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ObjectivePopulation-based osteoarthritis (OA) cohorts provide vital data on risk factors and outcomes of OA, however the methods to define OA vary between cohorts. We aimed to provide recommendations for combining knee and hip OA data in extant and future population cohort studies, in order to facilitate informative individual participant level analyses.MethodInternational OA experts met to make recommendations on: 1) defining OA by X-ray and/or pain; 2) compare The National Health and Nutrition Examination Survey (NHANES)-type OA pain questions; 3) the comparability of the Western Ontario & McMaster Universities Osteoarthritis Index (WOMAC) scale to NHANES-type OA pain questions; 4) the best radiographic scoring method; 5) the usefulness of other OA outcome measures. Key issues were explored using new analyses in two population-based OA cohorts (Multicenter Osteoarthritis Study; MOST and Osteoarthritis Initiative OAI).ResultsOA should be defined by both symptoms and radiographs, with symptoms alone as a secondary definition. Kellgren and Lawrence (K/L) grade ≥2 should be used to define radiographic OA (ROA). The variable wording of pain questions can result in varying prevalence between 41.0% and 75.4%, however questions where the time anchor is similar have high sensitivity and specificity (91.2% and 89.9% respectively). A threshold of 3 on a 0-20 scale (95% CI 2.1, 3.9) in the WOMAC pain subscale demonstrated equivalence with the preferred NHANES-type question.ConclusionThis research provides recommendations, based on expert agreement, for harmonising and combining OA data in existing and future population-based cohorts.

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

The anteromedial reach test (ART) is a new outcome measure for assessing dynamic knee stability in anterior cruciate ligament-injured patients. The effect of learning and leg length on distance reached in the ART was examined. Thirty-two healthy volunteers performed 15 trials of the ART on each leg. There was a moderate correlation (r = .44-.50) between reach distance and leg length, therefore reach distances were normalized for leg length. Normalized reach distance increased significantly over the 15 trials (p < .01), reaching a plateau after 8 trials, identified by a moving average graph. It is recommended that participants be afforded eight practice trials and that reach distances be normalized by expressing them as a percentage of leg length. [ABSTRACT FROM AUTHOR]

Using examples from the field of anterior cruciate ligament rehabilitation, this review provides sports and health practitioners with a comprehensive, user-friendly, guide to selecting outcome measures for use with active populations. A series of questions are presented for consideration when selecting a measure: is the measure appropriate for the intended use? (appropriateness); is the measure acceptable to patients? (acceptability); is it feasible to use the measure? (feasibility); does the measure provide meaningful results? (interpretability); does the measure provide reproducible values? (reliability); does the measure assess what it is supposed to assess? (validity); can the measure detect change? (responsiveness); do substantial proportions of patients achieve the worst or best scores? (floor and ceiling effects); is the measure structured and scored correctly? (dimensionality and internal consistency); has the measure been tested with the types of patients with whom it will be used? (sample characteristics). Evaluation of the measure using these questions will assist practitioners in making their judgements. [ABSTRACT FROM AUTHOR]

Initial management of chest pain in athletes always should involve assessment for serious, life-threatening causes, such as myocardial infarction. However, atypical chest pain, or chest pain not due to myocardial ischaemia, is a common presentation in the athletic population. This review looks at the possible causes of atypical chest pain in athletes, focusing upon conditions that are more common in athletes than the general population or that have a link to exercise. Causes can be grouped due to the system involved (musculoskeletal, gastrointestinal, respiratory, cardiac) with more common causes including rib stress fractures, costochondritis, muscle strain, gastroesophageal reflux, and exercise-induced asthma. Psychogenic causes can be common in children/adolescents. Return to play is discussed, with some conditions such as myocarditis warranting a long (at least 6 months) absence from training, whereas others such as precordial catch require nothing more than reassurance. [ABSTRACT FROM AUTHOR]

Objectives: To determine whether young fast bowlers are exceeding directives limiting bowling and how incidence of fast bowling injury varies with amount of bowling.Methods: A prospective cohort study of injuries sustained by 70 fast bowlers (mean (SD) age 15.3 (2.4) years) was undertaken. Bowlers were recruited from the Centres of Excellence of three "First Class" counties in England in January 1998. Details of injuries were collected by telephone questionnaire every six weeks for six months from each bowler. The number of balls bowled in matches and practices by each bowler was recorded. The cohort was divided into groups according to the number of balls bowled in the study period, and bowling injury incidences were calculated for each group.Main Outcome Measures: All injuries caused by bowling and interfering with bowling.Results: Telephone follow up was achieved when planned on 97.9% of occasions. There were 23 bowling injuries reported in the study period that met the inclusion criteria. The overall incidence of bowling injury in the study period was 32.8 per 100 fast bowlers. The incidence of bowling injury for the 15 bowlers who bowled less than 1000 balls in the study period was 20.0 per 100 fast bowlers. The incidence for the 32 who bowled 1000-2000 balls was 37.5 per 100 fast bowlers. The incidence for the 14 who bowled 2000-3000 balls was 35.7 per 100. The incidence for the nine who bowled more than 3000 balls was 33.3 per 100.Conclusions: The expected increased incidence of bowling injury in young fast bowlers who bowl most was not observed, although more than 12% exceeded the recommended limit. [ABSTRACT FROM AUTHOR]

Athletes who participate in sports that require repetitive twisting and turning at speed, such as soccer or ice hockey, may be at risk of developing a 'sports hernia'--disruption of the inguinal canal without a clinically detectable hernia. Insidious onset of unilateral groin pain is the most common symptom. Concurrent pathologies, such as osteitis pubis and adductor tenoperiostitis, may complicate diagnosis. Plain radiographs and a bone scan can aid differential diagnosis, but herniography is not recommended. Surgery is the preferred treatment. Structured rehabilitation should enable athletes to return to sports activity 6 to 8 weeks after surgery. [ABSTRACT FROM AUTHOR]

Objectives: To assess the effects that the recent seasonal change in rugby league from winter to summer has had on the incidence of injury.Methods: All injuries that occurred during games and training were recorded throughout four consecutive seasons (three winter, one summer) for the first team squad of a British professional rugby league club. Data included nature of injury, days lost as the result of injury, player position, month, and season.Results: An increasing incidence of injury over the four seasons was observed, with the summer seasons having an incidence almost double that of the first winter season recorded (696.8 per 1000 hours and 363.55 per 1000 hours respectively). The severity of injury was shown to decline over the four seasons. Most injuries were incurred in matches (74.9%) rather than during training (25.1%).Conclusions: The findings show an increasing incidence of injury in summer rugby but with decreased severity. It is not known if this is the result of playing back to back rugby seasons or is a consequence of a change in playing season and ground conditions. [ABSTRACT FROM AUTHOR]

Objectives: Metatarsal fractures are commonly sustained during sport but little is written about metatarsal fractures in the athletic population. Demographics and definitive treatment in patients who sustained metatarsal fractures through sport were compared with an overall metatarsal fracture population.Materials and Methods: We used a prospective cohort study from a teaching hospital fracture clinic. Eighteen months of data were coded from presentation with a metatarsal fracture. Demographics, metatarsal fracture, participating sport and treatment were recorded and analysed.Results: 791 patients presented with metatarsal fractures in an 18 month period with 74 metatarsal fractures sustained through sport. In the overall cohort group, there were 443 females and 348 males with a mean age of 44 (age range 15-91) and in the athletic population there were 6 females and 68 males with a mean age of 26 (age range 15-62). The majority of the metatarsal fractures sustained from sport were from soccer (73%), with the fifth metatarsal being the most commonly fractured. The definitive treatment in both groups appears to be similar, where the mainstay of treatment is conservative with the use of cast or early mobilisation with an elasticated support stocking.Conclusion: In this cohort approximately 9% of metatarsal fractures were sustained through sport, with soccer being the most common sport. Following high profile injuries to metatarsals in soccer players, it has been suggested that the incidence of these fractures is rising. Thus, it is recommended that a detailed prospective study be undertaken to specifically study the incidence, aetiology and morbidity of metatarsal fractures in the athletic population. [ABSTRACT FROM AUTHOR]

An elite junior badminton player presented with a chronic painful dominant shoulder after an intense training course. An acute stress fracture to the proximal humeral epiphysis was found. Two-plane radiography will identify abnormalities of the growth plate but comparative films of the unaffected side may also be required to differentiate subtle changes. Rest with subsequent rehabilitation is the appropriate management of these injuries although ideally they should be subjected to primary prevention. [ABSTRACT FROM AUTHOR]

The importance of exercise medicine and its impact on public health has been recognised by sports medicine physicians in Britain. [ABSTRACT FROM AUTHOR]

Introduction and Hypothesis: Pelvic floor dysfunction (PFD) affects many women and participation in elite sport and high-impact exercise has been reported as a potential risk. However, few studies have investigated the effects of exercising at recreational levels on PFD. Our aim was to investigate levels of PFD in women exercising at, or above, UK guidelines for health and compare them with levels in non-exercisers., Method: Data on levels of PFD and potential risk factors (age, hormonal status, body mass index, constipation, parity, forceps delivery, and recreational exercise) were collected using a cross-sectional survey distributed via social media. The International Consultation Incontinence Questionnaire (ICIQ) Urinary Incontinence Short Form was used to estimate prevalence of urinary incontinence (UI). Selected questions from the ICIQ vaginal symptom and bowel symptom questionnaires were used to estimate prevalence of anal incontinence (AI) and pelvic organ prolapse (POP). Logistic regression analysis was used to compare exercisers and non-exercisers after adjusting for potential confounders., Results: We recruited 1,598 adult women (1,141 exercisers and 457 non-exercisers). The majority were parous. High prevalence of UI (70%), AI (52%) and POP (18%) was reported. No significant association was found between recreational exercise and PFD despite adjustment for confounders, or further investigation regarding exercise involving impact, although some increased reporting of AI was seen in those exercising for over 10 hours per week., Conclusion: High levels of all PFD were reported but no significant association was found between recreational exercise and symptoms. However, data suggest that women modify their exercise regimes as required. Few symptomatic women sought professional help., (© 2023. The Author(s).)

Objectives: (1) To determine the prevalence of spine and upper limb osteoarthritis (OA) and pain in retired Olympians; (2) identify risk factors associated with their occurrence and (3) compare with a sample of the general population., Methods: 3357 retired Olympians (44.7 years) and 1735 general population controls (40.5 years) completed a cross-sectional survey. The survey captured demographics, general health, self-reported physician-diagnosed OA, current joint/region pain and significant injury (lasting ≥1 month). Adjusted ORs (aORs) compared retired Olympians and the general population., Results: Overall, 40% of retired Olympians reported experiencing current joint pain. The prevalence of lumbar spine pain was 19.3% and shoulder pain 7.4%, with lumbar spine and shoulder OA 5.7% and 2.4%, respectively. Injury was associated with increased odds (aOR, 95% CI) of OA and pain at the lumbar spine (OA=5.59, 4.01 to 7.78; pain=4.90, 3.97 to 6.05), cervical spine (OA=17.83, 1.02 to 31.14; pain=9.41, 6.32 to 14.01) and shoulder (OA=4.91, 3.03 to 7.96; pain=6.04, 4.55 to 8.03) in retired Olympians. While the odds of OA did not differ between Olympians and the general population, the odds of lumbar spine pain (1.44, 1.20 to 1.73), the odds of shoulder OA after prior shoulder injury (2.64, 1.01 to 6.90) and the odds of cervical spine OA in female Olympians (2.02, 1.06 to 3.87) were all higher for Olympians compared with controls., Conclusions: One in five retired Olympians reported experiencing current lumbar spine pain. Injury was associated with lumbar spine, cervical spine and shoulder OA and pain for Olympians. Although overall OA odds did not differ, after adjustment for recognised risk factors, Olympians were more likely to have lumbar spine pain and shoulder OA after shoulder injury, than the general population., Competing Interests: Competing interests: TS works as Scientific Manager in the Medical and Scientific Department of the IOC. LE is Head of Scientific Activities in the Medical and Scientific Department of the IOC. LE is Editor and KS coeditor of the British Journal of Sports Medicine–Injury Prevention and Health Protection. RB is Director of the Medical and Scientific Department of the IOC., (© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: The effect of physical activity on the risk of developing knee osteoarthritis (OA) is unclear. We undertook this study to examine the relationship between recreational physical activity and incident knee OA outcomes using comparable physical activity and OA definitions., Methods: Data were acquired from 6 global, community-based cohorts of participants with and those without knee OA. Eligible participants had no evidence of knee OA or rheumatoid arthritis at baseline. Participants were followed up for 5-12 years for incident outcomes including the following: 1) radiographic knee OA (Kellgren-Lawrence [K/L] grade ≥2), 2) painful radiographic knee OA (radiographic OA with knee pain), and 3) OA-related knee pain. Self-reported recreational physical activity included sports and walking/cycling activities and was quantified at baseline as metabolic equivalents of task (METs) in days per week. Risk ratios (RRs) were calculated and pooled using individual participant data meta-analysis. Secondary analysis assessed the association between physical activity, defined as time (hours per week) spent in recreational physical activity and incident knee OA outcomes., Results: Based on a total of 5,065 participants, pooled RR estimates for the association of MET days per week with painful radiographic OA (RR 1.02 [95% confidence interval (95% CI) 0.93-1.12]), radiographic OA (RR 1.00 [95% CI 0.94-1.07]), and OA-related knee pain (RR 1.00 [95% CI 0.96-1.04]) were not significant. Similarly, the analysis of hours per week spent in physical activity also showed no significant associations with all outcomes., Conclusion: Our findings suggest that whole-body, physiologic energy expenditure during recreational activities and time spent in physical activity were not associated with incident knee OA outcomes., (© 2021 The Authors. Arthritis & Rheumatology published by Wiley Periodicals LLC on behalf of American College of Rheumatology.)

Background: Targeted self-management programmes may improve health and increase physical activity (PA) in people with multimorbidity., Aim: To investigate the impact of a structured, theoretically driven, self-management group education programme on habitual PA levels in people with multimorbidity., Design and Setting: Individually randomised controlled trial with 12-month follow-up, involving nine primary care practices in Leicestershire, UK., Method: In total, 353 adults with multimorbidity (age 67.8 years [±9 years], 161 male sex) were randomised to intervention ( n = 180) or control ( n = 173) groups. Intervention participants were invited to attend four group-based self-management sessions, centred primarily on increasing PA, and received motivational text-message support. The primary outcome measure was change in overall volume (time and intensity) of daily PA at 12 months, as measured by the GENEActiv wrist-worn accelerometer device., Results: At baseline, the total sample achieved 22 min of moderate-vigorous intensity PA per day (mean/participant). At 12 months, in the complete-case analysis, a reduction in daily mean PA volume was seen in the intervention group relative to control (-0.80 milligravity [m g ]; 95% confidence interval [CI] = -1.57 to -0.03; P = 0.04). Reductions were also seen in the intervention group in time spent in moderate-vigorous PA (-3.86 min per day; 95% CI= -6.70 to -1.03; P = 0.008) and time spent at an intensity equivalent to a slow walk (-4.66 min per day; 95% CI = -8.82 to -0.51; P = 0.028). However, the per-protocol analysis (excluding participants who did not attend at least one education session) found no between-group differences in overall daily PA at 12 months (-0.65 mg; 95% CI = -1.46 to 0.15; P = 0.11)., Conclusion: The self-management programme elicited a slight reduction in PA levels in people with multimorbidity. Future research should identify and target subgroups of those with multimorbidity in greatest need of PA promotion in order to maximise potential capacity for benefit, and also focus on refining the intervention in order to increase efficacy in increasing PA., (© The Authors.)

Background: The relationship between Olympic career sport injury and the long-term musculoskeletal health of the elite athlete remains unclear. This study describes the lifetime prevalence of medical attention injuries that occurred during training and/or competition as part of the athlete's Olympic career, reasons for retirement from Olympic sport, and the point prevalence of pain and osteoarthritis (OA) among retired Great Britain's (GB) Olympians., Methods: This cross-sectional study involved distributing a questionnaire to retired GB Olympians who had competed at 36 Olympic Games between Berlin 1936 and Sochi 2014. The questionnaire captured Olympic career injury history (lasting ≥ 1 month), sport exposure, musculoskeletal pain (last 4 weeks), physician-diagnosed OA, and joint replacement. Injury prevalence was calculated for sports with a minimal of 15 respondents. Adjusted odds ratios (aOR) were estimated in logistic regression for pain, OA, and joint replacement. Models were adjusted for age, sex, BMI, and career duration., Results: Six hundred fifty (57.8% male; 42.2% female) retired athletes representing 40 sports (29 summer; 11 winter), aged 60.5 years (range 23-97), completed the questionnaire. Overall, 721 injuries (368 athletes) were self-reported equating to a lifetime Olympic career injury prevalence of 56.6%. Injury prevalence was highest in field athletics (81.0%), gymnastics (75.0%), and track athletics (67.7%). Injuries most frequently occurred at the knee (19.0%), lower back (15.4%), and shoulder (11.5%). Of those injured, 19.5% retired from sport due to injury. Pain was most prevalent at the lumbar spine (32.8%), knee (25.3%), and hip (22.5%), and OA at the knee (13.4%), hip (10.4%), and lumbar spine (4.6%). Injury was associated with pain at the hip (aOR 4.88; 95% CI, 1.87-12.72, p = 0.001), knee (aOR 2.35; 95% CI, 1.45-3.81, p = 0.001), and lumbar spine (aOR 2.53; 95% CI, 1.63-3.92, p < 0.001); OA at the hip (aOR 5.97; 95% CI, 1.59-22.47, p = 0.008) and knee (aOR 3.91; 95% CI, 2.21-6.94, p < 0.001); and joint replacement at the hip (aOR 8.71; 95% CI, 2.13-35.63, p = 0.003) and knee (aOR 5.29; 95% CI, 2.39-11.74, p < 0.001)., Conclusion: The lifetime prevalence of Olympic career injury was 56.6%, with those injured more likely to self-report current pain and/or OA at the hip, knee, and lumbar spine and joint replacement at the hip and knee., (© 2021. The Author(s).)

Objective: To determine risk factors for 3 knee osteoarthritis (KOA) outcomes, knee pain (KP), radiographic KOA (RKOA), and total knee replacement (TKR) in professional footballers., Design: This was a cross-sectional study involving a postal questionnaire, followed by radiographic assessment in a subcohort of responders., Settings and Participants: Four thousand seven hundred seventy-five questionnaires were sent to retired professional footballers, who had played in the English football league, and 1207 responded. Of these, 470 underwent knee radiographs., Assessment of Risk Factors: Potential factors include age, body mass index (BMI), knee alignment, a history of football-related knee injury, and training hours (during career) were collected through the questionnaire., Main Outcome Measures: Knee osteoarthritis outcomes were current KP (pain for most days of the previous month), TKR (self-reported), and RKOA (observed through radiographs)., Results: Football-related injury was the strongest risk factor for KP [adjusted odds ratio (aOR), 4.22; 95% confidence interval (CI), 3.26-5.48], RKOA [aOR, 2.88; 95% CI, 1.81-4.59], and TKR [aOR, 4.83; 95% CI, 2.87-8.13]. Footballers had a 7% increased risk of RKOA for every 1000 hours trained. Although age and gout were associated with all 3 KOA outcomes, BMI, nodal osteoarthritis (OA), a family history of OA, knee malalignment, and 2D:4D ratio were associated with one or another of these 3 KOA outcomes., Conclusion: This study is the first to examine KOA risk factors in retired professional footballers. The study has identified several risk factors, both specific (eg, knee injury and training dose) and nonspecific (eg, age and gout) to footballers. This may be used to develop prevention strategies to reduce the risk of KOA in professional footballers after retirement., Competing Interests: The authors report no conflicts of interest., (Copyright © 2019 The Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Ankle sprains are one of the most common musculoskeletal injuries, accounting for up to 5% of all Emergency Department visits in the United Kingdom. Ankle injury may be associated with future ankle osteoarthritis. Up to 70% of ankle osteoarthritis cases may be associated with previous ankle injury. There is limited research regarding the association between ankle sprain and ankle osteoarthritis development. The current study aims to phenotype those who suffer significant ankle ligament injuries, identify potential risk factors for ankle injuries and subsequent poor recovery, examine why individuals may develop osteoarthritis, and what factors influence this chance., Methods: In this multicentre cohort study participants were recruited from nine Emergency Departments and two Urgent Care Centres in the United Kingdom. Participants (aged 18-70 years old) were defined as those who had suffered an isolated acute ankle sprain, which was Ottawa Ankle Rules positive, but negative for a significant ankle fracture on x-ray. Age and sex matched controls were also recruited. The controls were individuals who had not suffered a significant ankle injury, including ankle pain, function affected for more than 7 days, or the ankle caused them to report to an Emergency Department. Data is collected through a series of seven questionnaires (at baseline, 3 months, 1 year, 3 years, 5 years, 10 years, and 15 years later). The questionnaires include four sections (demographic questions; index injury, and injury history questions; functional assessment questions; and quality of life questions) and are designed to collect detailed information about the individual, their injury, potential risk factors for ankle sprains and ankle osteoarthritis, plus their medical history and any medication consumed., Discussion: The Significant Ankle Ligament Injury (SALI) study aims to add to the limited knowledge regarding which factors can predict ankle sprains, complaints, and osteoarthritis. This is important because despite ankle sprains being regarded as a benign injury that resolves quickly, residual symptoms are not uncommon months and years after the injury.

Background: Osteoarthritis (OA) is a chronic joint disease, with increasing global burden of disability and healthcare utilisation. Recent meta-analyses have shown a range of effects of OA on mortality, reflecting different OA definitions and study methods. We seek to overcome limitations introduced when using aggregate results by gathering individual participant-level data (IPD) from international observational studies and standardising methods to determine the association of knee OA with mortality in the general population., Methods: Seven community-based cohorts were identified containing knee OA-related pain, radiographs, and time-to-mortality, six of which were available for analysis. A two-stage IPD meta-analysis framework was applied: (1) Cox proportional hazard models assessed time-to-mortality of participants with radiographic OA (ROA), OA-related pain (POA), and a combination of pain and ROA (PROA) against pain and ROA-free participants; (2) hazard ratios (HR) were then pooled using the Hartung-Knapp modification for random-effects meta-analysis., Findings: 10,723 participants in six cohorts from four countries were included in the analyses. Multivariable models (adjusting for age, sex, race, BMI, smoking, alcohol consumption, cardiovascular disease, and diabetes) showed a pooled HR, compared to pain and ROA-free participants, of 1.03 (0.83, 1.28) for ROA, 1.35 (1.12, 1.63) for POA, and 1.37 (1.22, 1.54) for PROA., Discussion: Participants with POA or PROA had a 35-37% increased association with reduced time-to-mortality, independent of confounders. ROA showed no association with mortality, suggesting that OA-related knee pain may be driving the association with time-to-mortality., Funding: Versus Arthritis Centre for Sport, Exercise and Osteoarthritis and Osteoarthritis Research Society International.

Objective: Describe the self-reported prevalence and nature of Olympic-career injury and general health and current residual symptoms in a self-selected sample of retired Olympians., Methods: 3357 retired Olympians from 131 countries completed a cross-sectional online survey, distributed by direct email through World Olympians Association and National Olympian Associations databases. The survey captured Olympic sport exposure, significant training and competition injury history (lasting > 1 month), general health (eg, depression) during the athlete's career, and current musculoskeletal pain and functional limitations., Results: 55% were men (44% women, 1% unknown), representing 57 sports (42 Summer, 15 Winter), aged 44.7 years (range 16-97). A total of 3746 injuries were self-reported by 2116 Olympians. This equated, 63.0% (women 68.1%, men 59.2%) reporting at least one significant injury during their Olympic career. Injury prevalence was highest in handball (82.2%) and lowest in shooting (40.0%) for Summer Olympians; and highest in alpine skiing (82.4%) and lowest in biathlon (40.0%) for Winter Olympians. The knee was the most frequently injured anatomical region (20.6%, 120 median days severity), followed by the lumbar spine (13.1%, 100 days) and shoulder/clavicle (12.9%, 92 days). 6.6% of Olympians said they had experienced depression during their career. One-third of retired Olympians reported current pain (32.4%) and functional limitations (35.9%)., Conclusions: Almost two-thirds of Olympians who completed the survey reported at least one Olympic-career significant injury. The knee, lumbar spine and shoulder/clavicle were the most commonly injured anatomical locations. One-third of this sample of Olympians attributed current pain and functional limitations to Olympic-career injury., Competing Interests: Competing interests: TS works as Scientific Manager in the Medical and Scientific Department of the IOC. LE is Head of Scientific Activities in the Medical and Scientific Depart of the IOC, and Editor of the British Journal of Sports Medicine. RB is Director of the Medical and Scientific Department of the IOC., (© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.)

Training in the medical specialty of sport and exercise medicine (SEM) is available in many, but not all countries. In 2015, an independent Delphi group, the International Syllabus in Sport and Exercise Medicine Group (ISSEMG), was formed to create a basic syllabus for this medical specialty. The group provided the first part of this syllabus, by identifying 11 domains and a total of 80 general learning areas for the specialty, in December 2017. The next step in this process, and the aim of this paper was to determine the specific learning areas for each of the 80 general learning areas. A group of 26 physicians with a range of primary medical specialty qualifications including, Sport and Exercise Medicine, Family Medicine, Internal Medicine, Cardiology, Rheumatology and Anaesthetics were invited to participate in a multiple round online Delphi study to develop specific learning areas for each of the previously published general learning areas. All invitees have extensive clinical experience in the broader sports medicine field, and in one or more components of sports medicine governance at national and/or international level. SEM, Family Medicine, Internal Medicine, Cardiology, Rheumatology and Anaesthetics were invited to participate in a multiple round online Delphi study to develop specific learning areas for each of the previously published general learning areas. All invitees have extensive clinical experience in the broader sports medicine field, and in one or more components of sports medicine governance at national and/or international level. The hierarchical syllabus developed by the ISSEMG provides a useful resource in the planning, development and delivery of specialist training programmes in the medical specialty of SEM., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Urinary incontinence (UI) affects up to 40% of adult women within the UK, and pelvic floor muscle training can be effective as a treatment. The prevalence of UI is higher in athletic women than in their sedentary counterparts, but there is little research into reasons for this or into treatment within this population.The aim of this study is to investigate the feasibility of conducting a future randomised controlled trial of physiotherapeutic management of UI in athletic women., Methods: This is a mixed methods study with three distinct but related phases.Phase 1: Semi-structured interviews with health care professionals in the community will explore current management practices of UI in women and particularly in female athletes in order to inform the control arm of a future study. It will also establish community health care professionals' understanding of pelvic health physiotherapy.Phase 2: Athletic and regularly exercising women recruited directly from gyms and sports clubs will undergo a course of physiotherapy to manage UI. This will establish study recruitment, eligibility, consent, attendance, attrition, and data completion rates. It will provide information regarding appropriate clinical venues and outcome measures to use for this patient group.Phase 3: Semi-structured interviews with purposefully selected participants from phase 2 will investigate participant satisfaction with recruitment procedures, the intervention, outcome measures and the venues. Further, we will collect data regarding the use of a smartphone 'app' for adherence and monitoring of home exercises and participants' beliefs around randomisation in a future study. We will explore the impact of UI on life and sport in more detail., Discussion: This study will establish the ease and acceptability of recruiting athletic women directly from gyms and sports clubs and identify attrition rates. It will also explore the acceptability of the intervention, clinical venues and outcome measures. Data collected will be used to inform a future randomised controlled trial., Trial Registration: NCT03986411 (clinicaltrials.gov). Registered on 14 June 2019., Competing Interests: Competing interestsThe authors declare that they have no competing interests., (© The Author(s) 2020.)

Background: The long-term risk from knee intra-articular (KIA) injections in professional athletes such as ex-footballers remains unknown. The use of KIA injections is controversial and remains anecdotally prolific as it is perceived as being safe/beneficial. The aim of this study was to determine the number, type and frequency KIA injections administered to retired professional footballers during their playing careers and the associations with post-career knee osteoarthritis (KOA)., Methods: This is a cross-sectional study involving a postal questionnaire (n = 1207) and subsequent knee radiographs in a random sample of questionnaire responders (n = 470). Footballers self-reported in the questionnaire whether they had received KIA injections and the estimated total number over the course of their playing career. Participant characteristics and football career-related details were also recorded. KOA was measured as self-reported knee pain (KP), total knee replacement (TKR) and radiographic KOA (RKOA)., Results: 44.5% of footballers had received at least one KIA injection (mean: 7.5; SD ± 11.2) during their professional career. 71% of knee injections were cortisone/corticosteroid based. Multivariate logistic regression, adjusting for age, body mass index (BMI) and significant knee injury identified that footballers with injections were two times more likely to have KP (OR 1.81, 95% CI 1.40-2.34) and TKR (OR 2.21, 95% CI 1.43-3.42) than those without injections. However, there was no association with RKOA (OR 1.30, 95% CI 0.85-2.01). Given, the association with KP and TKR, we found a significant dose-response relationship as the more injections a player received (by dose-response groups), the greater the risk of KP and TKR outcomes after adjustment for knee injury and other confounders (p for trend < 0.01)., Conclusion: On average, 8 KIA injections were given to the ex-footballers during their professional career. The most commonly administered injections were cortisone based. These injections associated with KP and TKR after they retired. The associations are independent of knee injuries and are dose dependent. The study suggests that there may have been excessive use of KIA injections to expedite return to play and this contributed to detrimental long-term outcomes such as KP and TKR post-retirement from professional football.

Objectives: To determine the prevalence of depressive symptoms and general health of male ex-professional footballers compared with general population controls., Methods: 572 retired professional footballers and 500 general population controls in the UK were assessed by postal questionnaire. Anxiety and depressive symptoms were assessed using the Hospital Anxiety and Depression Scale and a threshold score of ≥11 was used to indicate probable caseness. General health was ascertained using the Short Form-12 Health Survey Questionnaire quality of life (QoL) tool; self-reported comorbidities, analgesic usage and body pain; and Index of Multiple Deprivation based on postcode data. Mood was assessed using the Positive and Negative Affect Scale and sleep using the Medical Outcome Survey. Linear regression analysis was used to determine adjusted relative risk with 95% CI and adjusted for age, body mass index, comorbidities, body pain and medication usage., Results: The prevalence of depressive symptoms in retired professional footballers was 5.66% compared with 5.76% in the general population and anxiety prevalence was also comparable (12.01% vs 10.29%; all p>0.05). However, footballers had lower physical and mental component scores compared with controls (p<0.01). They also reported significantly more sleep problems, more negative mood profiles and more widespread body pain (adjusted relative risk (aRR) 1.88, 95% CI 1.15 to 3.09). They also reported greater pain medication usage compared with controls (aRR 1.54, 95% CI 1.26 to 1.89). However, compared with controls, they were 26% (95% CI 15% to 37%) less likely to report comorbidities, especially heart attacks (aRR 57%, 95% CI 27% to 74%) and diabetes (aRR 61%, 95% CI 37% to 76%)., Conclusions: The prevalence of depressive symptoms and anxiety symptoms and probable caseness in ex-professional footballers is comparable with general population controls. However, ex-footballers reported lower health-related QoL, more widespread body pain and higher analgesic usage. Conversely, lower reporting of diabetes and heart attacks indicates potential long-term physical health benefits of professional football., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

The burden of non-communicable diseases, such as osteoarthritis (OA), continues to increase for individuals and society. Regrettably, in many instances, healthcare professionals fail to manage OA optimally. There is growing disparity between the strength of evidence supporting interventions for OA and the frequency of their use in practice. Physical activity and exercise, weight management and education are key management components supported by evidence yet lack appropriate implementation. Furthermore, a recognition that treatment earlier in the disease process may halt progression or reverse structural changes has not been translated into clinical practice. We have largely failed to put pathways and procedures in place that promote a proactive approach to facilitate better outcomes in OA. This paper aims to highlight areas of evidence-based practical management that could improve patient outcomes if used more effectively., Competing Interests: Competing interests: RDL and MEB are funded by Arthritis Research UK. DJH provides consulting advice on scientific advisory boards for Merck Serono, TissueGene and Flexion., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2019. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Background: Knowledge of the epidemiology and potentially modifiable factors associated with musculoskeletal disease is an important first step in injury prevention among elite athletes., Aim: This study investigated the prevalence and factors associated with pain and osteoarthritis (OA) at the hip and knee in Great Britain's (GB) Olympians aged 40 and older., Methods: This is a cross-sectional study. A survey was distributed to 2742 GB Olympians living in 30 countries. Of the 714 (26.0%) who responded, 605 were eligible for analysis (ie, aged 40 and older)., Results: The prevalence of hip and knee pain was 22.4% and 26.1%, and of hip and knee OA was 11.1% and 14.2%, respectively. Using a multivariable model, injury was associated with OA at the hip (adjusted OR (aOR) 10.85; 95% CI 3.80 to 30.96) and knee (aOR 4.92; 95% CI 2.58 to 9.38), and pain at the hip (aOR 5.55; 95% CI 1.83 to 16.86) and knee (aOR 2.65; 95% CI 1.57 to 4.46). Widespread pain was associated with pain at the hip (aOR 7.63; 95% CI 1.84 to 31.72) and knee (aOR 4.77; 95% CI 1.58 to 14.41). Older age, obesity, knee malalignment, comorbidities, hypermobility and weight-bearing exercise were associated with hip and knee OA and/or pain., Conclusions: This study detected an association between several factors and hip and knee pain/OA in retired GB Olympic athletes. These associations require further substantiation in retired athletes from other National Olympic Committees, and through comparison with the general population. Longitudinal follow-up is needed to investigate the factors associated with the onset and progression of OA/pain, and to determine if modulation of such factors can reduce the prevalence of pain and OA in this population., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Background: The impracticalities and comparative expense of carrying out a clinical assessment is an obstacle in many large epidemiological studies. The purpose of this study was to develop and validate a series of electronic self-reported line drawing instruments based on the modified Beighton scoring system for the assessment of self-reported generalised joint hypermobility., Methods: Five sets of line drawings were created to depict the 9-point Beighton score criteria. Each instrument consisted of an explanatory question whereby participants were asked to select the line drawing which best represented their joints. Fifty participants completed the self-report online instrument on two occasions, before attending a clinical assessment. A blinded expert clinical observer then assessed participants' on two occasions, using a standardised goniometry measurement protocol. Validity of the instrument was assessed by participant-observer agreement and reliability by participant repeatability and observer repeatability using unweighted Cohen's kappa (k). Validity and reliability were assessed for each item in the self-reported instrument separately, and for the sum of the total scores. An aggregate score for generalised joint hypermobility was determined based on a Beighton score of 4 or more out of 9., Results: Observer-repeatability between the two clinical assessments demonstrated perfect agreement (k 1.00; 95% CI 1.00, 1.00). Self-reported participant-repeatability was lower but it was still excellent (k 0.91; 95% CI 0.74, 1.00). The participant-observer agreement was excellent (k 0.96; 95% CI 0.87, 1.00). Validity was excellent for the self-report instrument, with a good sensitivity of 0.87 (95% CI 0.81, 0.91) and excellent specificity of 0.99 (95% CI 0.98, 1.00)., Conclusions: The self-reported instrument provides a valid and reliable assessment of the presence of generalised joint hypermobility and may have practical use in epidemiological studies.

Background: Osteoarthritis (OA) is a chronic condition characterized by pain, impaired function, and reduced quality of life. A number of risk factors for knee OA have been identified, such as obesity, occupation, and injury. The association between knee OA and physical activity or particular sports such as running is less clear. Previous reviews, and the evidence that informs them, present contradictory or inconclusive findings., Purpose: This systematic review aimed to determine the association between running and the development of knee OA., Study Design: Systematic review and meta-analysis., Methods: Four electronic databases were searched, along with citations in eligible articles and reviews and the contents of recent journal issues. Two reviewers independently screened the titles and abstracts using prespecified eligibility criteria. Full-text articles were also independently assessed for eligibility. Eligible studies were those in which running or running-related sports (eg, triathlon or orienteering) were assessed as a risk factor for the onset or progression of knee OA in adults. Relevant outcomes included (1) diagnosis of knee OA, (2) radiographic markers of knee OA, (3) knee joint surgery for OA, (4) knee pain, and (5) knee-associated disability. Risk of bias was judged by use of the Newcastle-Ottawa scale. A random-effects meta-analysis was performed with case-control studies investigating arthroplasty., Results: After de-duplication, the search returned 1322 records. Of these, 153 full-text articles were assessed; 25 were eligible, describing 15 studies: 11 cohort (6 retrospective) and 4 case-control studies. Findings of studies with a diagnostic OA outcome were mixed. Some radiographic differences were observed in runners, but only at baseline within some subgroups. Meta-analysis suggested a protective effect of running against surgery due to OA: pooled odds ratio 0.46 (95% CI, 0.30-0.71). The I 2 was 0% (95% CI, 0%-73%). Evidence relating to symptomatic outcomes was sparse and inconclusive., Conclusion: With this evidence, it is not possible to determine the role of running in knee OA. Moderate- to low-quality evidence suggests no association with OA diagnosis, a positive association with OA diagnosis, and a negative association with knee OA surgery. Conflicting results may reflect methodological heterogeneity. More evidence from well-designed, prospective studies is needed to clarify the contradictions.

Physical activity (PA) is increasingly recognised as an important factor within studies of osteoarthritis (OA). However, subjective methods used to assess PA are highly variable and have not been developed for use within studies of OA, which creates difficulties when comparing and interpreting PA data in OA research. The aim of this study was, therefore, to gain expert agreement on the appropriate methods to harmonise PA data among existing population cohorts to enable the investigation of the association of PA and OA. The definition of PA in an OA context and methods of harmonization were established via an international expert consensus meeting and modified Delphi exercise using a geographically diverse committee selected on the basis of individual expertise in physical activity, exercise medicine, and OA. Agreement was met for all aims of study: (1) The use of Metabolic Equivalent of Task (MET) minutes per week (MET-min/week) as a method for harmonising PA variables among cohorts; (2) The determination of methods for treating missing components of MET-min/week calculation; a value will be produced from comparable activities within a representative cohort; (3) Exclusion of the domain of occupation from total MET-min/week; (4) The need for a specific measure of joint loading of an activity in addition to intensity and time, in studies of diseases, such as OA. This study has developed a systematic method to classify and harmonise PA in existing OA cohorts. It also provides minimum requirements for future studies intending to include subjective PA measures.

Objective: The primary aims of this retrospective study were to describe the burden of injury presenting to the medical team and the changes in injury profile over 10 years (2003-2012) at The Championships, Wimbledon. Secondary aims included description of gender difference in rates, distribution and pathology of injuries., Design: Retrospective observational cohort of player injury presentations over 10 years (2003-2012) at The Championships, Wimbledon., Results: The overall rate of presentation of injury for all players over the 10-year period was 20.7 per 1000 sets played. Injury rates were lower for male players (17.7 injuries per 1000 sets played) than female players (23.4 injuries per 1000 sets played). There was variability in the numbers of injuries reported by men and women players over the 10-year period., Conclusions: The rates of presentation of injury at this Grand Slam tennis tournament varied between male and female players, and between years. More robust systems of data collection are required in professional tennis to enable more sophisticated injury data analysis between sexes, years and different playing surfaces., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)

Purpose: Increase physical activity in health care employees using health messaging, and compare e-mail with mobile phone short-message service (SMS) as delivery channels., Design: Randomized controlled trial Setting. U.K. hospital workplace., Subjects: Two hundred ninety-six employees (19-67 years, 53% of study Web site visitors)., Intervention: Twelve-week messaging intervention designed to increase physical activity and delivered via SMS (n =147) or e-mail (n =149); content tailored using theory of planned behavior (TPB) and limited to 160 characters., Measures: Baseline and 6, 12, and 16 weeks. Online measures included TPB constructs, physical activity behavior on the Global Physical Activity Questionnaire, and health-related quality of life on the Short-Form 12., Analysis: General linear models for repeated measures., Results: Increase in duration (mean h/d) of moderate work-related activity and moderate recreational activity from baseline to 16 weeks. Short-lived increase in frequency (d/wk) of vigorous recreational activity from baseline to 6 weeks. Increase in duration and frequency of active travel from baseline to 16 weeks. E-mails generated greater changes than SMS in active travel and moderate activity (work and recreational)., Conclusion: Minimal physical activity promotion delivered by SMS or e-mail can increase frequency and duration of active travel and duration of moderate intensity physical activity at work and for leisure, which is maintained up to 1 month after messaging ends. Both channels were useful platforms for health communication; e-mails were particularly beneficial with hospital employees.

Background: A variety of risk factors predispose athletes to injury, such as impaired neuromuscular control, insufficient core stability, and muscular imbalances. The goal of assessing functional movement patterns is to detect imbalances and correct them with prevention strategies and thereby decrease injuries, and improve performance and quality of life., Purpose: The purpose of this study was to generate normative values for the 'Nine Test Screening Battery' (9TSB) in a group of recreational athletes. A secondary aim was to study gender differences and differences between subjects with (more than six weeks before test occasion) and without previous injury (regardless of injury location). A third aim was to investigate the psychometric properties of the 9TSB., Methods: Eighty healthy recreational athletes, (40 men and 40 women) aged 22-58, were included. The subjects were tested according to strict criteria during nine functional movement exercises that comprise the 9TSB; each graded using a ordinal scale of 0-3, at one occasion. The maximum possible score is 27 points., Results: The median score for the whole group was 18 (Range 12 - 24). A normal distribution of the test scores, with no floor-ceiling effects was found. There was no significant gender difference (p = 0.16) or difference between the group that reported previous injuries (regardless of injury location) and the group that did not (p = 0.65). The internal consistency was 0.41 with Cronbach's alpha., Conclusion: A normal distribution of test results with no floor-ceiling effect was found. History of previous injury (more than six weeks before testing) or gender did not affect the results. In order to determine and cut scores for what is considered optimal or dysfunctional movement patterns, further cohort studies are required.