measured with the Idexx and IRMA machine than with Cobas and ABL80 (PO2: P < 0.001; PCO2: P < 0.05). pH values were significantly higher when measured with the Idexx instrument than with others' devices (P < 0.01). An interaction between health status and results delivered by devices was found only for PO2 values. There was no significant difference in intra-analyzer variance between the 4 machines, for any of the measured variables. Conclusions PO2, PCO2, and pH differed significantly between the 4 analyzers. Differences in PO2 results were substantial and clinically relevant. All 4 analyzers displayed good intra-analyzer variance. Consequently, serial blood gas analysis should be performed on a single device and interpreted in accordance of the device's specific reference intervals.

Rugby is a sport that is growing in popularity. A contact sport par excellence, it causes a significant number of injuries. In Rugby Union, there are 30 to 91 injuries per 1000 match hours. This epidemiological review of injuries incurred by rugby players mentions the position and type of injuries, the causes, time during the match and season in which they occur and the players’ positions as well as the length of players’ absences following the injury.

Resume Le rugby est un sport en plein developpement. Sport de contact par excellence, il est a l’origine d’un nombre important de blessures. Au rugby a XV, l’incidence des blessures s’eleve de 30 a 91/1000 heures de match. Cette revue epidemiologique des blessures chez le rugbyman evoque leur localisation et leur nature, les causes, les moments des matches et de la saison auxquels elles se produisent, la position des joueurs et le type de terrain, ainsi que le temps d’interruption de la pratique a la suite d’une lesion.

Study Design Clinical measurement study. Background The Victorian Institute of Sport Assessment-Patella (VISA-P), originally developed in English, assesses the severity of patellar tendinopathy symptoms. To date, no French version of the questionnaire exists. Objectives The aim of our study was to translate the VISA-P into French and verify its psychometric properties. Methods The translation and cultural adaptation were performed according to international recommendations in 6 steps: initial translation, translation merging, back translation to the original language, use of an expert committee to reach a prefinal version, test of the prefinal version, and expert committee appraisal of a final version. Afterward, the psychometric properties of the final French version (VISA-PF) were assessed in 92 subjects, divided into 3 groups: pathological subjects (n = 28), asymptomatic subjects (n = 22), and sports-risk subjects (n = 42). Results All members of the expert committee agreed with the final version. On a scale ranging from 0 to 100, with 100 representing an asymptomatic subject, the average ± SD scores on the VISA-PF were 53 ± 17 for the pathological group, 99 ± 2 for the healthy group, and 86 ± 14 for the sports-risk group. The test-retest reliability of the VISA-PF was excellent, with good internal consistency. Correlations between the VISA-PF and divergent validity of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) were low, and the correlation coefficient values measured between the VISA-PF scores and converged items of the SF-36 were higher. Conclusion The VISA-PF is understandable, valid, and suitable for French-speaking patients with patellar tendinopathy. J Orthop Sports Phys Ther 2016;46(5):384-390. Epub 21 Mar 2016. doi:10.2519/jospt.2016.5937.

Objective—To assess the influence of age on pulmonary hemodynamics and hemorheological properties in healthy dogs. Animals—14 healthy Beagles. Procedures—Dogs were placed in 2 age groups as follows: young dogs (≤ 5 years old; n = 8) and old dogs (≥ 8 years old; 6). Hematologic characteristics, plasma total protein and fibrinogen concentrations, and blood viscosity were measured. Systolic time intervals of pulmonary blood flow were recorded by pulsed-wave Doppler echocardiography. Early (E′) and late (A′) diastolic myocardial velocities, isovolumic contraction velocity, and systolic myocardial velocity of the free tricuspid annulus were recorded by pulsed-wave tissue Doppler imaging (TDI). Dogs were anesthetized and pulmonary arterial pressures (PAP) and cardiac output were recorded with a pediatric thermodilution Swan-Ganz catheter. Results—Hemorheological measurements were not different between the 2 groups. Systolic, mean, and diastolic PAP were higher in old dogs, compared with values in young dogs; this difference was attributed to a high pulmonary vascular resistance and low arterial compliance in old dogs. Systolic time intervals of pulmonary blood flow stayed unchanged. The A′ wave of the free tricuspid annulus was increased in old, compared with that young dogs, and the E′:A′ ratio was decreased. Pulmonary vascular resistance was inversely correlated with compliance. Conclusions and Clinical Relevance—The age of dogs should be taken into account when interpreting pulmonary hemodynamic results and TDI variables of right ventricular diastolic function.

Study Design Translation and validation of algo-functional questionnaire. Introduction The lateral elbow tendinopathy is a common injury in tennis players and physical workers. The Patient-Rated Tennis Elbow Evaluation (PRTEE) Questionnaire was specifically designed to measure pain and functional limitations in patients with lateral epicondylitis (tennis elbow). First developed in English, this questionnaire has since been translated into several languages. Purpose of the study The aims of the study were to translate and cross-culturally adapt the PRTEE questionnaire into French and to evaluate the reliability and validity of this translated version of the questionnaire (PRTEE-F). Methods The PRTEE was translated and cross-culturally adapted into French according to international guidelines. To assess the reliability and validity of the PRTEE-F, 115 participants were asked twice to fill in the PRTEE-F, and once the Disabilities of Arm, Shoulder and Hand Questionnaire (DASH) and the Short Form Health Survey (SF-36). Internal consistency (using Cronbach's alpha), test-retest reliability (using intraclass correlation coefficient (ICC), standard error of measurement and minimal detectable change), and convergent and divergent validity (using the Spearman's correlation coefficients respectively with the DASH and with some subscales of the SF-36) were assessed. Results The PRTEE was translated into French without any problems. PRTEE-F showed a good test-retest reliability for the overall score (ICC 0.86) and for each item (ICC 0.8-0.96) and a high internal consistency (Cronbach's alpha = 0.98). The correlation analyses revealed high correlation coefficients between PRTEE-F and DASH (convergent validity) and, as expected, a low or moderate correlation with the divergent subscales of the SF-36 (discriminant validity). There was no floor or ceiling effect. Discussion and Conclusions The PRTEE questionnaire was successfully cross-culturally adapted into French. The PRTEE-F is reliable and valid for evaluating French-speaking patients with lateral elbow tendinopathy.

Copyright: © 2015 Delvaux F, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. The anterior cruciate ligament (ACL) injury is the sport-related injury that generates the largest amount of scientific studies. By simply searching for the keywords « anterior cruciate ligament » on Pubmed, about 15000 results appear, with more than 1200 in 2015 alone. The important sports, medical and economic consequences of such an injury could justify this scientific enthusiasm. In these studies, there is a large variety of topics: epidemiologic data in specific populations, comparisons of different types of surgery or rehabilitation...

This study investigated the effect of inhaled fluticasone on lower airway inflammation and bronchial responsiveness (BR) to inhaled carbachol in cats with very mild, chronic bronchitis ( n=5) that were compared with healthy cats serving as controls ( n=6). Chest radiographs, BR tests performed non-invasively by barometric whole body plethysmography (BWBP) and bronchoalveolar lavage (BAL) were performed before and after treatment. BR was quantified by calculating the concentration of carbachol inducing bronchoconstriction (C-Penh300%), defined as a 300% increase of baseline Penh, an index of bronchoconstriction obtained by BWBP. BAL fluid was analyzed cytologically and the oxidant marker 8-iso-PGF2α was determined. At test 1, healthy cats and cats with bronchitis were untreated, whereas for test 2 inhalant fluticasone (250 μg once daily) was administrated for 2 consecutive weeks to cats with bronchitis. Control cats remained untreated. Inhaled fluticasone induced a significant increase in C-Penh300% and a significant decrease of BAL fluid total cells, macrophages, neutrophils and 8-iso-PGF2α in cats with bronchitis, whilst untreated control cats did not show significant changes over time. This study shows that a 2-week fluticasone treatment significantly reduced lower airway inflammation in very mild bronchitis. BR could be successfully monitored in cats using BWPB and decreased significantly in response to inhaled fluticasone. 8-Iso-PGF2α in BAL fluid was responsive to treatment and appeared as a sensitive biomarker of lower airway inflammation in cats.

Introduction. Different series emphasized the necessity of rehabilitation program after infiltration of platelet-rich plasma (PRP) in case of tendino - pathy. However, most of them describe only briefly the reeducation protocol and these programs vary. Our aim was to extensively describe a specific standardized rehabilitation program. Methods. After a review of literature of post-PRP infiltration protocols, we had developed a standardized rehabilitation protocol. This protocol was evaluated by 30 subjects with chronic jumper’s knee who. A standardised progressive sub-maximal eccentric program supervised by a physical therapist for 6 weeks was started 1 week post-infiltration. The patient benefited also from electromyostimulation, isometric strengthening and stretching of the quadriceps, cycloergometer and cryotherapy. After the supervised program, the patient had to make an auto-reeducation added to the reathletisation protocol for 6 more weeks which was followed by maintenance exercises up to 1 year. The assessments were made using a VAS, IKDC and VISA-P scores. Results. The VAS, IKDC and VISA-P scores decreased very significantly with time. The compliance to auto-reeducation was good. Conclusions. We proposed a simple and efficient protocol based on sub-maximal eccentric reeducation to add to PRP infiltrations in case of patellar tendinopathy

Introduction: Joint hypermobility involves an increased range of motion compared to normal amplitudes for the same age, sex and ethnic group. Patients with hypermobility suffer from joints problems and chronic pain is the most frequently reported symptom. Eccentric muscle strengthening could be very important to protect hypermobile joints. Case report: An Ehler-Danlos syndrome patient presented pain in the right elbow and the right wrist after a season of tennis. Her physiotherapy (18 sessions, 3 times a week) consisted of wrist prono-supination and flexion-extension muscle group reinforcement and proprioceptive training. To protect the wrist against excessive load, the eccentric strengthening exercises of prono-supinator and flexor-extensor muscles of elbow and wrist were undertaken gradually, at increasing speeds [30°/s, 60°/s, and 90°/s] within a limited range of motion in flexion and extension, on an isokinetic device after an evaluation. She was also given an ortheosis restricting the joint range of motion of the wrist. The patient rapidly noted a decrease in pain and an increase in the stability of her right arm even when playing tennis. Isokinetic evaluation objectified an improvement in maximal torque of 20 to 25% in flexion-extension muscles of the right elbow. She was also given individualized home exercises. Conclusion: The goal of rehabilitation is to avoid hypermobility by using the muscles as a protective brake in the control of joint positioning. Muscles can be reinforced in eccentric mode with starting position at the maximum length of these muscles when unstreched. The exercises can be carried out safely on an isokinetic device, at slow speed and limited range of joint motion to avoid risk of luxation. Thus, in this case report, the eccentric exercises using an isokinetic device were effective to safely reinforce the muscles as a protective brake for joint hypermobility.

This study investigated the effect of bronchoscopy and bronchoalveolar lavage (BAL) on respiratory function, determined by barometric whole-body plethysmography (BWBP), of healthy and allergen-sensitized cats. Furthermore, the efficacy of inhaled bronchodilators in preventing changes in respiratory function was determined. For test 1, 18 healthy experimental cats were investigated on day 1 by BWBP. On day 2, the cats underwent BWBP after sedation (medetomidine), after anesthesia induction (propofol), and after bronchoscopy and BAL. Enhanced pause (Penh) was significantly increased after bronchoscopy and BAL (1.64 +/- 0.17 versus 1.23 +/- 0.07, P.05). For test 2, 6 cats were sensitized to ovalbumin (OVA), 6 cats were sensitized to Ascaris suum (AS), and 6 cats served as controls. On day 0, OVA- and AS-sensitized cats underwent an inhaled allergen challenge, whereas controls were exposed to saline. On days 1 and 2, the same protocol as described for test 1 was repeated. Post-BAL Penh of the AS-sensitized cats was significantly higher than at test 1 (2.28 +/- 0.22 versus 1.69 +/- 0.33, P.05) and was correlated with BAL fluid neutrophil count (r = 0.55, P.05). During tests 3, 4, and 5, the same protocol as used for test 2 was applied to each cat group, with the animals being randomly treated before sedation with inhaled salbutamol (200 microg), ipratropium bromide (40 microg), or a combination of both (200 + 40 microg). Post-BAL Penh of the AS-sensitized group was significantly decreased after the salbutamol + ipratropium bromide treatment (1.56 +/- 0.18 versus 2.28 +/- 0.22, P.05). This study suggests that bronchoscopy and BAL induce airflow limitation in cats, which is more severe in the presence of lower airway inflammation. Inhaled salbutamol + ipratropium bromide reduce BAL-induced bronchoconstriction in AS-challenged cats and might be recommended as preventive treatment of asthmatic cats undergoing bronchoscopy.

Background Return-to-play (RTP) criteria after a sport injury represent a key point in order to decrease the risk of subsequent re-injury. Objective To analyze how clinicians decide, in their daily practice, when a hamstring injured professional soccer player is fully able to get back to competitive activities. Methods Thirty-seven doctors for French and Belgian professional soccer clubs filled in a questionnaire formulated with multiple choice questions. Results Nearly 80% of the questioned doctors declared to use at least 7 criteria in order to assess player9s ability to return to competitive soccer after a hamstring injury. The most important ones are: complete pain relief, normalized muscle strength assessment, subjective feeling reported by the player, normalized flexibility and achievement of a specific soccer test. For some of these criteria, most notably muscle strength assessment, there is a lack of consensus about the choice of assessment parameters and the limit value allowing doctors to authorize or forbid RTP. Our study also highlighted the interest for clinicians to consider the opinion of physical therapists and physical trainers. Conclusion After a hamstring injury, clinicians for professional soccer clubs assess player9s ability to return to full sport according to a “criteria-approach” instead of a “timed-based” approach. However, even if the scientific evidence about this topic is not sufficient at the moment, the implementation, in daily practice, of scientifically demonstrated assessment parameters and limit values should help the RTP decision and decrease the risk of re-injury.