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RationaleParticipation in high-intensity exercise in early life might act as stressor to the airway barrier.ObjectivesTo investigate the effect of intense exercise and associated exposure to air pollution on the airway barrier in adolescent elite athletes compared with healthy controls and to study exercise-induced bronchoconstriction (EIB) in this population.MethodsEarly-career elite athletes attending ‘Flemish-Elite-Sports-Schools’ (12–18 years) of 4 different sport disciplines (n=90) and control subjects (n=25) were recruited. Presence of EIB was tested by the eucapnic voluntary hyperventilation (EVH) test. Markers at mRNA and protein level; RNA-sequencing; carbon load in airway macrophages were studied on induced sputum samples.Results444 genes were differentially expressed in sputum from athletes compared with controls, which were related to inflammation and epithelial cell damage and sputum samples of athletes contained significantly more carbon loaded airway macrophages compared with controls (24%, 95% CI 20% to 36%, p10and PM2.5exposure.ConclusionEarly-career elite athletes showed increased markers of air pollution exposure, epithelial damage and airway inflammation compared with controls. Acute exposure to increased air pollution PM10levels was linked to increased airway hyper-reactivity.Trial registration numberNCT03587675.

Background Platelet-rich plasma (PRP) injections have been proposed as an additional therapy in the treatment of chronic midsubstance Achilles tendinopathy (AT). The use of PRP injections as pharmacological treatment added to a conservative approach has gained growing interest, but the efficacy remains highly debated. The varying methodological quality of the available studies may contribute to these contradictory results. The aim of this systematic review with meta-analysis was to establish the existing evidence of PRP injections for chronic midsubstance AT on the functional outcome, with a risk of bias assessment of each included study. Methods According to the PRISMA guidelines systematic searches were performed in Embase, the Cochrane library and Pubmed on June 12, 2020 for relevant literature. Only clinical trials comparing PRP injections with placebo, additional to an eccentric training program, in midsubstance AT were included. The primary outcome was Victorian Institute of Sport Assessment - Achilles (VISA-A) score at 3, 6 and 12 months post-injection. Risk of bias was assessed using the Cochrane risk-of-bias tool for randomized trials (Rob 2). As secondary outcome we assessed reported changes in tendon structure after PRP injections. Results A total of 367 studies were identified with the initial database search. Finally, four randomized controlled trials (RCTs) met inclusion criteria for systematic review and meta-analysis with data of 170 patients available for pooling. Results showed no difference in clinical outcome between the PRP and placebo group at different points in time using the VISA-A score as outcome parameter (3 months 0.23 (CI -0.45, 0.91); 6 months 0.83 (CI -0.26, 1.92); 12 months 0.83 (CI -0.77, 2.44)). The bias analysis showed a low or intermediate risk of bias profile for all studies which supports the good methodological quality of each included article. Finally, it is unclear whether PRP injections cause an improvement in tendon structure. However, no direct relationship between tendon structure and clinical presentation of AT could be found. Conclusion PRP has no clear additional value in management of chronic midsubstance Achilles tendinopathy and therefore should not be used as a first-line treatment option.

Key summary points Aim To retrospectively analyse data obtained from the multi-domain assessment of hospitalized COVID-19 patients, to describe their health status at discharge, and to investigate whether subgroups of patients, more specific ICU patients and older adults (> 70 years), had more (or less) risk to experience specific impairments. Findings The results of the assessment show that physical, functional, cognitive, nutritional, and psychological impairments are highly prevalent in the group of COVID-19 patients, both in ICU and non-ICU patients, adults and older adults. Message The high prevalence of physical, cognitive, psychological, and functional impairments in hospitalized COVID-19 patients, both ICU and non-ICU patients, indicates that assessment of impairments is imperative., Objective To retrospectively analyse data obtained from the multi-domain assessment of hospitalized COVID-19 patients, to describe their health status at discharge, and to investigate whether subgroups of patients, more specific ICU patients and older adults (> 70 years), had more (or less) risk to experience specific impairments. Methods Retrospective case series in the University Hospitals Leuven, Belgium of confirmed COVID-19 patients ‘after surviving an ICU-stay’, ‘aged ≥ 70 years’, or ‘aged 7 days’. Exclusion criteria were ‘unwilling to cooperate’, ‘medically unstable’, or ‘palliative care policy’. Following tests were used: ‘Five Times Sit To Stand Test’, ‘hand grip dynamometry’, ‘Barthel index’, ‘Swallowing screening’, ‘Montreal Cognitive Assessment’, ‘Hospital Anxiety and Depression Scale’, and ‘Nutritional Risk Screening 2002’. Results One or more tests were obtained in 135/163 patients (83.3%). Physical impairments were present in 43.2–82.8% of the patients. Median BI was 10/20 indicating limited self-dependency. Swallow impairments were present in 3/53 (5.7%) and 24/76 (31.6%) had risk of malnutrition. Impaired memory was seen in 26/43 (60.5%) and 22/47 (46.8%) had elevated anxiety/depression scores. Older adults had more physical, functional, and cognitive impairments. ICU patients had a lower hand grip force. Conclusion(s) The high prevalence of physical, cognitive, psychological, and functional impairments in hospitalized COVID-19 patients, both ICU and non-ICU patients, indicates that assessment of impairments is imperative. These results imply that rehabilitation and follow-up is essential for these patients. This paper proposes a short, workable assessment composed with known outcome measures to assess different domains of COVID-19 patients.

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.

Background: Nine core domains for tendinopathy have been identified. For Achilles tendinopathy there is large variation in outcome measures used, and how these fit into the core domains has not been investigated. Objective: To identify all available outcome measures outcome measures used to assess the clinical phenotype of Achilles tendinopathy in prospective studies and to map the outcomes measures into predefined health-related core domains. Design: Systematic review. Data Sources: Embase, MEDLINE (Ovid), Web of Science, CINAHL, The Cochrane Library, SPORTDiscus and Google Scholar. Eligibility Criteria for Selecting Studies: Clinical diagnosis of Achilles tendinopathy, sample size ��� ten participants, age ��� 16 years, and the study design was a randomized or non-randomized clinical trial, observational cohort, single-arm intervention, or case series. Results: 9376 studies were initially screened and 307 studies were finally included, totaling 13,248 participants. There were 233 (177 core domain) different outcome measures identified across all domains. For each core domain outcome measures were identified, with a range between 8 and 35 unique outcome measures utilized for each domain. The proportion of studies that included outcomes for predefined core domains ranged from 4% for the psychological factors domain to 72% for the disability domain. Conclusion: 233 unique outcome measures for Achilles tendinopathy were identified. Most frequently, outcome measures were used within the disability domain. Outcome measures assessing psychological factors were scarcely used. The next step in developing a core outcome set for Achilles tendinopathy is to engage patients, clinicians and researchers to reach consensus on key outcomes measures. Prospero Registration: CRD42020156763.

Combining evidence-based medicine and shared decision making, current guidelines support an evidence-based personalised approach (EBPA) for idiopathic scoliosis in adolescents (AIS). EBPA is considered important for adolescents’ compliance, which is particularly difficult in AIS. Benchmarking to existing Randomised Controlled Trials (RCTs) as paradigms of single treatments, we aimed to check the effectiveness and burden of care of an EBPA in high-risk AIS. This study’s design features a retrospective observation of a prospective database including 25,361 spinal deformity patients &lt, 18 years of age. Participants consisted of 1938 AIS, 11–45° Cobb, Risser stage 0–2, who were studied until the end of growth. EBPA included therapies classified for burdensomeness according to current guidelines. Using the same inclusion criteria of the RCTs on exercises, plastic, and elastic bracing, out of the 1938 included, we benchmarked 590, 687, and 884 participants, respectively. We checked clinically significant results and burden of care, calculating Relative Risk of success (RR) and Number Needed to Treat (NNT) for efficacy (EA) and intent-to-treat analyses. At the end of growth, 19% of EBPA participants progressed, while 33% improved. EBPA showed 2.0 (1.7–2.5) and 2.9 (1.7–4.9) RR of success versus Weinstein and Coillard’s studies control groups, respectively. Benchmarked to plastic or elastic bracing, EBPA had 1.4 (1.2–1.5) and 1.7 (1.2–2.5) RR of success, respectively. The EBPA treatment burden was greater than RCTs in 48% of patients, and reduced for 24% and 42% versus plastic and elastic bracing, respectively. EBPA showed to be from 40% to 70% more effective than benchmarked individual treatments, with low NNT. The burden of treatment was frequently reduced, but it had to be increased even more frequently.

INTRODUCTION: Peripheral muscle and tendon changes after stroke can influence the functional outcome of patients. The aim of this systematic review was to summarize the evidence of ultrasonographic changes in morphological muscle and tendon properties of the spastic hemiparetic lower leg in patients with first ever stroke. EVIDENCE ACQUISITION: A systematic search was conducted through PubMed, Embase, Scopus, Cinahl, Cochrane Library, and manual searches from inception until May 1, 2020. Observational case control or cohort studies were included. Risk of bias was evaluated by using the Newcastle-Ottawa Quality Assessment Scale. Outcome parameters of interest included muscle thickness, muscle and tendon length, fascicle length, pennation angle and echo-intensity. EVIDENCE SYNTHESIS: Nine studies investigated outcome parameters beyond one-month after stroke. We are unable to make a comprehensive statement. Nevertheless, there are some arguments for reduced muscle thickness and reduced fascicle length of the hemiplegic, spastic leg. CONCLUSIONS: Despite the fact that objective assessment by ultrasonography holds promise for diagnosis and follow-up of spastic hemiparesis after stroke, more evidence is needed to determine how changes in morphological muscle and tendon properties are related to muscle weakness, severity of spasticity and compensation strategies such as disuse or overuse in longitudinal studies starting early after stroke. ispartof: EUROPEAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE vol:57 issue:4 pages:495-510 ispartof: location:Italy status: published

Objective The first aim of this review was to investigate the association between age, sex, height, weight, physical activity level, posture, lumbar level and body side, and structural characteristics (cross-sectional area [CSA], thickness, linear dimensions, and echo intensity) of the lumbar multifidus (LM) measured by ultrasound. Second, differences between healthy individuals and patients with chronic low back pain (CLBP) were investigated. TYPE: Systematic review. Literature survey PubMed, Embase and Web of Science were searched until September 2018. Methodology Studies were included if (a) full text was available in English, Dutch, or French; (b) participants were older than 18 years of age and were asymptomatic or had nonspecific CLBP; and (c) the relation between structural characteristics of the LM, measured by ultrasound, and at least one of the above-mentioned factors was described, and/or a comparison between a CLBP and control group was made. Data were extracted independently by two reviewers. Quality of studies was assessed using an adapted version of the Downs and Black checklist. Synthesis Twenty-seven studies were included. Thickness and CSA of the LM do not correlate with age. Males have a larger LM size than females. Thickness and CSA of left and right LM are highly correlated in healthy subjects. More significant side-to-side differences are present in subjects with CLBP than in those without. Muscle size increases from proximal to caudal lumbar levels. The presence of CLBP is associated with muscle size and function. Conclusions The association between the factors age, sex, height, weight, physical activity level, posture, lumbar level, body side, and presence of CLBP, and the ultrasound characteristics of the LM is discussed. These factors should be taken into account in future research on structural muscle characteristics, or when correlating with functional behavior or investigating the effect of a targeted intervention. Level of evidence I.

OBJECTIVE: Decisions concerning the rehabilitation process and return to play (RTP) after cervical spine surgery in a general sporting population can be difficult and may be influenced by several factors. Moreover, no clear guidelines for this are currently available. The aim of this study was to create tentative guidelines for rehabilitation and RTP after cervical surgery in a general sporting population. DESIGN: Five-step Delphi analysis. SETTINGS: Primary, secondary, and tertiary medical practitioners. PARTICIPANTS: Panel of Belgian neurosurgeons, orthopedic surgeons, physiotherapists, and physical and rehabilitation medicine practitioners. ASSESSMENT: Round 1 (R1) was a brainstorm phase. A comprehensive list of answers from R1 was validated in round 2 (R2). In round 3 (R3), experts ranked these items in a chronological order. Contraindications and criteria to start each rehabilitation step were linked in round 4 (R4). In round 5 (R5), panelists ranked theses about contraindications and criteria on a 5-point Likert scale. MAIN OUTCOME MEASURES: Theses scoring ≥10% "oppose" or "strongly oppose" were rejected. RESULTS: The response rate was 100% (n = 15) for R1, 93% (n = 14) for R2, 73% (n = 11) for R3, 53% (n = 8) for R4, and 67% (n = 10) for R5. In R5, 25 theses on absolute and relative contraindications and criteria were endorsed. CONCLUSIONS: This Delphi analysis resulted in contraindications and criteria for the rehabilitation process and RTP after cervical surgery in a general athletic population. Tentative guidelines and timetable are proposed. Key messages from these guidelines are (1) Rehabilitation should start before surgery with education; (2) Rehabilitation should be patient-tailored; and (3) An unstable arthrodesis is an absolute contraindication for RTP. ispartof: Clin J Sport Med vol:31 issue:2 pages:145-150 ispartof: location:United States status: published

OBJECTIVE To evaluate the impact of a lower limb amputation for chronic pain and/or functional impairment on pain and participation in daily living activities and to assess the use of prostheses. To improve decision-making for this controversial treatment. DESIGN Survey. SETTING University hospital. SUBJECTS Patients who had an amputation of a lower limb for chronic pain and/or functional impairment. RESULTS Eighty-one percent of the patients were satisfied with the amputation and would decide to undergo an amputation again under the same conditions. Sixty-nine percent of the patients reported an improvement in pain, 69% an improvement in mobility, 75% in daily living activities, and 56% an improvement in sleep. Seventy-five percent of the patients used their prosthesis on a daily basis. CONCLUSION Most patients who underwent an amputation in our hospitals for chronic pain and/or functional impairment of a lower limb were satisfied and reported an improvement in function and pain.

Retrospective chart audit. Firstly determining the prevalence of scoliosis in myelomeningocele (MMC) patients of the University Hospitals Leuven. Secondly analyzing whether there are differences concerning distribution of radiological level, ambulatory status, hydrocephalus, tethered cord, and syringomyelia in MMC patients with/without scoliosis. University Hospitals Leuven, spina bifida convention. The following data were collected: age, gender, radiograph type, age at the time of the radiograph, position during radiograph, presence of fusion, age at the time of fusion, diagnosis of hydrocephalus, tethered cord, or syringomyelia, radiological level of MMC, ambulatory status, main Cobb angle, main curve convexity, and main curve location. Correlation between prevalence of scoliosis and ambulatory status, neurological comorbidities, and radiological level were investigated. There were 116 patients remaining, after excluding patients without MMC or useful images. The scoliosis prevalence in MMC patients was 78.4% (95% CI, 71.0–85.8) for Cobb angle ≥10°; 60.3% (95% CI, 51.4–69.2) for ≥20°, 52.6% (95% CI, 43.5–61.7) for ≥30°, and 36.6% (95% CI, 27.7–45.5) for an angle ≥40°. Wheelchair users had 4 to 8 times more chance of having scoliosis than patients able to walk on all surfaces without aid. Thoracolumbar and lumbar radiological levels had a slightly higher prevalence of scoliosis than sacral levels. The high prevalence of scoliosis warrants a thorough screening and follow-up for MMC. There was no statistically significant difference between hydrocephalus, tethered cord, or syringomyelia regarding scoliosis. Future studies should focus on the interactions of the neurological comorbidities associated with MMC and scoliosis.

BACKGROUND: Non-inflammatory thickening of the subsynovial connective tissue is a common histological finding in carpal tunnel syndrome. This subsynovial connective tissue thickening may precede changes in electrodiagnostic testing. Therefore, measuring subsynovial connective tissue thickness may help in detecting early changes in carpal tunnel syndrome. METHODS: To provide an overview of subsynovial connective tissue thickness characteristics in subjects with and without carpal tunnel syndrome, a systematic review of articles, assessing human subsynovial connective tissue, was performed using MEDLINE, CENTRAL and EMBASE. FINDINGS: Seven studies were included for qualitative analysis. Measurements were done ex vivo (laser (n = 3), photographic (n = 1), micrometric (n = 1)) and in vivo (ultrasound (n = 3)). All four case-control studies showed a significant difference in subsynovial connective tissue thickness between subjects with and without carpal tunnel syndrome. One study showed good correlation between ultrasound and anatomical measurements. No correlation was found between subsynovial connective tissue thickness and symptom duration, electrodiagnostic changes, age and sex. INTERPRETATION: Subsynovial connective tissue thickness may be a valuable aid in diagnosing carpal tunnel syndrome. No factors influencing subsynovial connective tissue thickness are identified, although they are not well investigated. ispartof: CLINICAL BIOMECHANICS vol:75 ispartof: location:England status: published

Background A high burden of lower airway symptoms is found in elite swimmers. To what extent elite swimmers suffer from upper airway symptoms and how these associate with nasal inflammation is less clear. We here aimed to evaluate upper airway symptoms and nasal inflammation in elite athletes. Methodology Elite swimmers, indoor athletes and age-matched controls were recruited. Upper airway symptoms were assessed by sino-nasal outcome test (SNOT)-22 questionnaire. Visual Analogue score (VAS) for nasal symptoms as well as neurogenic and inflammatory mediators in nasal fluid were assessed at baseline, immediately and 24-hours after sport-specific training. The effect of hypochlorite on nasal epithelial cells was evaluated in vitro. Results Baseline SNOT-22 and VAS for nasal itch and impaired smell were significantly higher in swimmers compared to controls. Nasal substance P and uric acid levels were increased in elite swimmers 24-hours after swimming compared to baseline. In elite swimmers, uric acid levels 24-hours post-exercise correlated with baseline SNOT-22. As increased symptoms and inflammation were found in swimmers but not in indoor athletes, we hypothesized that hypochlorite exposure might be the underlying mechanism. In vitro, the highest dose of hypochlorite decreased nasal epithelial cell integrity and induced release of uric acid. Conclusion Upper airway symptoms are frequently reported in elite swimmers. Intensive swimming resulted in a delayed increase of epithelial injury and neurogenic inflammation.

OBJECTIVES: To investigate the temporal relationship between two-dimensional measured frontal plane joint angles and three-dimensional measured kinematic profiles during the stance phase of running, and to assess the intra- and intertester reliability of the two-dimensional angles. DESIGN: Observational study. SETTING: Research laboratory. PARTICIPANTS: Fifteen injury-free elite athletes. MAIN OUTCOME MEASURES: Contralateral pelvic drop (CPD), femoral adduction (FA), hip adduction (HA) and knee valgus (KV) were measured at the deepest landing position during midstance with two-dimensional video analysis during running. CPD, HA and knee abduction were measured continuously during the entire stance phase through three-dimensional motion analysis. One-dimensional statistical parametric mapping was used to examine the temporal relationships between the two-dimensional angles and three-dimensional kinematic profiles. In addition, intra-class correlation coefficients (ICC) were calculated to assess the intra- and intertester reliability of the two-dimensional angles. RESULTS: Two-dimensional CPD, FA and HA were significantly related to the three-dimensional HA kinematic profile. Two-dimensional CPD was significantly related to the three-dimensional CPD kinematic profile. No significant relationship was found between two-dimensional KV and three-dimensional knee abduction. Excellent intra- and intertester reliability was found for the two-dimensional angles (ICC 0.90-0.99). CONCLUSIONS: These findings support implementing two-dimensional video analysis to evaluate CPD and HA during running. ispartof: PHYSICAL THERAPY IN SPORT vol:29 pages:84-92 ispartof: location:England status: published

Introduction Mechanical loading in Achilles tendinopathy, e.g. eccentric exercise, is commonly performed in both extended and flexed knee positions. The goal of this study was to evaluate the impact of this changing knee angle on the non-uniform behaviour in the Achilles tendon, i.e. superficial-to-deep variation in displacement with highest displacement in the deep layer. It was hypothesized that a flexed knee position would lead to a more non-uniform behaviour, due to greater differential loading of soleus versus gastrocnemius in this position. Materials and methods Nineteen healthy subjects participated in this study. A high-spatial and high-temporal resolution US system was used to acquire 2D+time ultrasound images during an isometric contraction at 25%, 50% and 75% MVC in the extended and flexed knee position. Local tendon tissue displacement of the different tendon layers and normalized displacement ratio, a measure for non-uniformity, were calculated. Results Contrary to the hypothesis, it was found that the non-uniform deformation, with highest displacement in the deep tendon layer, is consistently present and not influenced by a change in knee angle. Conclusion From clinical perspective, this might indicate the absence of a mechanical rationale for a change in knee angle during loading exercises. Additionally, it was found that despite reaching high levels of force, the contribution of the AT to this deformation is sometimes unexpectedly smaller, potentially due to compensatory actions. This is relevant for AT rehabilitation as the goal there is to reach specific local tendon loading.

PURPOSE: Bracing is frequently prescribed following lumbar surgery for degenerative conditions. However, previous studies failed to demonstrate the advantage of postoperative lumbar bracing in both short- and long-term outcome in terms of pain, quality of life and fusion rate. The purpose of this study was to assess the prescription patterns and rationale for postoperative bracing amongst spinal surgeons in Belgium. METHODS: A 16-item online survey was distributed by email to spinal surgeons affiliated to the Spine Society of Belgium (N = 252). RESULTS: A total of 105 surgeons (42%) completed the survey. The overall bracing frequency following lumbar surgery was 38%. A brace was more often prescribed following the fusion procedures (52%) than after the non-fusion procedures (21%) (p

Study Design Controlled laboratory study with a prospective cohort design. Background Postural stability deficits during single-leg stance have been reported in persons with anterior cruciate ligament (ACL) injury, ACL reconstruction, and chronic ankle instability. It remains unclear whether impaired postural stability is a consequence or cause of these injuries. Objectives To prospectively investigate whether postural stability deficits during single-leg stance predict noncontact lower extremity injuries. Methods Fifty injury-free female athletes performed a transition task from double-leg stance to single-leg stance with eyes closed. Center-of-pressure displacement, the main outcome variable, was measured during the first 3 seconds after the time to a new stability point was reached during single-leg stance. Noncontact lower extremity injuries were recorded at a 1-year follow-up. Results Six participants sustained a noncontact ACL injury or ankle sprain. Center-of-pressure displacement during the first 3 seconds after the time to a new stability point was significantly increased in the injured (P = .030) and noninjured legs (P = .009) of the injured group compared to the respective matched legs of the noninjured group. The area under the receiver operating characteristic curve (AUC) analysis revealed significant discriminative accuracy between groups for the center-of-pressure displacement during the first 3 seconds after the time to a new stability point of the injured (AUC = 0.814, P = .015) and noninjured legs (AUC = 0.897, P = .004) of the injured group compared to the matched legs of the noninjured group. Conclusion This preliminary study suggests that postural stability measurements during the single-leg stance phase of the double- to single-leg stance transition task may be a useful predictor of increased risk of noncontact lower extremity injury. Further research is indicated. Level of Evidence Prognosis, level 4. J Orthop Sports PhysTher 2016;46(8):650-657. Epub 3 Jul 2016. doi:10.2519/jospt.2016.6278. ispartof: Journal of Orthopaedic and Sports Physical Therapy vol:46 issue:8 pages:650-657 ispartof: location:United States status: published

Several studies have already identified atopy as a risk factor for the development of exercise-induced bronchoconstriction (EIB) in adult elite athletes (1-3). Skin prick test or serum specific IgE to common aero-allergens is used to determine the patient's atopy status (4). In 2009, Bonini M et al. introduced a screening tool to predict atopy in elite adult athletes, namely the Allergy Questionnaire for Athletes or short the AQUA© questionnaire (5). This article is protected by copyright. All rights reserved. ispartof: PEDIATRIC ALLERGY AND IMMUNOLOGY vol:29 issue:6 pages:648-650 ispartof: location:England status: published

Achilles tendinopathy remains a prevalent condition among recreational and high-level athletes. Mechanical loading has become the gold standard in managing these injuries, but exercises are often generic and prescribed in a "one-size-fits-all" principle. The aim of this study was to evaluate the impact of knee angle changes and different levels of force production on the non-uniform behavior in the Achilles tendon during isometric contractions. It was hypothesized that a flexed knee position would lead to a more distinct non-uniform behavior, due to greater differential loading of soleus vs gastrocnemius, and that this effect would be attenuated by higher levels of force production. Contrary to the hypotheses, it was found that the non-uniform deformation, that is, superficial-to-deep variation in displacement with highest displacement in the deep layer, is consistently present, irrespective of the level of force production and knee angle (n = 19; mean normalized displacement ratio 6.32%, 4.88%, and 4.09% with extended knee vs 5.47%, 2.56%, and 6.01% with flexed knee, at 25%, 50%, and 75% MVC, respectively; P > .05). From tendon perspective, aside from the influence on muscle behavior, this might question the mechanical rationale for a change in knee angle during eccentric heel drops. Additionally, despite reaching high levels of plantar flexion force, the relative contribution of the AT sometimes appears to be decreased, potentially due to compensatory actions by agonist muscle groups. These results are relevant for optimizing AT rehabilitation as the goal is to reach specific local tendon loading. ispartof: SCANDINAVIAN JOURNAL OF MEDICINE & SCIENCE IN SPORTS vol:28 issue:11 pages:2322-2329 ispartof: location:Denmark status: published

Study design: Systematic Review. Objectives: To investigate the effect of interventions enhancing (re) employment following spinal cord injury (SCI). Setting: Studies from multiple countries were included. Methods: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL, PsycINFO and SPORTDISCUS databases were searched. Randomized controlled trials (RCTs) and non-randomized studies (NRSs) describing a hospital- or a community-based intervention aiming at employment in a SCI population were selected. Quality appraisal was done using the SIGN methodology, and the quality of evidence was graded using the Grade approach. Data extraction was performed according to the Cochrane Handbook. Employment rate and duration were primary outcomes. Results: Only one RCT, including 201 patients describing an intervention over 1 and 2 years, was of sufficient quality. In this study, the employment rate was 26% after 1 and 31% after 2 years for competitive work, compared with 10% in the treatment as usual-intervention site (TAU-IS) control group and 2% in the treatment as usual observational site (TAU-OS) after 1 and 2 years. Other studies were of low quality and describe higher employment rates from 36 to 100%. Conclusions: Only one RCT was of sufficient quality and showed evidence that a vocational rehabilitation programme based on the principles of supported employment integrated in a multidisciplinary team enhances employment for SCI people. As the vast majority of studies included in this review are of low methodological quality, further research is needed.

Estimation of strain in tendons for tendinopathy assessment is a hot topic within the sports medicine community. It is believed that, if accurately estimated, existing treatment and rehabilitation protocols can be improved and presymptomatic abnormalities can be detected earlier. State-of-the-art studies present inaccurate and highly variable strain estimates, leaving this problem without solution. Out-of-plane motion, present when acquiring two-dimensional (2D) ultrasound (US) images, is a known problem and may be responsible for such errors. This work investigates the benefit of high-frequency, three-dimensional (3D) US imaging to reduce errors in tendon strain estimation. Volumetric US images were acquired in silico, in vitro, and ex vivo using an innovative acquisition approach that combines the acquisition of 2D high-frequency US images with a mechanical guided system. An affine image registration method was used to estimate global strain. 3D strain estimates were then compared with ground-truth values and with 2D strain estimates. The obtained results for in silico data showed a mean absolute error (MAE) of 0.07%, 0.05%, and 0.27% for 3D estimates along axial, lateral direction, and elevation direction and a respective MAE of 0.21% and 0.29% for 2D strain estimates. Although 3D could outperform 2D, this does not occur in in vitro and ex vivo settings, likely due to 3D acquisition artifacts. Comparison against the state-of-the-art methods showed competitive results. The proposed work shows that 3D strain estimates are more accurate than 2D estimates but acquisition of appropriate 3D US images remains a challenge.

The Achilles tendon has a unique structure-function relationship thanks to its innate hierarchical architecture in combination with the rotational anatomy of the sub-tendons from the triceps surae muscles. Previous research has provided valuable insight in global Achilles tendon mechanics, but limitations with the technique used remain. Furthermore, given the global approach evaluating muscle-tendon junction to insertion, regional differences in tendon mechanical properties might be overlooked. However, recent advancements in the field of ultrasound imaging in combination with speckle tracking have made an intratendinous evaluation possible. This study uses high-frequency ultrasound to allow for quantification of regional tendon deformation. Also, an interactive application was developed to improve clinical applicability. A dynamic ultrasound of both Achilles tendons of ten asymptomatic subjects was taken. The displacement and regional strain in the superficial, middle and deep layer were evaluated during passive elongation and isometric contraction. Building on previous research, results showed that the Achilles tendon displaces non-uniformly with a higher displacement found in the deep layer of the tendon. Adding to this, a non-uniform regional strain behavior was found in the Achilles tendon during passive elongation, with the highest strain in the superficial layer. Further exploration of tendon mechanics will improve the knowledge on etiology of tendinopathy and provide options to optimize existing therapeutic loading programs. Bogaerts S., de Brito Carvalho C., Scheys L., Desloovere K., D’hooge J., Maes F., Suetens P., Peers K., ''Evaluation of tissue displacement and regional strain in the Achilles tendon using quantitative high-frequency ultrasound'', PLOS ONE, vol. 12, no. 7, pp. e0181364, 2017. ispartof: PLoS One vol:12 issue:7 ispartof: location:United States status: published

© 2016 IEEE. Tendon strain is a topic of interest within the orthopaedics and sports medicine community. If accurately estimated, it can improve existing treatment and rehabilitation protocols and aid in detection of presymptomatic abnormalities. This paper presents a novel US-based strain estimation framework that integrates an affine image registration approach to quantify tendon strain with a high-resolution 3D US imaging system. Validation of this framework was performed on simulated and phantom data. An accuracy test of the acquisition system and the performance of 3D and 2D strain estimations were evaluated. Results show that attention should be paid to the acquisition protocol, best accuracy is obtained for simulation data and along the major deformation direction and 3D strain estimations seems to reduce out-of-plane effect. By using this technique, it is expected that clinicians expand knowledge on aetiology of tendinopathy and optimize the existing therapeutic programs. Furthermore this technique can be extrapolated to other tendons and ligaments that are vulnerable to overuse. de Brito Carvalho C., Bogaerts S., Scheys L., D'hooge J., Peers K., Suetens P., ''3D tendon strain estimation on high-frequency 3D ultrasound images. A simulation and phantom study'', Proceedings 13th IEEE international symposium on biomedical imaging - ISBI 2016, pp. 172-175, April 13-16, 2016, Prague, Czech Republic. ispartof: pages:172-175 ispartof: Proceedings ISBI 2016 vol:2016-June pages:172-175 ispartof: IEEE international symposium on biomedical imaging - ISBI 2016 location:Prague, Czech Republic date:13 Apr - 16 Apr 2016 status: published

Study design: Review. Objectives:The aim is to highlight the epidemiology of spinal cord injuries (SCIs) in Sub-Saharan Africa in order to improve prevention strategies. Setting: University Hospitals Leuven, Belgium. Methods: Pubmed was searched over August and September 2010. A combination of the following MeSH-terms was used: 'Africa South of the Sahara', 'Spinal Cord Diseases', 'Paraplegia' and 'Spinal Cord Injuries'. Limits were set on articles published as from 1990. The World Health Organization database was also consulted. Results: We obtained 243 hits of which 13 articles were relevant to the case. These papers covered seven countries: Ethiopia, Ghana, Nigeria, Senegal, Sierra Leone, South Africa and Zimbabwe. In traumatic SCIs, motor vehicle accidents are the most frequent cause of injury followed by falling from a height and thirdly violence, being the most important cause of SCI in South Africa. In the Plateau State of Nigeria, collapsing tunnels in illegal mining are the most prevalent cause. For the non-traumatic SCIs, tuberculosis appeared to be the most important cause, followed by malignant illnesses. Human immunodeficiency virus (HIV) serology tests were only available in the article concerning Ethiopia. Relatively more men were involved in traumatic SCIs and the average age was higher in the non-traumatic than in the traumatic group. Conclusion: Although literature on the subject is scarce, prevention should focus on road-safety, tuberculosis and HIV. Standardized registration of SCI is needed for prevention and further research. The use of the current International SCI core data set should be encouraged worldwide as a uniform classification method. Language: en

Introduction/Background Decisions concerning the rehabilitation process and return to play (RTP) after cervical spine surgery in a general sporting population can be difficult and may be influenced by several factors. Moreover, no guidelines are present for this. The aim of this study was to create a consensus on this topic. Material and method A 5-step Delphi analysis with panels of neurosurgeons, orthopaedic surgeons, physiotherapists and physical and rehabilitation medicine practitioners in Belgium was conducted. The first round (R1) was a brainstorm phase. A comprehensive list of answers from R1 was validated in round 2 (R2). In round 3 (R3) experts ranked these items in a chronological order. Next, contraindications and criteria to start each rehabilitation step were linked by experts in round 4 (R4). In round 5 (R5) panellists ranked theses about contraindications and criteria on a 5-point Likert scale. Results The response rate was 100% (n = 15) for R1, 93% (n = 14) for R2, 73% (n = 11) for R3, 53% (n = 8) for R4 and 67% (n = 10) for R5. In R5, 25 theses on absolute and relative contraindications and criteria were endorsed. Conclusion This Delphi analysis resulted in contraindications and criteria for the rehabilitation process and return to play after cervical surgery. Tentative guidelines and timetable are proposed.

Background Impaired muscle activation may predispose subjects to develop chronic ankle instability. It has been suggested that impairments are found not only in structures around the injured ankle but also around the more proximal joint complexes. Hypothesis Subjects with chronic ankle instability were expected to show later onset times for lower limb and trunk muscle activation when compared with control subjects. They were expected to show less variability in muscle activation patterns compared with the control group. Study Design Controlled laboratory study. Methods Thirty control subjects and 10 subjects with chronic ankle instability participated in the study. The onset of muscle activity of 14 muscles of the lower limb and trunk was measured during the transition from a double-leg stance position to a single-leg stance position in eyes-open and eyes-closed test conditions. Results Subjects with chronic ankle instability showed significantly later onset times for the ankle, hip, and hamstring muscles compared with control subjects. They used a similar muscle activation pattern in both test conditions, whereas control subjects adjusted their activation pattern according to the condition. Conclusions Differences in muscle activation patterns between subjects with chronic ankle instability and control subjects occur not only around the ankle but also around other joints. Subjects with chronic ankle instability show less variability in muscle activation patterns between test conditions. Clinical Relevance Knowledge of muscle activation patterns in the whole lower limb and trunk in noninjured subjects and the differences found in chronic ankle instability subjects broadens the physical therapy approach to the treatment of chronic ankle instability.

Introduction: Exercise-induced bronchoconstriction (EIB) is more common in athletes compared to the general population. The eucapnic voluntary hyperventilation test is used to detect EIB in adult athletes. It is however unclear whether this technique is also applicable to young athletes. Methods Young athletes (basketball (n = 13), football (n = 19), swimming (n = 12)) were recruited at the start of their elite sports career (12–14 years). Eight age-matched controls were also recruited. Eucapnic voluntary hyperventilation test was performed according to ATS guidelines in all subjects. A second (after 1 year, n = 32) and third (after 2 years, n = 39) measurement was performed in a subgroup of athletes and controls. Results At time of first evaluation, 3/13 basketball players, 4/19 football players, 5/11 swimmers and 1/8 controls met criteria for EIB (fall in FEV 1 ≥10% after EVH). A ventilation rate of >85% of the maximal voluntary ventilation (MVV) is recommended by current guidelines (for adults) but was only achieved by a low number of individuals (first occasion: 27%, third occasion: 45%) However, MVV in young athletes corresponds to 30 times FEV 1 , which is equivalent to 85% of MVV in adults. A threshold of 70% of MVV (21 times FEV 1 ) is feasible in the majority of young athletes. Conclusion EIB is present in a substantial number of individuals at the age of 12–14 years, especially in swimmers. This underscores the importance of screening for EIB at this age. EVH is feasible in young elite athletes, however target ventilation needs to be adjusted accordingly.

Twenty-five patients with chronic Achilles tendinopathy were clinically and ultrasonographically evaluated. A positive correlation existed between power Doppler ultrasonography (PDU) and tendon thickness (r=0.63, p

Objective.Osteoarthritis (OA) is a common cause of disability worldwide. Knee OA care is often suboptimal. A first necessary step in quality improvement is to gain a clear insight into usual care. We developed a set of evidence-based quality indicators for multidisciplinary high-quality knee OA care.Methods.A Rand-modified Delphi method was used to develop quality indicators for knee OA diagnosis, therapy, and followup. Recommendations were extracted from international guidelines as well as existing sets of quality indicators and scored by a multidisciplinary expert panel. Based on median score, prioritization, and agreement, recommendations were labeled as having a high, uncertain, or low potential to measure quality of care and were discussed in a consensus meeting for inclusion or exclusion. Two final validation rounds yielded a core set of recommendations, which were translated into quality indicators.Results.From a total of 86 recommendations and existing indicators, a core set of 29 recommendations was derived that allowed us to define high-quality knee OA care. From this core set, 22 recommendations were considered to be measurable in clinical practice and were transformed into a final set of 21 quality indicators regarding diagnosis, lifestyle/education/devices, therapy, and followup.Conclusion.Our study provides a robust set of 21 quality indicators for high-quality knee OA care, measurable in clinical practice. These process indicators may be used to measure usual care and evaluate quality improvement interventions across the entire spectrum of disciplines involved in knee OA care.

The burden of hip muscles weakness and its relation to other impairments has been well documented. It is therefore a pre-requisite to have a reliable method for clinical assessment of hip muscles function allowing the design and implementation of a proper strengthening program. Motor-driven dynamometry has been widely accepted as the gold-standard for lower limb muscle strength assessment but is mainly related to the knee joint. Studies focusing on the hip joint are less exhaustive and somewhat discrepant with regard to optimal participants position, consequently influencing outcome measures. Thus, we aimed to develop a standardized test setup for the assessment of hip muscles strength, i.e. flexors/extensors and abductors/adductors, with improved participant stability and to define its psychometric characteristics. Eighteen participants performed unilateral isokinetic and isometric contractions of the hip muscles in the sagittal and coronal plane at two separate occasions. Peak torque and normalized peak torque were measured for each contraction. Relative and absolute measures of reliability were calculated using the intraclass correlation coefficient and standard error of measurement, respectively. Results from this study revealed higher levels of between-day reliability of isokinetic/isometric hip abduction/flexion peak torque compared to existing literature. The least reliable measures were found for hip extension and adduction, which could be explained by a less efficient stabilization technique. Our study additionally provided a first set of reference normalized data which can be used in future research. ispartof: PLoS One vol:8 issue:11 ispartof: location:United States status: published

Ultrasound image has already been proved to be a useful tool for non-invasive strain quantifications in soft tissue. While clinical applications only include cardiac imaging, the development of techniques suitable for musculoskeletal system is an active area of research. On this study, a technique for speckle tracking on ultrasound images using non-rigid image registration is presented. This approach is based on a single 2D+t registration procedure, in which the temporal changes on the B-mode speckle patterns are locally assessed. This allows estimating strain from ultrasound image sequences of tissues under deformation while imposing temporal smoothness in the deformation field, originating smooth strain curves. METHODS: The tracking algorithm was systematically tested on synthetic images and gelatin phantoms, under sinusoidal deformations with amplitudes between 0.5% and 4.0%, at frequencies between 0.25Hz and 2.0Hz. Preliminary tests were also performed on Achilles tendons isolated from human cadavers. RESULTS: The strain was estimated with deviations of -0.011%±0.053% on the synthetic images and agreements of ±0.28% on the phantoms. Some tests with real tendons show good tracking results. However, significant variability between the trials still exists. CONCLUSIONS: The proposed image registration methodology constitutes a robust tool for motion and deformation tracking in both simulated and real phantom data. Strain estimation in both cases reveals that the proposed method is accurate and provides good precision. Although the ex-vivo results are still preliminary, the potential of the proposed algorithm is promising. This suggests that further improvements, together with systematic testing, can lead to in-vivo and clinical applications. Almeida N.C.M., Slagmolen P., Barbosa D., Scheys L., Geukens L., Fukagawa S., Peers K., Bellemans J., Suetens P., D'hooge J., ''Tendon strain imaging using non-rigid image registration: a validation study'', Ultrasonic imaging, tomography, and therapy conference, part of SPIE medical imaging, February 5-6, 2012, San Diego, California, USA. ispartof: pages:832010- ispartof: SPIE Medical Imaging 2012 vol:8320 pages:832010- ispartof: SPIE Medical Imaging - Ultrasonic imaging, tomography, and therapy location:San Diego, California, USA date:5 Feb - 6 Feb 2012 status: published

Retrospective study of three cases.To report three cases of muscle rupture caused by minimal trauma in spinal cord injury (SCI) patients with severe spasticity and a literature review of the underlying mechanisms.Department of Physical and Rehabilitation Medicine, University Hospitals Leuven, BelgiumRetrospective study of three cases of muscle ruptures in SCI patients with severe spasticity. All muscle lesions were diagnosed by ultrasound. Literature review (Pubmed) was performed to identify extrinsic and intrinsic risk factors.According to the literature and our clinical findings, several structural and mechanical alterations of the spastic muscle in combination with specific stretching during therapy or a transfer can cause a muscle rupture after minimal trauma.To the authors' knowledge, this is the first report of muscle rupture due to spasticity in SCI patients. Altered mechanical properties of the spastic muscle in combination with extreme stretching may cause partial or complete ruptur. Although this is a rare complication of spasticity, medical staff and therapists should be aware of the risk factors in order to prevent and quickly identify muscle lesions.

Exercise induced bronchoconstriction (EIB) is more prevalent in elite athletes compared to controls. It is however unclear how many young athletes suffer from EIB.

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BACKGROUND: There is limited evidence on neuromuscular risk factors for anterior cruciate ligament (ACL) injuries, with most work mainly focusing on hamstrings and quadriceps muscle strength. This prospective pilot study explored if neuromuscular activation patterns of the quadriceps and hamstrings during a drop vertical jump influence ACL injury risk. METHODS: Forty-six female athletes performed a drop vertical jump at baseline. Injuries were monitored throughout a one-year follow-up. Neuromuscular activation patterns of the vastus medialis, vastus lateralis, hamstrings medialis and hamstrings lateralis, and selected landing kinematic and kinetic profiles (knee flexion, knee abduction and hip flexion angles, and knee abduction moments), were compared between athletes who sustained a non-contact ACL injury and those who remained injury free. Electromyogram vector fields were created to represent neuromuscular activation patterns of muscle pairs around the knee joint rather than only considering individual muscle activations, and compared using Statistical Parametric Mapping. RESULTS: Four athletes sustained an ACL injury. Significantly greater {hamstrings medials, hamstrings lateralis}, {vastus lateralis, hamstrings lateralis} and {hamstrings lateralis, vastus medialis} activations, mainly due to greater hamstrings lateralis activation, were found in the injured group around peak loading and just before take-off (P