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José Martins Juliano Eustaquio,1,2 Alberto Martins Fontoura Borges,2 Lorena Souza Vilela,2 Matheus Pizarro Carvalho Gouveia,2 Amanda Laruzo Rabelo,2 Camila Cohen Kaleka,3 Pedro Debieux,3,4 Octávio Barbosa Neto1 1Exercise Science, Health and Human Performance Research Group, Graduate Program in Physical Education, Federal University of Triângulo Mineiro (UFTM – Universidade Federal do Triângulo Mineiro), Uberaba, MG, Brazil; 2Department of Orthopedics and Traumatology, Mário Palmerio Hospital, University of Uberaba (UNIUBE – Universidade de Uberaba), Uberaba, MG, Brazil; 3Knee Surgery Group, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil; 4Knee Surgery and Arthroscopy Group, Federal University of São Paulo (UNIFESP – Universidade Federal de São Paulo), São Paulo, SP, BrazilCorrespondence: José Martins Juliano EustaquioMário Palmerio Hospital, University of Uberaba (UNIUBE – Universidade de Uberaba), Av. Cecília Palmerio, s/n, Uberaba, MG, CEP: 38050175, BrazilEmail zemartinsjuliano@hotmail.com; octavio.neto@uftm.edu.brPurpose: To evaluate the prevalence and characteristics of orthopedic injuries associated with the technical-tactical profiles of Brazilian Jiu-Jitsu (BJJ) fighters, according to the fighters’ graduation level (beginner and advanced).Patients and Methods: Cross-sectional study, which included the participation of amateur and professional BJJ athletes, aged between 18 and 60 years and practitioners of the sport for at least six months. All answered a mixed self-reported morbidity questionnaire. Participants were divided into four groups, according to the technical-tactical profile in the fight (keeper and passer) and the fighter’s graduation level (beginner and advanced), and also into four subgroups, divided by joining the groups in pairs above. Descriptive and analytical statistical procedures were used, with a level of statistical significance set at 5% (p < 0.05).Results: A total of 198 participants were included in the study. There was a higher prevalence of musculoskeletal injuries in advanced fighters (p< 0.001), with no significant difference between the profiles of guard and passer fighters. Sprains were the most common type of injury in all studied groups and subgroups. The anatomical segments knee and shoulder, respectively, were the most affected in all groups, and both segments showed significant associations of the athletes in the advanced and guard groups.Conclusion: The study showed important data for creation of specifics injury prevention protocols, through the higher prevalence of injuries in athletes of the advanced profile and in the segments of the knee and shoulder, with emphasis on the guard fighters.Keywords: martial arts, sports injuries, orthopedics

David Heath, David Momtaz, Abdullah Ghali, Luis Salazar, Jonathan Bethiel, Boris Christopher, Caitlyn Mooney, Katherine C Bartush UT Health San Antonio, Department of Orthopaedics, San Antonio, TX, 78249, USACorrespondence: Katherine C BartushUT Health San Antonio, Department of Orthopaedics, 7703 Floyd Curl Dr, MC-7774, San Antonio, Tx, 78229-3900, USATel +1-574-514-2499Fax +1-210-567-5125Email bartush@uthscsa.eduBackground: The rate of medial meniscus tear (MMT) in professional soccer players is high. There are no studies on objective performance metrics following medial meniscus repair in these athletes.Purpose: Examine the impact of MMT treated with surgical repair on performance metrics and career longevity in Major League Soccer (MLS) players.Methods: MLS players who sustained an MMT between 1993 and 2019 were identified via publicly available databases. These players were each matched to 2 uninjured controls by debut date, experience, position, race, ethnicity, height, weight, and body mass index (BMI). Demographic data and performance metrics were then collected for both groups. Matches, minutes, goals, assists, shots, shots on target, duels, and duel percentage won are collectively referred to as performance metrics. Statistical analysis compared demographic distributions and performance metrics between the MMT and control groups.Results: Thirty-three MLS players who had undergone medial meniscus repair were identified and matched to 66 controls. All performance metrics decreased in the MMT group when compared to their controls in the first year after injury. This difference remained significant even when the performance metrics were normalized with respect to time, indicating that the injured players both played less and were not as productive. At 2 years after injury, performance metrics returned to pre-injury levels and were equivalent to those of the healthy controls. Career length was found to be significantly different between the two groups at 8.81 ± 3.9 years for the MMT group and 12.63 ± 3.51 years for the control group (P < 0.001).Conclusion: MLS players undergoing medial meniscus repair had decreased performance metrics in the first year after injury but returned to baseline levels of play at the second year after injury. Their careers were also shorter than those of their uninjured controls.Keywords: meniscus tear, soccer, return to play, return to sport

Andrew Kompel,1 Prashanth H Haran,1 Akira M Murakami,1 Lars Engebretsen,2– 4 Mohamed Jarraya,1,5 Frank Roemer,1,6,* Ali Guermazi1,7,* 1Department of Radiology, Boston University School of Medicine, Boston, MA, USA; 2Medical and Scientific Department, International Olympic Committee, Lausanne, Switzerland; 3Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway; 4Department of Orthopedic Surgery, Oslo University Hospital, University of Oslo, Oslo, Norway; 5Department of Radiology, Brigham and Women’s Hospital, Boston, MA, USA; 6Department of Radiology, Friedrich-Alexander University Erlangen-Nürnberg, & Universitätsklinikum Erlangen, Erlangen, Germany; 7Department of Radiology, VA Boston Health System, Boston, MA, USA*These authors contributed equally to this workCorrespondence: Andrew KompelDepartment of Radiology, Boston University School of Medicine, 820 Harrison Avenue, FGH Building 3rd Floor, Boston, MA, 02118, USATel +1 617 638-6610Fax +1 617 638-6616Email Andrew.Kompel@bmc.orgPurpose: Describe the frequency and severity of knee ligament sprains diagnosed by MRI in athletes participating at the 2016 Summer Olympic Games, their association with certain sports and assess correlations with additional knee structural injury.Patients and Methods: All knee MRIs performed in the Olympic Village and polyclinics during the 2016 Olympics were retrospectively, blindly reviewed for ligament sprains and associated knee injuries. In addition to the absence or presence of these abnormalities, athletes were stratified by age, gender and sport.Results: 11,274 athletes participated in the 2016 Olympic Games: 113 athletes received at least one knee MRI with some having bilateral or repeat MRI on the same knee. Anterior cruciate and medial collateral ligament (ACL/MCL) sprains were most common, accounting for 32 of the 43 sprains (74.4%). Wrestling (10), hockey (7), athletics (7), and judo (5) accounted for over half of ligament sprains. ACL sprains showed a significant positive correlation with medial, lateral meniscal tears and bone contusions. The positive correlation between posterior cruciate ligament (PCL) sprains with MCL/lateral collateral ligament sprain, and popliteus tendon tear was statistically significant with 50% of total PCL sprains occurring in hockey. When athletes were stratified by gender, ligament sprains had a similar occurrence and distribution between men and women.Conclusion: Knee ligament sprains, at the Rio 2016 Games, were most common in wrestling, hockey, athletics and judo with ACL and MCL sprains most frequent. Meniscal tears and bone contusions occurred often with ACL sprains. PCL sprains tended to be multi-ligamentous injuries. Sustained ligament sprains had similar occurrence between genders, while men had a peak incidence of sprains at a younger age and women at an older age.Keywords: Olympics, knee, ligament, sprain, MRI

Yasuharu Nagano,1 Yui Shimada,2 Naoki Sasaki,1 Masaki Shibata1 1Faculty of Physical Education, Japan Women’s College of Physical Education, Tokyo, Japan; 2Faculty of Health Sciences, Tokyo Ariake University of Medical and Health Sciences, Tokyo, JapanCorrespondence: Yasuharu NaganoFaculty of Physical Education, Japan Women’s College of Physical Education, 8-19-1, Kitakarasuyama, Setagaya, Tokyo, 157-8565, JapanTel +81-3-3300-5437Fax +81-3-3300-5437Email nagano.yasuharu@jwcpe.ac.jpIntroduction: The purpose of this prospective cohort study was to investigate the prevalence and burden of “any physical complaint” in college female basketball athletes using a daily questionnaire.Methods: Fifty-four female college basketball players were recruited and followed up for 135 days using the Oslo Sports Trauma Research Centre questionnaire.Results: The questionnaire response rate was 96.4% (95% confidence interval: 95.7– 97.1). The average daily prevalenceof any problem was 44.4%, whereas that of substantial problems was 16.0%. The anatomical areas found to be most frequently affected by physical problems were the ankle (average daily prevalence: 14.5%, 95% confidence interval: 13.4– 15.7), lower back (14.4%, 95% confidence interval: 13.7– 15.2), and knee (9.6%, 95% confidence interval: 9.0– 10.2). The cumulative severity score, calculated by summing severity scores and dividing by number of respondents, showed that ankle, knee, and lower back problems exhibited greater relative burden.Discussion: Injuries common in basketball athletes, such as ankle sprain, anterior cruciate ligament injury, overuse knee pain, and low-back pain, are reflected in the present data.Keywords: epidemiology, sports injuries, overuse injuries, ankle, knee

Guy W Nicolette, Jocelyn R Gravlee University of Florida, Gainesville, FL, USA Introduction: Elbow ulnar collateral ligament (UCL) injuries in gymnastics have not been well documented in the literature, in comparison to UCL injuries in baseball. Few studies have examined the mechanism and nonoperative management of this injury, and no studies to date have been published on incidence of injury and return to play recommendations in gymnastics. Patient case review: A literature search was performed using PubMed to review articles from 1980 to 2016 that addressed the biomechanics of UCL injury in baseball and gymnastics, the anatomy of the elbow, injury rates, surgical vs non-surgical management, rehabilitation, and return to play recommendations for the sport of gymnastics. Five female collegiate gymnasts sustained UCL injury over a 3-year period. Electronic medical records for each case were thoroughly reviewed including imaging, surgical and non-surgical management, rehabilitation, and the progressive return to gymnastics. Discussion: Four UCL injuries were confirmed by MRI to be avulsions at the distal insertion of the UCL and one was an avulsion at the proximal origin. While less than half of baseball players can return to competition with conservative management of these types of injuries, four out of five gymnasts were able to return to competition with nonoperative management. One gymnast opted to have reconstruction after a successful competition season. Time to return to play varied seemingly dependent on the severity of UCL injury and event. Conclusion: In our case series, collegiate female gymnasts were able to return to participation with nonoperative treatment of the UCL. Their success in returning to competitive gymnastics may also depend on the event(s) in which they are trying to participate. Strength of Recommendation Taxonomy: C. Keywords: elbow ulnar collateral ligament, gymnastics, gymnast

Ryan M Weatherwax,1,2 Nigel K Harris,1 Andrew E Kilding,3 Lance C Dalleck2 1Auckland University of Technology, Human Potential Center, Auckland, New Zealand; 2Western State Colorado University, Recreation and Exercise & Sport Science, Gunnison, CO, USA; 3Auckland University of Technology, Sports Performance Research Institute New Zealand, Auckland, New Zealand Background: Even though cardiorespiratory fitness (CRF) training elicits numerous health benefits, not all individuals have positive training responses following a structured CRF intervention. It has been suggested that the technical error (TE), a combination of biological variability and measurement error, should be used to establish specific training responsiveness criteria to gain further insight on the effectiveness of the training program. To date, most training interventions use an absolute change or a TE from previous findings, which do not take into consideration the training site and equipment used to establish training outcomes or the specific cohort being evaluated. The purpose of this investigation was to retrospectively analyze training responsive­ness of two CRF training interventions using two common criteria and a site-specific TE.Methods: Sixteen men and women completed two maximal graded exercise tests and verification bouts to identify maximal oxygen consumption (VO2max) and establish a site-specific TE. The TE was then used to retrospectively analyze training responsiveness in comparison to commonly used criteria: percent change of >0% and >+5.6% in VO2max.Results: The TE was found to be 7.7% for relative VO2max. χ2 testing showed significant differences in all training criteria for each intervention and pooled data from both interventions, except between %Δ >0 and %Δ >+7.7% in one of the investigations. Training nonresponsiveness ranged from 11.5% to 34.6%.Conclusion: Findings from the present study support the utility of site-specific TE criterion to quantify training responsiveness. A similar methodology of establishing a site-specific and even cohort specific TE should be considered to establish when true cardiorespiratory training adaptations occur. Keywords: training responders, training nonresponders, cardiorespiratory fitness, exercise training&nbsp

Markus Posch,1 Martin Burtscher,1 Alois Schranz,2 Katja Tecklenburg,2 Kenneth Helle,2 Gerhard Ruedl1 1Department of Sport Science, University of Innsbruck, Innsbruck, Austria; 2Medalp Sportclinic, Imst, Austria Background and purpose: The ability to successfully self-release the ski binding can prevent skiing-related injuries of the lower extremities. Failure of binding release associated with a knee injury is significantly higher among females compared to males. The International Standards Organization ISO 11088 standard for binding setting values allows a lowering by 15% upon request of the skier. Thus, the aim of this study was to evaluate the impact of lowered ski binding settings by 15% on the outcome of the self-release test among female recreational skiers. Materials and methods: In this randomized single-blinded study, a cohort of 20 females (24.5±2.7 years) performed the self-release test in the laboratory thrice with each leg under two conditions: 1)with an actual ISO 11088 setting and 2) with a setting lowered by 15%. For each attempt, torques calculated via the force plate were normalized to torques measured by a binding adjustment system (relative release torque, RRT). Results: Among 240 trials in total, more females were significantly able to self-release their ski bindings with lowered binding settings when compared to their actual ISO settings (53% vs 9%, p

Purpose The aim of this study was to examine the physical and training characteristics of recreational marathon runners within finish time bandings (2.5–3 h, 3–3.5 h, 3.5–4 h, 4–4.5 h and >4.5 h). Materials and methods A total of 97 recreational marathon runners (age 42.4 ± 9.9 years; mass 69.2 ± 11.3 kg; stature 172.8 ± 9.1 cm), with a marathon finish time of 229.1 ± 48.7 min, of whom n = 34 were female and n = 63 were male, completed an incremental treadmill test for the determination of lactate threshold (LT1), lactate turn point (LT2) and running economy (RE). Following a 7-min recovery, they completed a test to volitional exhaustion starting at LT2 for the assessment of V˙O2max. In addition, all participants completed a questionnaire gathering information on their current training regimes exploring weekly distances, training frequencies, types of sessions, longest run in a week, with estimations of training speed, and load and volume derived from these data. Results Training frequency was shown to be significantly greater for the 2.5–3 h group compared to the 3.5–4 h runners (P < 0.001) and >4.5 h group (P = 0.004), while distance per session (km·session−1) was significantly greater for the 2.5–3 h group (16.1 ± 4.2) compared to the 3.5–4 h group (15.5 ± 5.2; P = 0.01) and >4.5 h group (10.3 ± 2.6; P = 0.001). Race speed correlated with LT1 (r = 0.791), LT2 (r = 0.721) and distance per session (r = 0.563). Conclusion The data highlight profound differences for key components of marathon running (V˙O2max, LT1, LT2, RE and % V˙O2max) within a group of recreational runners with the discriminating training variables being training frequency and the absolute training speed., Video abstract

Lisa Müller,1 Carolin Hildebrandt,1,2 Erich Müller,3 Renate Oberhoffer,2 Christian Raschner1 1Department of Sport Science, University of Innsbruck, Innsbruck, Austria; 2Department of Sport and Health Science, Preventative Pediatrics, Technical University of Munich, Munich, Germany; 3Department of Sport Science and Kinesiology, University of Salzburg, Salzburg, Austria Background: Studies on injuries and illnesses involving youth ski racers younger than 15 years are lacking in the literature. The aim of this study was prospectively to assess the incidence, prevalence, and severity of traumatic and overuse injuries, as well as illnesses of elite youth ski racers with regard to sex, biological maturity status, and relative age.Subjects and methods: A prospective, longitudinal cohort design was used to monitor the anthropometrics, training characteristics, traumatic and overuse injuries, and illnesses of 82 elite youth ski racers (51 males, 31 females, age 9–14 years) over 2 consecutive years. The exact training exposure (skiing and athletic) was recorded. Relative age and estimated biological maturity status were assessed.Results: Relatively low injury incidence or prevalence (traumatic, 0.86/1,000 hours of training; overuse, 0.28/1,000 hours) and comparably high illness prevalence (2.4/athlete) were reported. The knee was the most commonly affected body part (traumatic injuries 36.5%, overuse injuries 82%). A high number of bone fractures were revealed (46%), while no stress fractures occurred; 66% of the illnesses were respiratory tract infections. No differences were found between males and females, the differing maturity groups, or relative age quartiles. Early-maturing athletes had comparably low traumatic and overuse-injury rates. Relatively younger athletes had low traumatic injury rates.Conclusion: The injury-prevention measures implemented in the training process of youth ski racers seem to contribute to a low incidence of injury. Biological maturity status should be considered in the training process to prevent injuries in late-maturing athletes. Keywords: traumatic and overuse injuries, health problems, youth alpine ski racing, birth quarter, biological development

Anna Cronström,1 Ewa M Roos,2 Eva Ageberg1 1Department of Health Sciences, Lund University, Lund, Sweden; 2Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark Background: In patients with anterior cruciate ligament (ACL) deficiency (ACLD) or reconstruction (ACLR), sensory deficits are commonly assessed as knee kinesthesia using time-consuming laboratory equipment. Portable equipment such as that used for evaluation of vibration sense would be preferable. In contrast to kinesthesia, vibration sense is not well studied in these patients. Objectives: 1) To study the association between kinesthesia and vibration sense to investigate if one sensory measurement can replace the other; and 2) to determine the clinical relevance by investigating associations between the sensory measurements and functional performance and patient-reported outcomes in patients with ACLD or ACLR. Methods: Twenty patients with ACLD and 33 patients with ACLR were assessed with knee kinesthesia, vibration sense, the one-leg hop test for distance, as well as the Knee injury and Osteoarthritis Outcome Score (KOOS) and the Tegner Activity Scale. Results: There were no significant correlations between kinesthesia and vibration sense (r=–0.267, p>0.269) or between the sensory measures and hop performance (r= –0.351, p>0.199). In patients with ACLD, worse knee kinesthesia was associated with worse scores on KOOS subscales pain (r= –0.464, p=0.046) and activities of daily living (r= –0.491, p=0.033), and worse vibration sense was associated with worse scores on KOOS subscale quality of life (r=–0.469, p=0.037) and worse knee confidence (item Q3 from subscale quality of life) (rs=0.436, p=0.054). In patients with ACLR, worse vibration sense was associated with worse scores on KOOS subscales pain (r= –0.402, p=0.020) and activities of daily living (r= –0.385, p=0.027). Conclusion: Kinesthesia and vibration sense cannot be used interchangeably as measures of sensory function in patients with ACLD or ACLR. Both sensory measurements were weakly related to hop performance. Adequate sensory function appears to have importance for perceived function in patients with ACLD or ACLR and may therefore be a factor that needs to be addressed in rehabilitation programs for these patients. Keywords: knee injury, proprioception, sensory function, functional performance, patient reported outcomes

Pantelis Theodoros Nikolaidis,1 Krzysztof Buśko,2 Filipe Manuel Clemente,3 Ioannis Tasiopoulos,1 Beat Knechtle4 1Exercise Physiology Laboratory, Nikaia, Greece; 2Department of Biomechanics, Institute of Sport-National Research Institute, Warsaw, Poland; 3School of Sport and Leisure, Polytechnic Institute of Viana do Castelo, Melgaço, Portugal; 4Institute of Primary Care, University of Zurich, Zurich, Switzerland Abstract: Anthropometry and neuromuscular fitness have been shown to relate with taekwondo (TKD) performance; however, little information is available on the variation of these fitness components by sex and age in athletes practicing this sport. The aim of the present study was to examine the anthropometry and neuromuscular fitness of TKD athletes by sex and age. Atotal of 393 athletes (7–48 years old), separated into six age groups (7–9, 10–11, 12–13, 14–17, 18–32, and 33+), were examined for anthropometry and performed a series of neuromuscular fitness tests (flexibility, agility, muscle power, and isometric strength). An age × sex interaction on body mass, body height, and body fat percentage (BF, p≤0.003, η2≥0.045), but not on body mass index (p=0.172, η2=0.020), was shown, where a larger increase in body mass and body height from 12–13 to 14–17 groups was observed in males than in females, and the sex difference in BF increased from 12–13 to 14–17 age group. An age × sex interaction on sit-and-reach (SAR) test, mean power output in the Bosco test, and Abalakov jump (p≤0.038, η2≥0.031) was observed with larger differences between 12–13 and 18–32 groups in males than in females. In SAR, it was remarkable that the male athletes achieved similar scores as female athletes in the 18–32 group. An age × sex group interaction on measures of isometric muscle strength (right and left handgrip, trunk, and legs) was also shown (p≤0.002, η2≥0.068), where larger differences in male than female athletes were observed between the 12–13 and 14–17 groups. From a practical perspective, coaches can use these findings as reference for the evaluation of their athletes. Because the anthropometric characteristics and neuromuscular fitness varied by sex (i.e., highest scores in males, except flexibility) and age (i.e., highest scores in the 18–32 age group) with unique sport-specific patterns in TKD athletes, these findings would be important for the development of specific training programs. Keywords: agility, flexibility, isometric muscle strength, jumping ability, sit-and-reach test

Alberto Migliore,1 Silvana Giannini,2 Emanuele Bizzi,1 Umberto Massafra,1 Maurizio Cassol,3 Martin Jose Michael Abilius,1 Giovanni Boni4 1Operative Unit of Rheumatology, San Pietro Fatebenefratelli Hospital, Rome 00189, Italy; 2Department of Radiology, Villa Stuart Sport Clinic, Rome 00136, Italy; 3Department of Internal Medicine, San Pietro Fatebenefratelli Hospital, Rome 00189, Italy; 4ANTIAGE Sportive Medicine Ambulatory Department (Ambulatorio di Medicina dello Sport Antiage), Foligno, Italy Objective: The aim of this study is to investigate the effect of intra-articular hyaluronic acid administration in active football players complaining of knee pain after sports activity. Efficacy and safety profiles of intra-articular hyaluronic acid and time needed for football players to recover and restart sports activity were examined.Methods: Clinical data of active football players reporting knee pain after sports activity were included in this retrospective study. All patients who received an intra-articular injection at time 0 and after 2 weeks were included in the study. Patients underwent laboratory examination, knee X-ray, ultrasound, and clinical examination before receiving the intra-articular injection. Effusions or cysts were drained before injections. Lequesne index score, pain visual analog scale (VAS) score, and patient’s global assessment score were recorded at time 0 (day of the first injection), 1 and 2 days after the first injection, at 2 weeks (day of the second injection), and at follow-up visits. Only data from patients completing the follow-up were analyzed.Results: Data from 17 patients were analyzed: 16 males and one female, of which three were professional players (two males and one female) and 14 were nonprofessional players. The mean age of patients was 39.8±11.8 years. Two patients (one male and one female) showed joint effusion. Two patients reported relevant joint pain after injection that regressed without any medication. At the first week, all parameters examined indicated improvement that was maintained until the end of follow-up. One day after the first and second injection, patients reported a slight increase in pain VAS score, which was not statistically significant, and the pain resolved after 1 day. All patients successfully restarted playing after the first injection within 3.1±2.0 days and kept playing after the second injection following our indication (1 day of break).Conclusion: The use of a medium-molecular weight hyaluronic acid in football players affected by knee osteoarthritis seems efficacious and safe and resulted, in our experience, a stable improvement of symptoms; moreover, it allowed a rapid restart of sports activity. Larger studies on larger populations are needed to confirm these findings. Keywords: sports, hyaluronic acid, intra-articular, injection, football, trauma

Lianne Bissell,1,2 Peter Lorentzos1,2 1School of Medicine, University of Dundee, Dundee, UK; 2Department of Orthopaedics, Westmead Hospital, Sydney, NSW, Australia Purpose: The aim of this study was to investigate the prevalence of overuse injuries in non-elite netballers and whether these increase over a typical competitive season and to establish if player age, experience, training, and use of bracing are related to overuse injuries.Patients and methods: A prospective study was conducted over a 12-week period, using a recently developed questionnaire. Data were collected on overuse injuries in the knee, ankle, and shoulder areas every week.Results: Thirty-seven players responded to the questionnaire, with an average response rate of 65%. The total prevalence of overuse injuries identified was 52.7%, with ankle problems accounting for 26% (75 cases), knee problems accounting for 21.2% (61 cases), and shoulder problems accounting for 5.5% (16 cases). Ankle injuries increased over the study period, while knee and shoulder problems decreased. Injuries were more common in players over 36years old or those with less than 5years of playing experience. Players who used a brace were more likely to have an overuse complaint. Training volume was not associated with increased risk.Conclusion: Overuse injuries are common in netballers, particularly of the knee and ankle. Shoulder overuse complaints are higher than previously reported. Risk factors for injury include older age and less playing experience, and these should be considered when planning injury prevention programs for this sport. Keywords: sports, injury, risk, prevention&nbsp

Vani Sabesan,1 Zachary Steffes,2 Daniel J Lombardo,1 Graysen R Petersen-Fitts,1 Toufic R Jildeh2 1Department of Orthopaedic Surgery, 2Wayne State University School of Medicine, Detroit, MI, USA Abstract: Rugby participation in the US is increasing, and with its inclusion in the 2016 Summer Olympics, the increased participation rates are expected to continue. Naturally, as participation increases, so too do rugby-related injuries. The difference in injury patterns with regard to age and gender illustrates differences in how the game is being played. Understanding what accounts for these emerging injury patterns will help guide future injury prevention efforts. This study provides an update on injury rates for the growing population of rugby players in the US, especially young players. Our results focus on the variation of injury types and the injury rates of various levels of rugby players, including youth, collegiate, and recreational. Using injury data from the National Electronic Injury Surveillance System, we analyzed data in rugby patients for age, gender, body region, type of injury, and severity. We employed statistical weights to calculate national injury estimates. During the 10years studied, the trend in the number of rugby injuries among all age groups showed a statistically significant increase (R=0.804, P=0.005). The average age of injury was 21.5±6.3years with facial and head injuries constituting >33% of all injuries, representing a proportional increase of >10%. Men were most frequently injured in the face (18.2%) and head (15.9%); women were most frequently injured in the head (23%) and shoulder (12.3%). There were 9,059 concussions, constituting 7% of all injuries. Keywords: rugby, injury pattern, epidemiology

Jeffrey B Kreher Department of Orthopaedics, Division of Pediatric Orthopaedics, Massachusetts General Hospital and Massachusetts General Hospital for Children, Boston, MA, USA Abstract: Overtraining syndrome is a condition of maladapted physiology in the setting of excessive exercise without adequate rest. The exact etiology and pathogenesis are unknown and being investigated. Symptoms are multisystem in nature and often representative of underlying hormonal, immunologic, neurologic, and psychologic disturbances. Unfortunately, systematic review of the literature does not clearly direct diagnosis, management, or prevention. However, given the severity of symptoms and impairment to quality of life, prevention of overtraining syndrome should be considered by all who interact with endurance athletes. This article will provide suggestions for management of at-risk athletes despite absence of validated diagnostic tests and preventative measures. Keywords: overreaching, unexplained underperformance, burnout, muscle failure syndrome

Ashim Aggarwal,1 Jeffrey J Heslop,1 Rebecca R Wigant,1 Suneetha Venkatapuram,1 Stephanie J Hillis,1 Alan R Parr,1 Hakan Oral,2 Timir S Baman11Cardiology Department, University of Illinois College of Medicine at Peoria and OSF Saint Francis Medical Center, Peoria, IL, USA; 2Cardiac Arrhythmia Service, University of Michigan, Ann Arbor, MI, USAAlthough low-to-moderate intensity exercise has been shown to result in decreased cardiovascular morbidity and mortality, limited data suggest that there may be an association between atrial fibrillation (AF) and trained endurance athletes.1 The aim of our study was to prospectively evaluate moderately trained athletes for the occurrence of occult AF.

Matthew D Barrett,1 Terence F McLoughlin,2 Kieran R Gallagher,1 Don Gatherer,3 Michael TR Parratt,1 Jonathan R Perera,1 Tim WR Briggs1 1Royal National Orthopaedic Hospital, Stanmore, Middlesex, United Kingdom; 2Royal Liverpool University Hospital, Liverpool, Mersey Deanery, United Kingdom; 3The Gatherer Partnership, Aylesbury, United Kingdom Purpose: To investigate the effect of a tailored neck muscle conditioning program on neck muscle strength, neck muscle fatigue, and range of neck movement in 16–18-year-old male rugby players. Materials and methods: Thirty-four male rugby players were divided into forward and back playing positions and randomized within these groups. Seventeen players were randomly assigned to each group. The test group was given a tailored 6-week exercise regime based on their baseline measurements to be performed three times a week in addition to their normal training and playing. The control group trained and played as normal. The outcome measures used were cervical spine range of movement, neck strength, and neck muscle fatigability. Results: There were no clinically relevant statistically significant differences between the two groups. Trends identified between the two groups suggest that a tailored neck exercise program increases neck strength, particularly neck extension, and increases resistance to fatigue, as well as influencing right- and left-sided neck muscle balance. A reduction in range of movement was also demonstrated in the test group. There was a great deal of variability in range of movement and strength within this age group. No previously undiagnosed neck conditions were detected, and there were no adverse events reported. Conclusion: This study has shown that neck strength, range of movement, and susceptibility of the neck muscles to fatigue can be influenced using a focused neck training regime. It forms an important basis for a larger, multicenter study to ensure the neck is given due attention in rugby training and receives the same focus of conditioning as other parts of the body. Keywords: injury, sport, muscle, youth, scrum

Background and objective Family physicians are expected to be comfortable in treating common sports injuries. Evidence shows a limited level of comfort in treating these injuries in pediatric and internal medicine residents. Studies are lacking, however, in family medicine residents. The purpose of this study is to assess the comfort level of family medicine residents in treating common sports injuries in adults and children based on their perceived level of knowledge and attitudes. Methods This is a cross-sectional study of family medicine residents in the United Sates. A written survey of 25 questions related to sports injury knowledge and factors affecting comfort level were collected. A chi-square test was implemented in calculating P-values. Results Five hundred and fifty-seven residents responded to the survey. A higher percentage of doctors of osteopathy (86.6%, 82.5%, 69.6%, and 68.7%) compared to doctors of medicine (78.5%, 71.6%, 53.4%, and 52.8%) respectively identified ankle sprain, concussion, plantar fasciitis, and lateral epicondylitis as common injuries, and felt comfortable in treating them (P-values =0.015, 0.004, 0.0001, and 0.0002, respectively). Residents with high interest in sports medicine correctly identified the injuries as common and felt comfortable treating them as well (knowledge, P=0.027, 0.0029, Video abstract

Background: Excessively high stresses are applied to the shoulder joint of handball players, mainly caused by overhead throwing. Shoulder pain is a significant problem among junior female team handball players and both male and female top-level team handball players in Norway. Method: A randomized selection was performed among the best female junior teams (J 16) in the Trøndelag region of Norway in the 2014–2015 season. Three teams were randomized to the intervention group and three teams to the control group. Players in the intervention group (n=53) participated in a seven-month, three-times-a-week shoulder-muscle strength-training program, while those in the control group (n=53) participated in a comparable handball training, but did not conduct any specific strength training during the season. Results: A strength-training program had no effect on the prevention of shoulder pain. Overall, the players reported shoulder pain, but graded the pain low on visual analog scale (VAS). Both the intervention group and the control group reported pain under 1 on VAS at baseline and posttest, and there was no significant difference within or between the groups when it came to the intensity of pain reported on VAS. A significant difference (p

Olufemi R Ayeni,1 Marcin Kowalczuk,1 Jordan Farag,1 Forough Farrokhyar,1,2 Raymond Chu,1 Asheesh Bedi,3 Kevin Willits,4 Mohit Bhandari1,2 1Division of Orthopaedic Surgery, Department of Surgery, 2Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada; 3Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA; 4Department of Orthopaedic Surgery, University of Western Ontario, London, ON, Canada Background: There has been a noted increase in the diagnosis and reporting of sporting hip injuries and conditions in the medical literature but reporting at the minor hockey level is unknown. The purpose of this study is to investigate the trend of reporting hip injuries in amateur ice hockey players in Canada with a focus on injury type and mechanism. Methods: A retrospective review of the Hockey Canada insurance database was performed and data on ice hockey hip injuries reported between January 2005 and June 2011 were collected. The study population included all male hockey players from Peewee (aged 11–12 years) to Senior (aged 20+ years) participating in amateur level competition sanctioned by Hockey Canada. Reported cases of ice hockey hip injuries were analyzed according to age, mechanism of injury, and injury subtype. Annual injury reporting rates were determined and using a linear regression analysis trended to determine the change in ice hockey hip injury reporting rate over time. Results: One hundred and six cases of ice hockey-related hip injuries were reported in total. The majority of injuries (75.5%) occurred in players aged 15–20 years playing at the Junior level. Most injuries were caused by a noncontact mechanism (40.6%) and strains were the most common subtype (50.0%). From 2005 to 2010, the number of reported hip injuries increased by 5.31 cases per year and the rate of reported hip injury per 1,000 registered players increased by 0.02 cases annually. Conclusion: Reporting of hip injuries in amateur ice hockey players is increasing. A more accurate injury reporting system is critical for future epidemiologic studies to accurately document the rate and mechanism of hip injury in amateur ice hockey players. Keywords: amateur ice hockey, hip injury, pelvic injury, mechanism

Luke S Hopper,1 Nahoko Sato,2 Andries L Weidemann1 1Western Australian Academy of Performing Arts, Edith Cowan University, Mt Lawley, WA, Australia; 2Department of Physical Therapy, Nagoya Gakuin University, Seto, Japan Abstract: The physical assessments used in dance injury surveillance programs are often adapted from the sports and exercise domain. Bespoke physical assessments may be required for dance, particularly when ballet movements involve “turning out” or external rotation of the legs beyond that typically used in sports. This study evaluated the ability of the traditional single-leg squat to predict the leg alignment of dancers performing ballet movements with turnout. Three-dimensional kinematic data of dancers performing the single-leg squat and five ballet movements were recorded and analyzed. Reduction of the three-dimensional data into a one-dimensional variable incorporating the ankle, knee, and hip joint center positions provided the strongest predictive model between the single-leg squat and the ballet movements. The single-leg squat can predict leg alignment in dancers performing ballet movements, even in “turned out” postures. Clinicians should pay careful attention to observational positioning and rating criteria when assessing dancers performing the single-leg squat. Keywords: injury, motion capture, clinical assessment

Michael TC Liang,1 Lorena Quezada,1 WY Jamie Lau,1 Bulent Sokmen,2 Thomas W Spalding11Department of Kinesiology and Health Promotion, California State Polytechnic University, Pomona, CA, USA; 2Department of Kinesiology, Sonoma State University, Rohnert Park, CA, USAAbstract: To examine the effect of a 10-week upper-body resistance training program on bone turnover markers and site-specific bone mineral density (BMD) in the wrist and distal half of the ulna and radius in untrained and healthy young premenopausal women.Methods: Twenty-two subjects (aged 22.1 ± 1.8 years) were randomly assigned to a resistance training (n = 12) or no training control (n = 10) group. The following outcome variables were measured before and after 10 weeks of resistance training: (1) bone formation biomarker osteocalcin, and bone resorption biomarker tartrate-resistant acid phosphatase isoform 5b; (2) BMD in the wrist and distal half of the ulna and radius; (3) isokinetic strength of the elbow and knee extensors and flexors; (4) dynamic strength of the arm extensors and flexors; and (5) maximum number of push-ups.Results: The 10-week upper body resistance training intervention resulted in improved strength performance in push-ups (resistance training versus control: P < 0.05), chest presses (P < 0.05), and pulldowns (P < 0.05). However, there was no improvement in the BMD of the wrist (P > 0.05), BMD of the distal half of the ulna and radius (P > 0.05), and metabolic biomarkers osteocalcin (P > 0.05) and tartrate-resistant acid phosphatase isoform 5b (P > 0.05), except for the osteocalcin/tartrate-resistant acid phosphatase isoform 5b ratio. Also, no improvement in the resistance training group was observed for isokinetic strength of the knee and elbow flexion/extension.Conclusion: Upper-body muscular strength performance, but not bone metabolic markers and BMD of the wrist, can be improved with a 10-week upper body resistance training program of the nonweight-bearing limbs in untrained young premenopausal women.Keywords: osteocalcin, TRACP5b, wrist and heel mineral density, isokinetic strength, dynamic strength training

Erich Hohenauer,1-3 Peter Clarys,3 Jean-Pierre Baeyens,2-4 Ron Clijsen,1-31Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Landquart, Switzerland; 2University College Physiotherapy, Thim van der Laan, Landquart, Switzerland; 3Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium; 4Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, BelgiumAbstract: The purpose of this controlled trial was to investigate the effects of a single local cryotherapy session on the recovery characteristics over a period of 72 hours. Twentytwo young and healthy female (n=17; mean age: 21.9±1.1 years) and male (n=5;mean age:25.4±2.8 years) adults participated in this study. Following an exhaustive jump protocol (3×30 countermovement jumps), half of the participants received either a single local cryotherapy application (+8°C) or a single local thermoneutral application (+32°C) of 20-minute duration using two thigh cuffs. Subjective measures of recovery (delayed-onset muscle soreness and ratings of perceived exertion) and objective measures of recovery (vertical jump performanceand peak power output) were assessed immediately following the postexercise applications (0 hours) and at 24 hours, 48 hours, and 72 hours after the jump protocol. Local cryotherapy failed to significantly affect any subjective recovery variable during the 72-hour recovery period (P>0.05). After 72 hours, the ratings of perceived exertion were significantly lower in the thermoneutral group compared to that in the cryotherapy group (P=0.002). No significant differences were observed between the cryotherapy and the thermoneutral groups with respect to any of the objective recovery variables. In this experimental study, a 20-minute cryotherapy cuff application failed to demonstrate a positive effect on any objective measures of recovery. The effects of local thermoneutral application on subjective recovery characteristics were superior when compared to the effects of local cryotherapy application at 72 hours postapplication.Keywords: cryotherapy, cold cuff, muscle damage, recovery

Yuka Tsukahara, Jun Iwamoto, Kosui Iwashita, Takuma Shinjo, Koichiro Azuma, Hideo MatsumotoInstitute for Integrated Sports Medicine, Keio University School of Medicine, Tokyo, Japan Background: Whole-body vibration (WBV) exercise is widely used for training and rehabilitation. However, the optimal posture for training both the upper and lower extremities simultaneously remains to be established. Objectives: The objective of this study was to search for an effective posture to conduct vibration from the lower to the upper extremities while performing WBV exercises without any adverse effects. Methods: Twelve healthy volunteers (age: 22–34 years) were enrolled in the study. To measure the magnitude of vibration, four accelerometers were attached to the upper arm, back, thigh, and calf of each subject. Vibrations were produced using a WBV platform (Galileo 900) with an amplitude of 4 mm at two frequencies, 15 and 30 Hz. The following three postures were examined: posture A, standing posture with the knees flexed at 30°; posture B, crouching position with no direct contact between the knees and elbows; and posture C, crouching position with direct contact between the knees and elbows. The ratio of the magnitude of vibration at the thigh, back, and upper arm relative to that at the calf was used as an index of vibration conduction. Results: Posture B was associated with a greater magnitude of vibration to the calf than posture A at 15 Hz, and postures B and C were associated with greater magnitudes of vibration than posture A at 30 Hz. Posture C was associated with a vibration conduction to the upper arm that was 4.62 times and 8.26 times greater than that for posture A at 15 and 30 Hz, respectively. Conclusion: This study revealed that a crouching position on a WBV platform with direct contact between the knees and elbows was effective for conducting vibration from the lower to the upper extremities. Keywords: whole-body vibration exercise, upper extremities, lower extremities

Ramon Balius1, Carles Pedret2, Laura Pacheco1, Josep Antoni Gutierrez3, Joan Vives4, Jaume Escoda11Consell Català de l’Esport, Generalitat de Catalunya, Barcelona; 2Centro Mapfre de Medicina del Tenis, Barcelona; 3Spanish National Handball Team, Spain; 4Granollers Handball Club, Granollers, Barcelona, SpainAbstract: Muscle injuries generally occur in two-joint muscles with a high percentage of type II fibers during the performance of eccentric activity. Some muscle injuries, such as those located in the adductor longus, a monoarticular muscle, as well as rectus abdominis do not fully comply with these requirements. This study examines five cases of elite handball players with ruptured rectus abdominals. Sonographically, lesions in rectus abdominis are shown as a disruption of the fibrillar pattern with a hematic suffusion that invades the entire lesion. In some of the cases, the ultrasound study was complemented with a MRI. A unified rehabilitation protocol was applied and the return to play time of each handball player ranged between 16 and 22 days, with an average of 18.2 days. Follow-up at 15 months showed no evidence of re-injury or residual discomfort and all of them are playing at their highest level. The aim of this study was to illustrate a feature of handball injury that, as in tennis and volleyball, is uncommon and so far has not been specifically reported. The phenomenon of contralateral abdominal hypertrophy in handball appears in the dominant arm as in tennis and volleyball.Keywords: rectus abdominis, muscle injury, sonography, MRI, handball&nbsp

Linda S Chesterton, Christian D Mallen, Elaine M HayArthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Keele, Staffordshire, UKDate of preparation: April 21, 2011Conflict of interest: None declaredClinical question: What is the best treatment for tennis elbow?Results: Despite a wealth of research, there is no true consensus on the most efficacious management of tennis elbow especially for effective long-term outcomes. Corticosteroid injections do show large pain-relieving effects in the short term but are associated with risks of adverse events and long-term reoccurrence. Advice with a “wait and see” approach is recommended as the first-line treatment in primary care for most cases. In the medium term physiotherapy and or low-level laser therapy may be effective.Implementation: Rule out alternative diagnosis. Onward referral may be indicated if the condition does not resolve after 12 months.Keywords: tennis elbow, corticosteroids, physiotherapy, laser therapy

Alexander Matthews1, David Pyne1,2, Philo Saunders2, Kieran Fallon1,2, Peter Fricker1,21Medical School, Australian National University, Canberra, ACT, Australia; 2Australian Institute of Sport, Canberra, ACT, AustraliaPurpose: To develop and evaluate a questionnaire that quantifies the self-reported frequency, duration and severity of illness symptoms in highly-trained athletes. We examined whether runners had more symptoms than recreationally-active individuals, and whether runners more prone to illness were undertaking more strenuous training programs.Methods: A daily illness questionnaire was administered for three months during the summer to quantify the type, frequency, duration, and severity of illness symptoms as well as the functional impact on the ability to undertake exercise performance. A total of 35 participants (12 highly-trained runners living in a community setting and 23 recreationally-active medical students) completed the questionnaire.Results: Runners had a similar frequency of illness (2.1 ± 1.2 vs. 1.8 ± 2.3 episodes, mean ± SD, P = 0.58), but substantially longer duration (5.5 ± 9.9 vs 2.8 ± 3.1 days, P < 0.01) and illness load (7.7 ± 16.2 vs 4.5 ± 4.8 units, P = 0.001) than age- and sex-matched recreationally-active individuals respectively. Runners more prone to illness symptoms had marginally higher training loads.Conclusions: The athlete illness questionnaire is useful for quantifying the pattern of self-reported symptoms of illness in field settings. Highly-trained runners experience longer episodes of illness with a greater impact on daily activity than recreationally-active individuals.Keywords: athlete, self-reported illness, questionnaire, exercise performance

Natalia Covarrubias,1 Subir Bhatia,2 Luis F Campos,3 Dahn V Nguyen,2,3 Eric Y Chang1,4,51Department of Physical Medicine and Rehabilitation, University of California Irvine, Irvine, CA, USA; 2School of Medicine, University of California Irvine, Irvine, CA, USA; 3Institute for Clinical and Translational Science, Irvine, CA, USA; 4Department of Anesthesiology and Perioperative Care, University of California Irvine, Irvine, CA, USA; 5Reeve-Irvine Research Center, Irvine, CA, USA Objective: To correlate training habits of Taekwondo (TKD) athletes to risk for injury. Background: TKD is a Korean marital art that has been growing in popularity, with nearly 2 million individuals practicing the sport in the United States. Because of the combative nature of the sport, injuries are an inherent risk. However, data on proper training habits, types of injuries sustained during training, and recommendations for athletes to avoid injury are lacking. Frequently, studies of TKD evaluate athletes’ injuries during tournaments, but most do not evaluate athletes in training. Hypothesis: Increased training would potentially create more injuries secondary to increased exposure. Methods: This is a cross-sectional observational survey of 72 collegiate TKD athletes from the Pacific West Sanctioned Taekwondo Tournaments in the 2008–2009 season. Variables analyzed during training and competitions were training sessions per week, workout habits, belt level, years of experience, and characteristics of injury (location, type, mechanism, situation, treatment, and days missed). Results: TKD training habits of individuals who practiced four or more times per week (odds ratio [OR], 4.5; P=0.005) or sparred for more than 2 hours (OR, 8.7; P=0.003) were associated with significantly increased odds (risk) of sustaining an injury. Those who had more than 3 years of tournament experience were more likely to sustain an injury (OR, 0.198; P=0.020). Conclusion: Increased risk for injury with more frequent practice and longer sparring should remind coaches and trainers that monitoring and adjusting the athletes’ training schedules and exposure time could decrease the chance of injury. An athlete that has spent more years in tournaments along with high-frequency and long-duration training was associated with greater risk for injuries. Prevention and education about the risk for exposure to injury may may help athletes and trainers promote prevention strategies and adjust an athletes’ training and tournament schedules to decrease the risk for injury. Keywords: sports injuries, martial arts, collegiate athletes, training injuries

Anna Eriksson,1 Fredrik R Johansson,2 Maria Bäck3–5 1Rehab City Östermalm, Primary Health Care, 2Department of Environmental Medicine, Musculoskeletal and Sports Injury Epidemiology Center, Karolinska Institutet, Stockholm, 3Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, 4Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, 5Department of Medical and Health Sciences, Division of Physiotherapy, Linköping University, Linköping, Sweden Purpose: This study adds to the previous work in the field of sport-specific fitness testing by evaluating a tennis-specific agility test called “the 20-yard shuttle test”. The aim of the study was to evaluate the test–retest reliability, the inter-rater reliability, and the criterion-related validity of the 20-yard shuttle test on competitive junior tennis players. Participants and methods: Totally, 34 Swedish tennis players (13 girls), mean age 14±1.6 years, participated in the study. To examine test–retest reliability, the subjects performed the 20-yard shuttle test three times on the same day and then the same procedure was repeated after 3 days. To test the inter-rater reliability, the time was measured with a stopwatch simultaneously by two different raters. The time recorded manually was compared to the gold standard of digital timing to evaluate the criterion-related validity. Results: Excellent test–retest reliability was found both within the same day (intraclass correlation coefficient [ICC] 0.95) and between days (ICC 0.91). Furthermore, the results showed excellent inter-rater reliability (ICC 0.99) and criterion-related validity on both test occasions (ICC 0.99). Conclusion: We have provided introductory support for the 20-yard shuttle test as a reliable and valid test for use in competitive junior tennis players. The ease of administration makes this test a practical alternative to evaluate physical fitness in order to optimally train the athletes. Keywords: agility, physical fitness, physiotherapy, performance&nbsp

Eri Ito, Jun Iwamoto, Koichiro Azuma, Hideo MatsumotoInstitute for Integrated Sports Medicine, Keio University School of Medicine, Tokyo, JapanAbstract: The purpose of the present study was to investigate sex-specific differences in injury types among basketball players. According to our database, during the 20-year period between October 1991 and June 2011, 1,219 basketball players (640 males and 579 females) consulted our sports medicine clinic; in total, 1,414 injuries in basketball players (729 injuries in males and 685 injuries in females) were recorded. The mean age of patients was 19.6 years. The most common injury site was the knee, followed by the foot and ankle, lower back, and upper extremities. There was a higher proportion of female players presenting with a knee injury, compared with male players (50.4% vs 41.7%), and a lower proportion of female players presenting with an upper extremity injury (5.1% vs 9.7%). The proportion of anterior cruciate ligament injury in the 10–19-year-old age group was higher among female players than among male players (45.9% vs 22.1%), while the proportions of Osgood–Schlatter disease in the 10–19-year-old age group and jumper's knee (patellar and femoral tendinopathy) in the 20–29-year-old age group were higher among male players than among female players (12.5% vs 1.8% and 14.6% vs 3.7%, respectively). However, the proportions of other injuries did not differ significantly between male and female players. The present observational study, which was performed using a retrospective case-series design, showed the existence of sex-specific differences in knee injuries sustained while participating in basketball.Keywords: sports injury, sex, anterior cruciate ligament injury, Osgood–Schlatter disease, basketball

Kento Nakagawa, Takashi Obu, Kazuyuki KanosueFaculty of Sport Sciences, Waseda University, Tokorozawa, Saitama, Japan Purpose: To investigate the potential benefit of post-race wearing of unstable shoes (Masai Barefoot Technology [MBT]) on recovery from marathon race–induced fatigue.Patients and methods: Forty-five runners who participated in a full marathon race were divided into three groups: 1) MBT shoes, 2) trail running shoes, and 3) control (CON). Participants ran a full marathon with their own running shoes, and then put on the assigned shoes immediately after the race. They continued to wear the assigned shoes for the ensuing 3 days. The CON group wore their usual shoes. Estimates of post-race fatigue were made by the participants on questionnaires that utilized a visual analog scale. Estimates were made just after the race, as well as for the next 3 days.Results: The subjective fatigue of the MBT group was lower than that of the CON (P

Nejmeddine Ouerghi,1,2 Marwa Khammassi,1 Sami Boukorraa,1 Moncef Feki,2 Naziha Kaabachi,2 Anissa Bouassida,1,3 1Research Unit, Sportive Performance and Physical Rehabilitation, High Institute of Sports and Physical Education of Kef, University of Jendouba, Kef, Tunisia, 2Laboratory of Biochemistry, Rabta Hospital, Faculty of Medicine of Tunis, El Manar University, Tunis, 3Physiology Laboratory, Faculty of Medicine Ibn el Jazzar, Sousse, Tunisia Background: Data regarding the effect of training on plasma lipids are controversial. Most studies have addressed continuous or long intermittent training programs. The present study evaluated the effect of short-short high-intensity intermittent training (HIIT) on aerobic capacity and plasma lipids in soccer players. Methods: The study included 24 male subjects aged 21–26 years, divided into three groups: experimental group 1 (EG1, n=8) comprising soccer players who exercised in addition to regular short-short HIIT twice a week for 12 weeks; experimental group 2 (EG2, n=8) comprising soccer players who exercised in a regular football training program; and a control group (CG, n=8) comprising untrained subjects who did not practice regular physical activity. Maximal aerobic velocity and maximal oxygen uptake along with plasma lipids were measured before and after 6 weeks and 12 weeks of the respective training program. Results: Compared with basal values, maximal oxygen uptake had significantly increased in EG1 (from 53.3±4.0 mL/min/kg to 54.8±3.0 mL/min/kg at 6 weeks [P

Shinobu Okamura,1 Naoki Wada,1 Masayuki Tazawa,1 Makoto Sohmiya,1 Yoko Ibe,1 Toru Shimizu,1 Shigeru Usuda,2 Kenji Shirakura1 1Department of Rehabilitation Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan; 2Department of Physical Therapy, Gunma University School of Health Science, Maebashi, Gunma, Japan Abstract: This study retrospectively investigated 192 teenage speed and figure skaters with prior injuries documented by an athletes’ questionnaire, who underwent a physical examination to assess their muscle tightness and generalized joint laxity. In all athletes, the degree of muscle tightness and joint laxity were measured by a standardized physical examination. A descriptive report of the types of injuries showed a predominance of fractures, ligament injuries, enthesitis, and lower back pain. Approximately 5% of all skaters tested positive for tightness, while 25.8% of figure skaters and 15.2% of speed skaters had generalized ligamentous laxity. Statistical testing showed an association between ankle sprains and muscle tightness, and an association between knee enthesitis and muscle tightness in skating athletes. There was also an association between lower back pain and generalized joint laxity, which held true only for the male skaters. Keywords: sports injury, skating, junior athlete, tightness, joint laxity, medical checkup

David T Burke,1 David Tran,1 Di Cui,1 Daniel P Burke,2 Samir Al-Adawi,3 Atsu SS Dorvlo41Emory University Medical School, Atlanta, GA, USA; 2Georgia College and State University, GA, USA; 3Department of Behavioral Medicine, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman; 4Department of Mathematics and Statistics, College of Science, Sultan Qaboos University, Muscat, OmanAbstract: In an age of increasing numbers of lifestyle diseases and plasticity of longevity, exercise and weight training have been increasingly recognized as both preventing and mitigating the severity of many illnesses. This study was designed to determine whether significant weight-lifting gains could be realized through the Anatoly Gravitational System. Specifically, this study sought to determine whether this once-weekly weight-training system could result in significant weekly strength gains during a 10-week training period. A total of 50 participants, ranging in age from 17 to 67 years, completed at least 10 weekly 30-minute training sessions. The results suggest participants could, on average, double their weight-lifting capacity within 10 sessions. This preliminary study, which would require further scrutiny, suggests the Anatoly Gravitational System provides a rather unique opportunity to load the musculoskeletal system with extremely high loads, with rapid weekly weight gains, using only short weekly training sessions. More studies are warranted to scrutinize these findings.Keywords: Anatoly Gravitational System, weight training, musculoskeletal systemCorrigendum for this paper has been published.

Takuya Honda1, Hiroharu Kamioka21Research Fellow of the Japanese Society for the Promotion of Science, 2Laboratory of Physical and Health Education, Faculty of Regional Environment Science, Tokyo University of Agriculture, Tokyo, JapanBackground: The purpose of this study was to report on the health benefits and curative effects of aquatic exercise.Methods: We adopted the results of high-grade study designs (ie, randomized controlled trials and nonrandomized controlled trials), for which there were many studies on aquatic exercise. Aquatic exercise, in this study, means walking in all directions, stretching, and various exercises and conditioning performed with the feet grounded on the floor of a swimming pool. We excluded swimming. We decided to treat aquatic exercise, underwater exercise, hydrotherapy, and pool exercise as all having the same meaning.Results: Aquatic exercise had significant effects on pain relief and related outcome measurements for locomotor diseases.Conclusion: Patients may become more active, and improve their quality of life, as a result of aquatic exercise.Keywords: aquatic exercise, health enhancement, evidence

Michael F Joseph1, Craig R Denegar1, Elaine Horn1, Bradley MacDougall1, Michael Rahl1, Jessica Sheehan1, Thomas Trojian2, Jeffery M Anderson1, James E Clark1, William J Kraemer11Department of Kinesiology, 2Department of Sports Medicine, University of Connecticut, Storrs, CT, USAAbstract: Lower extremity mechanics during landing have been linked to traumatic and nontraumatic knee injuries, particularly in women’s athletics. The effects of efforts to mitigate these risks have not been fully elucidated. We previously reported that a 5° medial wedge reduced ankle eversion and knee valgus. In the present report we further investigated the effect of a 5° medial wedge inserted in the shoes of female athletes on frontal plane hip motion, as well as ankle, knee, hip, and trunk saggital plane motion during a jump landing task. Kinematic data were obtained from 10 intercollegiate female athletes during jump landings from a 31 cm platform with and without a 5° medial wedge. Hip adduction was reduced 1.98° (95% CI 0.97–2.99°) by the medial wedge but saggital plane motions were unaffected. A 5° medial wedge reduces frontal plane motion and takes the knee away from a position associated with anterior cruciate ligament injury and patellofemoral pain syndrome. Although frontal plane motion was not captured it is unlikely to have increased in a bilateral landing task. Thus, it is likely that greater muscle forces were generated in these highly trained athletes to dissipate ground reaction forces when a medial wedge was in place. Additional investigation in younger and lesser trained athletes is warranted to assess the impact of orthotic devices on knee joint mechanics.Keywords: jump landing, foot orthotic, lower extremity kinematics, knee biomechanics, knee injury

Rafael Júlio de Freitas Guina Fachina,1,2 Marília dos Santos Andrade,3 Fernando Roberto Silva,4 Silas Waszczuk-Junior,4 Paulo César Montagner,1 João Paulo Borin,1 Claudio Andre Barbosa de Lira5 1Departamento de Ciência do Esporte, Faculdade de Educação Física, Universidade Estadual de Campinas (UNICAMP), Campinas, Brazil; 2Confederação Brasileira de Basketball (CBB), Rio de Janeiro, Brazil; 3Departamento de Fisiologia, Universidade Federal de São Paulo, São Paulo, Brazil; 4Grêmio Barueri Futebol LTDA, Barueri, Brazil; 5Setor de Fisiologia Humana e do Exercício, Universidade Federal de Goiás, Câmpus Jataí, Jataí, Brazil Abstract: Soccer, which has a large number of participants, has a high injury incidence that causes both financial and time burdens. Therefore, knowledge about the epidemiology of soccer injuries could allow sports-medicine professionals, such as physicians and physiotherapists, to direct their work in specific preventive programs. Thus, our aim was to conduct an epidemiological survey of injuries sustained by professional soccer players from the same team who participated in the Brazilian championship premier league in 2009. To this end, we evaluated retrospectively player medical records from the team, which included name, date of birth, position, date of injury, mechanism of injury, and type of injury. In the period of study, 95 injuries were recorded: 42 (44.2%) were recorded during matches, and 53 (55.8%) during the training period. Injuries occurred more frequently in midfielders and strikers. All injuries happened in the lower limb, most of the injuries were muscular, and most occurred as the result of collisions with other athletes. In summary, this study demonstrates that there is a need for greater safety awareness in the training environment. Keywords: injuries, epidemiology, soccer players

Håvard Østerås,1 Kirsti Krohn Garnæs,2 Liv Berit Augestad3 1Department of Physical Therapy, Faculty of Health Education and Social Work, Sør-Trøndelag University College, Trondheim, Norway; 2Department of Human Movement Science, Norwegian University of Science and Technology, Trondheim, Norway; 3Department of Human Movement Science, Norwegian University of Science and Technology, Trondheim, Norway Abstract: The purpose was to examine musculoskeletal disorders in Norwegian female biathlon athletes (age ≥ 16), both juniors and seniors. The design was a retrospective cross-sectional study. In all, 148 athletes (79.1%) responded; of these, 118 athletes were 16–21 years (juniors) (77.6%), and 30 athletes were 22 years or older (seniors) (20.3%), and mean age was 19.1. A validated questionnaire was used to collect the data. The prevalence of musculoskeletal disorders was 57.8%. The most affected parts were the knee (23.0% of the total injuries), calf (12.2%), ankle/foot (10.8%), lower back (10.8%), and thigh (10.1%). The disorders resulted in training/competition cessation for 73.5% of athletes, in alternative training for 87.8%. Fifty percent of the athletes had one or several musculoskeletal disorders. Most of the problems occurred preseason, and the duration of symptoms was often prolonged. Few differences between the juniors and seniors were found. This study showed the prevalence of musculoskeletal problems among female biathlon athletes. The results indicate that prevention of lower limb problems must be prioritized, especially during the preseason. Keywords: injuries, cross-country skiing, skating

Objective Evaluation of elite athletes’ psycho-physiological condition at various stages of preparation and in international competition. Design Athletes were tested during training and participation in international competition using methods of galvanic skin response (GSR) and gas discharge visualization (GDV). Setting Saint Petersburg Federal Research Institute of Physical Culture and Sport, Russia and Paralympic athletic training camp, Norway. Participants Eighteen athletes from Russia’s Skiing and Biathlon Paralympic Team. All athletes had some level of damage to their musculoskeletal system. Main outcome measures Stress level (SL), energy potential (EP), and psycho-emotional tension (PET). Results It was found that the higher the level of EP achieved by the athlete in the training period, the lower the SL in the competition time. The SL of an athlete recorded in the training period significantly correlates with the SL both before and at the time of competition. The PET and SL before the World Cup was negatively correlated to the results of skiing competitions. Conclusion Evaluation of PET, EP, and SL through GSR and GDV offers a fast, highly precise, non-invasive method to assess an athlete’s level of readiness during both training and at the time of competition., Video abstract

Håkan Alfredson1,2 1Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden; 2Institute of Sport, Exercise and Health, University College London Hospitals, London, UKBackground: There is a general opinion that a structured and specific rehabilitation is needed after treatment of midportion Achilles tendinopathy to minimize recurrence of the condition. There is sparse knowledge about the recurrence rates in large patient materials after specific treatments for midportion Achilles tendinopathy.Aim: This study aimed to investigate the recurrence rates in a large number of patients with chronic painful midportion Achilles tendinopathy that had been surgically treated with the ultrasound (US) and Doppler (DP)-guided mini-surgical scraping technique. Postoperatively, a relatively simple rehabilitation protocol, including a range of movement exercises and gradually increased walking and biking before allowing free activity, was used.Materials and methods: From a database, information about the recurrence rates after US + DP-guided mini-surgical scraping, performed by a single surgeon on 519 tendons with US + DP-verified chronic painful midportion Achilles tendinopathy, was obtained.Results: Recurrence of painful midportion Achilles tendinopathy was found in 26 of 519 (5%) operated tendons, 13 from women and 13 from men. In 13 tendons, a close by located plantaris tendon was extirpated during the reoperation.Conclusion: In this large material on patients treated with US + DP-guided mini-surgical scraping for midportion Achilles tendinopathy, there were few recurrences, although only a simple and nonspecific rehabilitation protocol was used.Keywords: Achilles midportion, ultrasound, Doppler, mini-surgical scraping technique

Ridha Sallaoui1–3, Ines Zendah2, Habib Ghedira2, Mohcine Belhaouz3, Mourad Ghrairi3, Mohamed Amri31Issep Sfax, Unité de Recherche “Les déterminants psychoculturels et biologiques de l'accès à la haute performance sportive,” Sfax; 2Department of Lung Function Testing, Abderrahmen Mami Pneumo-Allergology Hospital, Department III, Tunis, Tunisia; 3Laboratoire de Physiologie de la Nutrition, Faculté des Sciences de Tunis, El Manar 1060 Tunis, TunisiaAbstract: Many studies have shown an increased risk of developing exercise-induced bronchoconstriction among the athletic population, particularly at the elite level. Subjective methods for assessing exercise-induced bronchoconstriction such as surveys and questionnaires have been used but have resulted in an underestimation of the prevalence of airway dysfunction when compared with objective measurements. The aim of the present study was to compare the prevalence of exercise-induced bronchoconstriction among Tunisian elite athletes obtained using an objective method with that using a subjective method, and to discuss the possible causes and implications of the observed discrepancy. As the objective method we used spirometry before and after exercise and for the subjective approach we used a medical history questionnaire. All of the recruited 107 elite athletes responded to the questionnaire about respiratory symptoms and medical history and underwent a resting spirometry testing before and after exercise. Post-exercise spirometry revealed the presence of exercise-induced bronchoconstriction in 14 (13%) of the elite athletes, while only 1.8% reported having previously been diagnosed with asthma. In conclusion, our findings indicate that medical history-based diagnoses of exercise-induced bronchoconstriction lead to underestimations of true sufferers.Keywords: exercise-induced bronchoconstriction, elite athletes, self-reported asthma

Rosario Barone1, Filippo Macaluso2, Marcello Traina3,4, Vincenza Leonardi4,5, Felicia Farina1, Valentina Di Felice11Human Anatomy Section 'E. Luna', BioNeC, University of Palermo, Palermo, Italy; 2Department of Physiological Science, Stellenbosch University, Stellenbosch, South Africa; 3Department of Internal Medicine, Cardiovascular and Renal Diseases, 4Methods and Didactics of Motory Activities, DISMOT, 5Department of General Surgery, Emergency and Organ Transplants (GENURTO), University of Palermo, Palermo, Italy Rosario Barone and Filippo Macaluso contributed equally to the workAbstract: The purpose of this study was to analyze the differences in standing balance during dominant and nondominant one-legged stance among athletes of different sports and sedentary subjects. The right-footed subjects of four groups (sedentary, n = 20; soccer, n = 20; basketball, n = 20; windsurfer n = 20) underwent 5-sec unipedal (left and right foot) stabilometric analysis with open eyes and closed eyes to measure center of pressure (COP) sway path and COP velocity (mean value, anteroposterior, and laterolateral in millimeters per second). The soccer group showed better standing balance on the left leg than the sedentary group (P < 0.05). No other significant differences were observed within and amongst groups. The soccer players have a better standing balance on the nondominant leg because of soccer activity.Keywords: body sway, bipedal stance, center of pressure, sport practice

Marie-Ludivine Chateau-Degat1, Gérard Papouin2, Philippe Saint-Val3, Antonio Lopez21Axe sante des populations et environmentale, CHUQ, Laval University, Quebec, Canada; 2Service de Cardiologie, Centre Hospitalier Territorial du Taone, 3Fédération Tahitienne de Karaté, Papeete, French PolynesiaBackground: Aging is associated with a decrease in physical skills, sometimes accompanied by a change in quality of life (QOL). Long-term martial arts practice has been proposed as an avenue to counter these deleterious effects. The general purpose of this pilot study was to identify the effects of an adapted karate training program on QOL, depression, and motor skills in 50-year-old men.Methods and design: Fifteen 50-year-old men were enrolled in a one-year prospective experiment. Participants practiced adapted karate training for 90 minutes three times a week. Testing sessions, involving completion of the MOS 36-item Short Form Health Survey (SF36) and Beck Depression Inventory, as well as motor and effort evaluation, were done at baseline, and six and 12 months.Results: Compared with baseline, participants had better Beck Depression Inventory scores after one year of karate training (P < 0.01) and better perception of their physical health (P < 0.01), but not on the mental dimension (P < 0.49). They also improved their reaction time scores for the nondominant hand and sway parameters in the eyes-closed position (P < 0.01).Conclusion: Regular long-term karate practice had favorable effects on mood, perception of physical health confirmed by better postural control, and improved performance on objective physical testing. Adapted karate training would be an interesting option for maintaining physical activity in aging.Keywords: karate, balance, training, sport, aging

Christian Ehrnthaller,1 Heinz Kusche,2 Florian Gebhard1 1Department of Traumatology, Hand-, Plastic-, and Reconstructive Surgery, Center of Surgery, University of Ulm, Germany; 2Department of Traumatology and Orthopedics, Garmisch-Partenkirchen Medical Center, Germany Introduction: Little is known about the distribution of injuries in competitive snowboarding and there are no reports describing long-term complications of professional snowboarding. To examine the injury distribution and long-term impairments in active and retired professional snowboarders, a retrospective data analysis was performed using a questionnaire. As a control group, injuries of recreational snowboarders of a southern German university clinic were examined. Methods: Retired and active snowboarders were identified from the result lists of the International Ski Federation (FIS) and from the current team lists of the German-speaking European national snowboard teams. After identification, a questionnaire regarding injury distribution/treatment was sent to the athletes and the filled-in questionnaires were subsequently evaluated. Injuries in recreational snowboarding were evaluated by analyzing the medical records and surgical reports for a seven-year period. Results: Compared to the available literature, significantly more severe injuries that necessitated surgical treatment in recreational snowboarders were documented. Most injuries accounted for wrist fractures but also many nonunions and spinal fractures were recorded. Between active professionals, distinct differences in injury distribution were found. The number of days off differed greatly with less days in speed disciplines (35.5 days) and the maximum number of days off in snowboardcross (51 days). Injury distribution varied clearly with more injuries of the upper extremity and ankle in speed disciplines compared to snowboardcross and freestyle professionals, who exhibited more injuries to the lower extremity and head. Freestyle athletes used significantly less protectors compared to speed (P=0.01) and snowboardcross athletes (P=0.00). An analysis of retired professionals revealed a higher number of impairments in daily life and a significantly higher number of days off snowboarding (P=0.018). Conclusion: Knowledge about snowboard-specific injuries is a requirement for an appropriate treatment of these patients. This first description of long-term impairments after professional snowboarding highlights the importance of the development of specific strategies to prevent daily life impairments after a professional sports career. Keywords: snowboarding, injury-distribution, professional snowboarding

Yusuke Osawa,1,2,* Koichiro Azuma,3,* Shogo Tabata,3 Fuminori Katsukawa,2 Hiroyuki Ishida,2 Yuko Oguma,2 Toshihide Kawai,4 Hiroshi Itoh,4 Shigeo Okuda,5 Hideo Matsumoto3 1Japan Society for the Promotion of Science, Graduate School of Arts and Sciences, University of Tokyo, Tokyo, Japan; 2Sports Medicine Research Center, Keio University, Kanagawa, Japan; 3Institute for Integrated Sports Medicine, School of Medicine, Keio University, Tokyo, Japan; 4Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Japan; 5Department of Radiology, School of Medicine, Keio University, Tokyo, Japan *Yusuke Osawa and Koichiro Azuma are co-first authors of this article Abstract: It is unclear whether combined leg and arm high-intensity interval training (HIIT) improves fitness and morphological characteristics equal to those of leg-based HIIT programs. The aim of this study was to compare the effects of HIIT using leg-cycling (LC) and arm-cranking (AC) ergometers with an HIIT program using only LC. Effects on aerobic capacity and skeletal muscle were analyzed. Twelve healthy male subjects were assigned into two groups. One performed LC-HIIT (n=7) and the other LC- and AC-HIIT (n=5) twice weekly for 16 weeks. The training programs consisted of eight to 12 sets of >90% VO2 (the oxygen uptake that can be utilized in one minute) peak for 60 seconds with a 60-second active rest period. VO2 peak, watt peak, and heart rate were measured during an LC incremental exercise test. The cross-sectional area (CSA) of trunk and thigh muscles as well as bone-free lean body mass were measured using magnetic resonance imaging and dual-energy X-ray absorptiometry. The watt peak increased from baseline in both the LC (23%±38%; P

Background Many national and international organizations recommend that adults achieve at least 150 minutes of aerobic physical activity (PA) weekly, at a minimum moderate intensity to optimize health benefits. It is unknown if people who consider themselves as active have the ability to identify what is considered moderate intensity. Methods Fifty-one participants who reported achieving a minimum 150 minutes per week at a minimum of moderate intensity PA were recruited through a local fitness facility. All participants underwent a single assessment involving questionnaires, clinical measures, and a treadmill test to measure the ability to perceive moderate intensity. Following the visit, participants’ PA level was evaluated by heart rate monitor, while exercising, for 7 consecutive days. Results Eighty percent of participants overestimated moderate intensity on the treadmill test; they were at vigorous intensity compared to what is considered moderate. Only 11.8% of participants accurately identified moderate intensity; all of them were women (P=0.03), had a high level of education (P=0.04), and knew that moderate intensity was the minimum intensity recommended by health organizations (P, Video abstract

David T Burke,1 Regina Bell,1 Samir Al-Adawi,2 Ariel Alexandroni,1 Atsu Dorvlo,3 Daniel P Burke4 1Emory University School of Medicine, Atlanta, Emory University, GA, USA; 2Department of Behavioral Medicine, College of Medicine and Health Sciences, 3Department of Mathematics and Statistics, College of Science, Sultan Qaboos University, Muscat, Oman; 4Georgia College and State University, Milledgeville, GA, USA Background: A preliminary study using the "gravitational wellness" weightlifting technique demonstrated this to be a unique technique for loading the musculoskeletal system with extremely high loads over short arcs. This leads to rapid weekly strength gains using 30-minute weekly training sessions. This study was designed to further assess the benefit–risk ratio of the gravitational wellness weightlifting technique. Purpose: This descriptive/retrospective study examined musculoskeletal and well-being outcomes as well as injuries reported by consecutive participants at one gravitational wellness gym. Materials and methods: All adults presenting for training at the Atlanta, Georgia, gravitational wellness system facility over a 6-month period were invited to participate. Data were obtained by telephone interview concerning the presenting complaint/objective of training, subjective outcome, weights lifted, and injuries incurred during training. Results: Of the 77 participants contacted via telephone, 92% agreed to participate (male, n=40; female, n=31). The participants ranged in age from 18 years to 69 years, with a mean age of 48.6 years. Of these, 42 (59%) presented to the gym with the objective of improving a defined musculoskeletal issue. The modal of these was chronic low-back pain. The subjects realized improvement on a 5-point Likert scale of 4.2/5 for their presenting complaint, and improved by 4.27/5 in their overall subjective health. There were no injuries. Conclusion: This study of consecutive participants at a gravitational wellness gym found that by lifting large weights over short arcs 30 minutes per week, participants significantly increased their strength, reduced their musculoskeletal pain, improve their subjective well-being, and reported a low rate of injury. Keywords: gravitational wellness system, rate of injuries, weight training, descriptive study

Nicholas P Bent,1 Alison B Rushton,1 Chris C Wright,1 Emma-Jane Petherick,2 Mark E Batt3 1School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, 2School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, 3Centre for Sports Medicine, Nottingham University Hospitals, Nottingham, UK Background: The Anteromedial Reach Test is a performance-based outcome measure for evaluating dynamic knee stability in patients with anterior cruciate ligament injury. No previously published study has adequately evaluated intrarater or interrater reliability of the Anteromedial Reach Test, so the purpose of this study was to assess these measurement properties in healthy participants prior to their investigation in patients with anterior cruciate ligament injury. Methods: Two raters (A and B) tested 39 healthy university staff and students (20 men, 19 women). For the intrarater reliability investigation, rater A tested participants on three separate test occasions (days 1, 2, and 3) at the same time of day. For the interrater reliability investigation, raters A and B independently tested participants on the same test occasion (day 3). Results: There was no significant systematic bias between test occasions or raters. Values of the intraclass correlation coefficient (2,1) were 0.96 for intrarater reliability of both the dominant leg and nondominant leg and 0.97 (dominant leg) and 0.98 (nondominant leg) for interrater reliability. Values for the standard error of measurement were 1.46 (dominant leg) and 1.62 (nondominant leg) for the intrarater investigation, and 1.26 (dominant leg) and 1.04 (nondominant leg) for the interrater investigation. At the 90% confidence level, the minimum detectable change was 3.8% and the error in an individual's score at a given point in time was ±2.7%. Conclusion: The Anteromedial Reach Test demonstrated excellent intrarater and interrater reliability in healthy participants. This provides a basis for future investigation of the measurement properties of the Anteromedial Reach Test in patients with anterior cruciate ligament injury. Keywords: anterior cruciate ligament, injury, dynamic stability, rehabilitation, outcome measures

Shane D Scholten,1 Igor N Sergeev21Department of Natural Sciences, University of Sioux Falls, Sioux Falls, SD, USA; 2Department of Health and Nutritional Sciences, South Dakota State University, Brookings, SD, USAPurpose: To evaluate the effects of chronic quercetin supplementation on endurance performance and antioxidant status in long distance runners. We hypothesized that an improved antioxidant status can be associated with enhanced performance.Methods: During 6 weeks of supplementation utilizing a double blind, randomized design, young male subjects received quercetin (1000 mg/day) or placebo while maintaining their current training schedules.Results: Following the end of the supplementation period, there was a significant time × supplement interaction for serum malondialdehyde (MDA), an indicator of lipid peroxidation. There were no significant pre- to post-supplement changes in parameter values employed for measuring total antioxidant capacity, superoxide dismutase activity, and protein oxidation (protein carbonyl) in serum. There were also no significant pre- to post-supplement differences in VO2peak, running economy, heart rate, and rating of perceived exertion (RPE) during the 10 km time trial.Conclusion: The findings obtained indicate that there is a relationship between quercetin supplementation and the statistically significant decreasing trend in MDA levels following 6 weeks of supplementation and training. This evidence suggests that quercetin can reduce oxidative stress (lipid peroxidation). However, performance improvements were not significant (as measured by VO2peak, running economy, heart rate, and RPE).Keywords: quercetin, antioxidant capacity, oxygen consumption, running economy, exercise performance

Romuald Lepers,1 Paul J Stapley,2 Beat Knechtle3,41INSERM U1093, University of Burgundy, Dijon, France; 2School of Health Sciences, University of Wollongong, Wollongong, New South Wales, Australia; 3Institute of General Practice and Health Services Research, University of Zurich, Zurich, Switzerland; 4Gesundheitszentrum St Gallen, St Gallen, SwitzerlandBackground: The purpose of the study was (1) to examine the changes in participation and performance of males and females at the Oita International Wheelchair Marathon in Oita, Japan, between 1983 and 2011, and (2) to analyze the gender difference in the age of peak wheelchair marathon performance.Methods: Age and time performance data for all wheelchair athletes completing the Oita International Wheelchair Marathon from 1983 to 2011 were analyzed.Results: Mean annual number of finishers was 123 ± 43 for males and 6 ± 3 for females (5.0% ± 2.0% of all finishers), respectively. Mean age of overall finishers was significantly (P = 0.026) greater for males (41.3 ± 1.8 years) compared to females (32.7 ± 1.4 years). In contrast, there was no difference in the mean age of the top three overall finishers between males (35.8 ± 3.2 years) and females (31.6 ± 1.5 years). The race time of the top three overall finishers was significantly lower (P < 0.01) for males (1:34 ± 0:11 hours:minutes) compared to females (1:59 ± 0:20 hours:minutes), but it was not significantly different between male (2:06 ± 0:12 hours:minutes) and female (2:12 ± 0:18 hours:minutes) overall finishers. The mean gender difference in time was 26.1% ± 9.7% for the top three overall finishers.Conclusion: Further studies are required to investigate the reasons for the low participation of females in wheelchair marathons and why the gender difference in marathon performance is much greater for disabled athletes than for able-bodied athletes.Keywords: endurance, sex difference, disabled athlete, spinal cord injury