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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.

Despite the essential role played by the scapula in shoulder function, current concepts in shoulder training and treatment regularly neglect its contribution. The 'scapular dyskinesis' is an alteration of the normal scapular kinematics as part of scapulohumeral rhythm, which has been shown to be a nonspecific response to a host of proximal and distal shoulder injuries. The dyskinesis can react in many ways with shoulder motion and function to increase the dysfunction. Thoracic kyphosis, acromio-clavicular joint disorders, subacromial or internal impingement, instability or labral pathology can alter scapular kinematics. Indeed, alteration of scapular stabilizing muscle activation, inflexibility of the muscles and capsule-ligamentous complex around the shoulder may affect the resting position and motion of the scapula. Given the interest in the scapular positioning and patterns of motion, this article aims to give a detailed overview of the literature focusing on the role of the scapula within the shoulder complex through the sports context. Such an examination of the role of the scapula requires the description of the normal pattern of scapula motion during shoulder movement; this also implies the study of possible scapular adaptations with sports practice and scapular dyskinesis concomitant to fatigue, impingement and instability. Different methods of scapular positioning evaluation are gathered from the literature in order to offer to the therapist the possibility of detecting scapular asymmetries through clinical examinations. Furthermore, current concepts of rehabilitation dealing with relieving symptoms associated with inflexibility, weakness or activation imbalance of the muscles are described. Repeating clinical assessments throughout the rehabilitation process highlights improvements and allows the therapist to actualize rationally his or her intervention. The return to the field must be accompanied by a transitory phase, which is conducive to integrating new instructions during sports gestures. On the basis of the possible scapular disturbance entailed in sports practice, a preventive approach that could be incorporated into training management is encouraged.

Compartment syndrome is defined as an increased intracompartmental pressure within inelastic fascia which surround muscular compartments. That pathology can be either acute or chronic. The acute situation is generally a medical emergency. Unless a fasciotomy is rapidly performed, increasing pressure may completely cut off blood flow and cause necrosis of the affected limb. The chronic compartment syndrome, more frequent, is characterized by exercise-induced pain and swelling that is relieved by rest. It results from an excessive intra-muscular pressure increase. The anterior compartment of the leg is most commonly involved. To accurately diagnose the compartment syndrome, physicians perform measurements of compartment pressure. By means of miniature digital instruments, exercise and rest intramuscular pressure are recorded. If pressures reach the critical threshold (30 mm Hg) and remain high five minutes after exercise, compartment syndrome is present. Treatment is nearly exclusively surgical. It consists in an fasciotomy allowing a complete recovery and a return to sport activities.

We determined the frequency of strength disorders in 26 athletes with a history of hamstring muscle injury and recurrent strains and discomfort. We also assessed the effectiveness of rehabilitation to correct muscle performance. After concentric and eccentric isokinetic assessment, 18 athletes were found to have strength deficits, as determined by statistically selected cutoffs of peak torque, bilateral differences, and the flexors/quadriceps ratio. The discriminating character of the eccentric trial was demonstrated, combining a preferential eccentric peak torque deficit and a significant reduction of the mixed eccentric flexors/concentric quadriceps ratio. The athletes with muscle imbalances followed a rehabilitation program individually adapted from their strength profile. Treatment length was from 10 to 30 sessions and resulted in isokinetic parameter normalization in 17 of 18 subjects. Isokinetically corrected subjects were observed for 12 months after return to athletics. None sustained a clinically diagnosed hamstring muscle reinjury. Subjective intensity of pain and discomfort were significantly reduced, and they all returned to their prior level of competition. These results demonstrate that persistent muscle strength abnormalities may give rise to recurrent hamstring injuries and discomfort. An individualized rehabilitation program emphasizing eccentric training based on specific deficits contributes to a decrease in symptoms on return to sports.

Neuromuscular electrical stimulation (NMES) is frequently used to strengthen the normal muscle. In medicine, several investigators have highlighted the value of NMES when treating amyotrophy related to immobilization. The efficacy of NMES of the quadriceps during rehabilitation following anterior cruciate ligament surgery has been well documented. These electrical stimulation programs are composed of stimulation--rest cycles and are performed with the aid of percutaneous electrodes situated in regard to muscle motor points. The stimulation frequency is chosen to induce tetanic contractions and is generally situated between 50 and 100 Hz. During NMES, the trainer or the physiotherapist can accurately modulate a large number of parameters but the sensory discomfort linked to the current intensity remains the major limitation for strength improvement. In the context of rehabilitation, the association of NMES with voluntary exercises is superior to the isolated utilization of the classic program composed of isometric voluntary contractions. To explain this advantage of associating NMES with voluntary contractions, it has been hypothesized that the electrically induced contractions impose specific patterns of muscle recruitment and a particular metabolic solicitation.

Tendonitis and tendons ruptures are mainly seen above 40 years of age, especially in sport practice. We discuss the physiopathology, diagnosis and treatment.

Stress fractures are very frequent injuries which account for 10% of all consultations in sports medicine, in a majority of cases affecting the lower limbs in young adults. They can be defined as a modification of the bone structure not necessarily associated with cortical infraction which occurs in the absence of injury. They happen as a result of an imbalance between the bone's capacity for adaptation and the overloading of mechanical constraints applied. This imbalance is adjusted by different favourable factors thus explaining the individual threshold to external demands. In theory, any bone might be damaged although more frequently they are to be found at the level of the tibia or the second and third metatarsals. The clinical picture is dominated by a symptomatology of pain which appears progressively strictly mechanical at the development stage. Further medical examination will include an x-ray (late diagnosis which often gives false-negative results) but, more importantly, a scintigraphy (which is very sensitive at an early stage but which is not specific enough). More recently, MRI has been a preferred means of detection. The treatment consists of obligatory segmented rest for a period of between two and six weeks. The intensity and length of treatment vary in function of the location of the injury and the reoccurrence of pain when the offending activity is restarted again. Rest is of utmost importance in order to avoid an evolution towards a true fracture which would result in long-term isolation from sport and social activities.

The assessment of human muscle strength is of considerable value in various pathological states with modifications of the performance level. The original concept of isokinetic dynamometry provides a precise and reliable quantification of strength. Identification of underlying deficits in bilateral and reciprocal muscle group relationships plays a great role in the treatment of anterior cruciate ligament (ACL) reconstruction and muscle injuries. The value of this type of assessment for prevention in uninjured subjects practicing sports at risk is suggested. Rehabilitative use of isokinetic includes muscle strengthening and tendinitis treatment by means of eccentric exercises.

The more frequent entrapment neuropathies related to sport are described: thoracic outlet syndrome in aquatic athletes and pitchers, long thoracic neuropathy in tennis players, suprascapular neuropathy in volleyball and tennis players, ulnar nerve entrapment at the elbow in pitchers and at the wrist in cyclists, Morton's syndrome in runners and dancers.