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Michael Kinchington1, Kevin Ball1, Geraldine Naughton21School of Human Movement, Recreation and Performance, Victoria University, Melbourne, Australia; 2The Centre of Physical Activity Across the Lifespan (COPAAL), Australian Catholic University, Victoria, AustraliaAims and Objectives: This study extends previous work in the field of injury awareness using a novel lower limb comfort index (LLCI), which was developed to assess comfort in professional football. Participants rated comfort for designated anatomical segments of the lower limb utilizing a seven point Likert scale. The aims of the study were (i) to assess the reliability of the LLCI in a competitive football environment (Australian Rules and Rugby League), and (ii) to assess whether LLCI measurements were responsive to changes in lower limb comfort over time.Methods and Results: The reliability of the LLCI was observed in two professional football environments: Training Week (mean difference 0.1 point, intra-class correlation coefficient, ICC 0.99) for n = 41 participants; and Match Day (mean difference 0.2 points, ICC 0.97) for n = 22 players. Measurements of lower limb comfort were responsive to changes in comfort over time. Within-player differences were not significant for periods 0–8 hrs (P > 0.05) but, generally, significant for time periods 0–24 hrs (P < 0.05), and significant between 24–96 hrs (P < 0.01). The results indicate that the LLCI was reliable when tested for repeated measures and indicated how the index measures lower limb comfort changes over time.Conclusion: This study shows that the use of a lower limb comfort index, when used in a competitive football environment, is both reliable and responsive to change during both a training week and under match day conditions.Keywords: lower limb comfort, musculoskeletal, football, injury

John Orchard1, Trefor James2, Alex Kountouris2, Marc Portus21School of Public Health, University of Sydney, Sydney, Australia; 2Cricket Australia, Melbourne, AustraliaAbstract: This study analyzes injuries occurring prospectively in Australian men’s cricket at the state and national levels over 11 seasons (concluding in season 2008–09). In the last four of these seasons, there was more cricket played, with most of the growth being a new form of the game – Twenty20 cricket. Since the introduction of a regular Twenty20 program, injury incidence rates in each form of cricket have been fairly steady. Because of the short match duration, Twenty20 cricket exhibits a high match injury incidence, expressed as injuries per 10,000 hours of play. Expressed as injuries per days of play, Twenty20 cricket injury rates compare more favorably to other forms of cricket. Domestic level Twenty20 cricket resulted in 145 injuries per 1000 days of play (compared to 219 injuries per 1000 days of domestic one day cricket, and 112 injuries per 1000 days of play in first class domestic cricket). It is therefore recommended that match injury incidence measures be expressed in units of injuries per 1000 days of play. Given the high numbers of injuries which are of gradual onset, seasonal injury incidence rates (which typically range from 15–20 injuries per team per defined ‘season’) are probably a superior incidence measure. Thigh and hamstring strains have become clearly the most common injury in the past two years (greater than four injuries per team per season), perhaps associated with the increased amount of Twenty20 cricket. Injury prevalence rates have risen in conjunction with an increase in the density of the cricket calendar. Annual injury prevalence rates (average proportion of players missing through injury) have exceeded 10% in the last three years, with the injury prevalence rates for fast bowlers exceeding 18%. As the amount of scheduled cricket is unlikely to be reduced in future years, teams may need to develop a squad rotation for fast bowlers, similar to pitching staff in baseball, to reduce the injury rates for fast bowlers. Consideration should be given to rule changes which may reduce the impact of injury. In particular, allowing the 12th man to play as a full substitute in first class cricket (and therefore take some of the bowling workload in the second innings) would probably reduce bowling injury prevalence in cricket.Keywords: injury profile, cricket, sport, Twenty 20

Christina M Chingkoe1, JeremyH White2, Luck J Louis2, Gordon Andrews2, Bruce B Forster21Faculty of Medicine, University of British Columbia, Vancouver BC, Canada; 2Department of Radiology, University of British Columbia, Vancouver BC, CanadaAbstract: Rotator cuff pathology is routinely evaluated in many imaging centers with both magnetic resonance imaging (MRI) and ultrasound. Despite good diagnostic accuracy using each of these modalities, certain limitations persist. In this pictorial essay, we describe five potential “troublemakers” of rotator cuff pathology which are recurrent themes in our busy shoulder referral center. The comparison of imaging findings on MRI and ultrasound are discussed. An awareness of these potential pitfalls will help improve radiologists’ diagnostic accuracy of rotator cuff pathology, and allow the clinician to optimize imaging referral and better interpret the subsequent report.Keywords: rotator cuff, ultrasound, MRI, correlation, shoulder

Nicola Maffulli1, Umile Giuseppe Longo2, Mattia Loppini2, Filippo Spiezia2, Vincenzo Denaro21Centre for Sports and Exercise Medicine, Queen Mary University of London, Barts and The London School of Medicine and Dentistry, Mile End Hospital, London, England; 2Department of Orthopedic and Trauma Surgery, Campus Biomedico University, Rome, ItalyAbstract: Tendon injuries can be acute or chronic, and caused by intrinsic or extrinsic factors, either alone or in combination. Tendinopathies are a common cause of disability in occupational medicine and account for a substantial proportion of overuse injuries in sports. Tendinopathy is essentially a failed healing response, with haphazard proliferation of tenocytes, abnormalities in tenocytes, with disruption of collagen fibres and subsequent increase in noncollagenous matrix. The scientific evidence base for managing tendinopathies is limited. What may appear clinically as an “acute tendinopathy” is actually a well advanced failure of a chronic healing response in which there is neither histologic nor biochemical evidence of inflammation. In this review we report the new options for the management of tendinopathy, including eccentric exercises, extracorporeal shockwave therapy, injections (intratendinous injections of corticosteroids, aprotinin, polidocanol platelet-rich plasma, autologous blood injection, high-volume injections) and surgery. Open surgery aims to excise fibrotic adhesions, remove areas of failed healing and make multiple longitudinal incisions in the tendon to detect intratendinous lesions, and to restore vascularity and possibly stimulate the remaining viable cells to initiate cell matrix response and healing. New surgical techniques aim to disrupt the abnormal neoinnervation to interfere with the pain sensation caused by tendinopathy. These procedures are intrinsically different from the classical ones in present use, because they do not attempt to address directly the pathologic lesion, but act only to denervate them. They include endoscopy, electrocoagulation, and minimally invasive stripping. Further randomized controlled trials are necessary to clarify better the best therapeutic options for the management of tendinopathy.Keywords: tendon, tendinopathy, management, injections, surgery, sports