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Purpose: To determine whether bone metabolic activity corresponds to bone and cartilage damage in patients with patellofemoral pain.Materials and Methods: We acquired magnetic resonance imaging (MRI) and (18) F-NaF positron emission tomography (PET) / computed tomography (CT) scans of the knees of 22 subjects. We compared locations of increased tracer uptake on the (18) F-NaF PET images to bone marrow edema and cartilage damage visualized on MRI.Results: We found that increased bone activity on (18) F-NaF PET does not always correspond to structural damage in the bone or cartilage as seen on MRI.Conclusion: Our results suggest that (18) F-NaF PET/CT may provide additional information in patellofemoral pain patients compared to MRI. [ABSTRACT FROM AUTHOR]

BACKGROUND: Tibial stress fractures increasingly affect athletes and military recruits, with few known effective management options. Electrical stimulation enhances regular fracture healing, but the effect on stress fractures has not been definitively tested. HYPOTHESIS: Capacitively coupled electric field stimulation will accelerate tibial stress fracture healing. STUDY DESIGN: Randomized controlled trial; Level of evidence, 1. METHODS: Twenty men and 24 women with acute posteromedial tibial stress fractures were referred from local clinicians. Subjects were randomly assigned active or placebo capacitively coupled electric field stimulation to be applied for 15 hours per day until healed, given supplemental calcium, and instructed to rest from provocative training. Healing was confirmed when hopping to 10 cm for 30 seconds could be achieved without pain. RESULTS: No difference in time to healing was detected between treatment and placebo groups. Women in the treatment group healed more slowly than did the men (P = .05). Superior treatment compliance was associated with reduced time to healing (P = .003). Rest noncompliance was associated with increased time to healing (P = .05). CONCLUSION: Whole-group analysis did not detect an effect of capacitively coupled electric field stimulation on tibial stress fracture healing; however, greater device use and less weightbearing loading enhanced the effectiveness of the active device. More severe stress fractures healed more quickly with capacitively coupled electric field stimulation. CLINICAL RELEVANCE: Although the use of capacitively coupled electric field stimulation for tibial stress fracture healing may not be efficacious for all, it may be indicated for the more severely injured or elite athlete/recruit whose incentive to return to activity may motivate superior compliance. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To evaluate whether playing ball sports during childhood and adolescence is associated with the risk of stress fractures in runners later in life. DESIGN: Retrospective cohort study. SETTING: National track and field championships, held at Stanford University. PARTICIPANTS: One hundred fifty-six elite female and 118 elite male distance runners, age 18 to 44 years. INTERVENTIONS: A 1-page questionnaire was used to collect data regarding ages during which athletes played basketball and soccer, as well as other important covariates and outcomes. OUTCOME MEASUREMENTS: Athletes reported the ages when stress fractures occurred. Time to event was defined as the number of years from beginning competitive running to the first stress fracture or to current age, if no fracture had occurred. RESULTS: In both men and women, playing ball sports in youth correlated with reduced stress fracture incidence later in life by almost half, controlling for possible confounders. In men, each additional year of playing ball sports conferred a 13% decreased incidence of stress fracture (adjusted hazard ratio [HR] and 95% confidence interval, 0.87 [0.79-0.95]. Among women with regular menses, the HR for each additional year of playing ball sports was similar: 0.87 (0.75-1.00); however, there was no effect of length of time played among women with irregular menses (HR, 1.03 [0.92-1.16]). In men, younger ages of playing ball sports conferred more protection against stress fractures (HR for each 1-year-older age at first exposure, 1.29 [1.14, 1.45]). CONCLUSIONS: Runners who participate during childhood and adolescence in ball sports may develop bone with greater and more symmetrically distributed bone mass, and with enhanced protection from future stress fractures. [ABSTRACT FROM AUTHOR]

High hamstring tendinopathy is an uncommon overuse injury seen in running athletes. Patients typically report deep buttock or thigh pain. A detailed physical examination and, occasionally, imaging studies are necessary to confirm the diagnosis. Rehabilitation involves soft-tissue mobilization, frequent stretching, and progressive eccentric hamstring strengthening and core stabilization exercises. In recalcitrant cases, an ultrasound-guided corticosteroid injection into the tendon sheath can be helpful, and, occasionally, surgery may be necessary to release the scar tissue around the proximal hamstring muscles and the sciatic nerve. [ABSTRACT FROM AUTHOR]

Flexion and extension of the spine induce loads to the anterior or posterior spinal column and therefore may affect disc hydration. Information related to the effect of activity on hydration of intervertebral discs could lead to a better understanding of the pathophysiology and rehabilitation of low back injury.A pilot study evaluating the effect of spine position and loading on the changes of disc hydration in vivo was conducted with three volunteers without low back pain history. Spines were scanned in neutral, flexion and extension positions. MRI was repeated after 6 hours of normal activity and 4 hours of heavy activity with a weighted vest. Signal intensities of the intervertebral discs were measured at the L4-5 and L5-S1 levels.The signal intensities decreased by 9.3% at L4-5 and 8.3% at L5-S1 intervertebral discs compared to baseline after 6 hours of daily activity. The intensities decreased more (14.5% and 12.4%) with additional four hours of heavy activity. There was no change in disc signal intensity between neutral, flexion and extension of the spine.This study showed that: 1) rapid fluctuation of load such as between flexion and extension does not change disc hydration 2) prolonged loading of the spine decreases disc hydration. [ABSTRACT FROM AUTHOR]

Sacral stress fractures are an underrecognized cause of low-back and gluteal pain in distance runners. The combination of low bone density and increased activity blurs the boundary between fatigue and insufficiency fractures in many runners. MRI is the preferred radiologic technique because of its ability to localize the site of injury and rule out tumors, disk disease, or sacroiliitis. By identifying the condition early, clinicians contribute to a favorable outcome and help most athletes return to full activity in 12 to 14 weeks. [ABSTRACT FROM AUTHOR]

Shoulder injuries are common in swimmers of all ages and abilities. Advances in the understanding of biomechanics help identify and correct stroke flaws to prevent shoulder injury. Physicians can demonstrate correct pull patterns and body alignment in an office setting, and proper coaching can help correct mistakes made in the water. If injury occurs, swimmers can employ rehabilitation techniques, including preventive scapular stabilization exercises, to prevent recurrence. The treating physician and physical therapist who understand stroke technique and prevention concepts may help decrease the incidence of swimming-related shoulder injuries. [ABSTRACT FROM AUTHOR]

The bones, ligaments, muscles, and nerves of the sacroiliac joint (SIJ) may be damaged by direct trauma or by smaller, repetitive stresses. Injury to many complex adjacent structures can refer pain to the SIJ, and SIJ pathology can refer pain elsewhere. Because of the varied and overlapping presentation of symptoms, a precise diagnosis of SIJ pain syndrome is often challenging. Physicians who recognize the condition early and offer prompt treatment (eg, physical therapy, corrective exercises with mobilization, and, if necessary, corticosteroid injection) will make a definite contribution to improving their patients' athletic performance. [ABSTRACT FROM AUTHOR]

Though recognizing the sharp, burning lateral knee pain of iliotibial band syndrome isn't difficult, treating the condition can be a challenge because underlying myofascial restrictions can significantly contribute to the patient's pain and disability. The physical exam should include a thorough evaluation to identify tender trigger points as well as tenderness and possible swelling at the distal iliotibial band. After acute symptoms are alleviated with activity restriction and modalities, problematic trigger points can be managed with massage therapy or other treatments. A stepwise stretching and strengthening program can expedite patients' return to running. [ABSTRACT FROM AUTHOR]

Medial tibial pain in runners has traditionally been diagnosed as either a shin splint syndrome or as a stress fracture. Our work using magnetic resonance imaging suggests that a progression of injury can be identified, starting with periosteal edema, then progressive marrow involvement, and ultimately frank cortical stress fracture. Fourteen runners, with a total of 18 symptomatic legs, were evaluated and, within 10 days, referred for radiographs, a technetium bone scan, and a magnetic resonance imaging scan. In 14 of the 18 symptomatic legs, magnetic resonance imaging findings correlated with an established technetium bone scan grading system and more precisely defined the anatomic location and extent of injury. We identified clinical symptoms, such as pain with daily ambulation and physical examination findings, including localized tibial tenderness and pain with direct or indirect percussion, that correlated with more severe tibial stress injuries. When clinically warranted, we recommend magnetic resonance imaging over bone scan for grading of tibial stress lesions in runners. Magnetic resonance imaging is more accurate in correlating the degree of bone involvement with clinical symptoms, allowing for more accurate recommendations for rehabilitation and return to impact activity. Additional advantages of magnetic resonance imaging include lack of exposure to ionizing radiation and significantly less imaging time than three-phase bone scintigraphy. [ABSTRACT FROM AUTHOR]

Objective: To determine how long injected fluid from an impingement test remains in the bursa or adjacent soft tissues after an injection.Design and Patients: Six patients prospectively underwent MRI of the shoulder immediately before and after an impingement test injection, and at 3 days, 2 weeks and 4 weeks later. MR images were evaluated and graded for fluid distribution within the bursa and adjacent soft tissues. The rotator cuff was evaluated for signal abnormalities related to the injection.Results and Conclusion: Three days after the injection, the soft tissue fluid had returned to pre-injection levels or less in five of the six patients. No patients showed rotator cuff signal abnormalities related to the impingement test injection. We recommend a delay of 3 days before a shoulder MR examination after an injection has been performed, to avoid misinterpretations. [ABSTRACT FROM AUTHOR]

Abstract Background Altered spinal mobility is thought to be related to current or past episodes of low back pain; however evidence of that relationship in younger subjects has not been established. The purpose of this study was to compare lumbar segmental mobility in asymptomatic and symptomatic subjects during posterior to anterior (PA) manual spinal mobilization and a self-initiated prone press-up (PU) maneuver. We hypothesized that persons with central low back pain would have an altered lumbar segmental mobility pattern compared to those without pain. Method Forty-five individuals (age 32.1 ± 8.5) with non-specific low back pain and 20 persons (age 31.1 ± 7.0) without low back pain participated. Each subject underwent dynamic imaging of the lumbar spine during a PA mobilization procedure and while performing a PU. Segmental motion was quantified as the change in the intervertebral angle between the resting and end-range vertebral positions. Results The symptomatic group had a larger percentage of subjects with evidence of single level segmental hypermobility than the asymptomatic group during the PA (40.0% vs. 5%) and PU (26.7% vs. 15%) procedures. Single lumbar motion-segment analysis revealed hyper-mobility in symptomatic subjects at L5 – S1 (Chi-square = 10.0, p ≤ 0.01) and L4 – L5 (Chi-square = 4.18, p ≤ 0.05) during the PA test. Conclusion Persons with non-specific low back pain have a tendency to demonstrate single level lumbar segmental hypermobility when compared to age specific asymptomatic subjects.

Female gender is one of the commonly mentioned risk factors for anterior knee pain (AKP), among a spectrum of other factors including anatomical, biomechanical, hormonal, behavioral and psychological elements contributing to its development. Despite the focus on individual risk factors, there's a notable gap in comprehending how gender influences and interacts with other risk factors. The objective of this review was to identify and emphasize the connections between these interactions, gender-related risk factors for AKP, and the potential mechanisms that explain their associations with other risk factors, aiming to aid in the creation of precise prevention and treatment approaches. Gender influences the majority of risk factors for AKP, including anatomical, biomechanical, hormonal, behavioral and psychological factors. Women have on average smaller patellae, higher patellofemoral cartilage stress and for AKP, disadvantageous trochlear morphology, ligament and muscle composition and unfavorable neuromuscular control pattern. In contrast, men show on average an increased ability to strengthen their hip external rotators, which are both protective against AKP. Particularly in kinetic and kinematic analysis, men have been shown to have a distinctly different risk factor profile than women. Sex hormones may also play a role in the risk of AKP, with estrogen potentially influencing ligamentous laxity, increasing midfoot loading and affecting neuromuscular control of the lower extremities and testosterone positively affecting muscle mass and strength. The higher incidence of AKP in women is likely due to a combination of slightly increased risk factors. Although all risk factors can be present in both men and women and the holistic evaluation of each individual's risk factor composition is imperative regardless of gender, knowing distinctive risk factors may help with focused evaluation, treatment and implementing preventive measures of AKP., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Anna Bartsch reports financial support was provided by Zaeslin Foundation, Martin Allgöwer Foundation and AO Trauma Switzerland. Dr. Sherman holds committee positions for AANA, AAOS, ACLSG, AOSSM, Biologic Association, ICRS and ISAKOS. He is on the editorial board for the Arthroscopy Journal, Cur Rev Musc Med, and VJSM. He is a course chair of ISMF and the PFF Masters Course and a member of the AO Sports Medicine Taskforce., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Objective: To evaluate the extent to which personal well-being may be associated with empathy, while controlling for potential confounders. Settings/Location: Residency programs throughout the United States. Subjects: A total of 407 medical residents from residencies including general medicine, surgery, specialized and diagnostic medicine participated in this study. Outcome Measures: Well-being was measured using the modified existential well-being subscale of the spiritual well-being scale. Empathy was measured using the Jefferson Scale of Empathy. Results: Well-being was found to be positively correlated with empathy when adjusted for possible confounders ( p  < 0.001). In addition to well-being, other factors noted to be statistically significant contributors to higher empathy scores while controlling for the others included age, gender, year in residency, specialty, and work-hours ( p  < 0.05 for each). After controlling for these factors, a resident's year in residency was not found to be a statistically significant contributor to empathy score. Conclusions: In this study, well-being was associated with empathy in medical and surgical residents. Empathy is a fundamental component of physician competency, and its development is an essential aspect of medical training. These findings suggest that efforts to increase well-being may promote empathy among medical residents.

Introduction: Although the female athlete triad (Triad) has been associated with increased risk of bone-stress injuries (BSIs), limited research among collegiate athletes has addressed the associations between the Triad and non-BSI injuries., Objective: To elucidate the relationship between Triad and both BSI and non-BSI in female athletes., Design: Retrospective cohort study., Setting: Primary and tertiary care student athlete clinic., Participants: National Collegiate Athletic Association Division I female athletes at a single institution., Intervention: Participants completed a pre-participation questionnaire and dual-energy x-ray absorptiometry, which was used to generate a Triad cumulative risk assessment score (Triad score). The number of overuse musculoskeletal injuries that occurred while the athletes were still competing collegiately were identified through chart review., Main Outcome Measure: BSI and non-BSI were treated as count variables. The association between BSI, non-BSI, and Triad score was measured using Poisson regression to calculate rate ratios., Results: Of 239 athletes, 43% of athletes (n = 103) sustained at least one injury. Of those, 40% (n = 95) sustained at least one non-BSI and 10% (n = 24) sustained at least one BSI over an average follow-up 2.5 years. After accounting for sport type (non-lean, runner, other endurance sport, or other lean advantage sport) and baseline age, we found that every additional Triad score risk point was associated with a significant 17% increase in the rate of BSI (rate ratio [RR] 1.17, 95% confidence interval [CI] 1.03-1.33; p = .016). However, Triad score was unrelated to non-BSI (1.00, 95% CI 0.91-1.11; p = .99). Compared with athletes in non-lean sports (n = 108), athletes in other lean advantage sports (n = 30) had an increased rate of non-BSI (RR: 2.09, p = .004) whereas distance runners (n = 46) had increased rates of BSI (RR: 7.65, p < .001) and non-BSI (RR: 2.25, p < .001)., Conclusions: Higher Triad score is associated with an increased risk of BSI but not non-BSI in collegiate athletes., (© 2024 American Academy of Physical Medicine and Rehabilitation.)

Abstract: Exercise leads to robust cardiovascular, musculoskeletal, and psychological benefits that improve quality of life and longevity for older adults, but accompanying improvements in athletic parameters are less well explored. The aim of this review is to summarize some of the most common exercise modalities, namely, Pilates, martial arts (tai chi, Japanese-style karate, hard martial arts), locomotion (brisk walking/jogging and running), Masters sports, resistance training, and high-intensity interval training, in improving athletic performance for older adults. Regular participation in these activities can have robust yet unique impacts on physical performance that prolong exercise participation. In particular, this review will explore benefits in cardiorespiratory fitness, power, strength, flexibility, and balance, thereby hopefully improving endurance, exercise adherence, and overall fall risk. A narrative literature review was performed to explore benefits, pitfalls, and recommendations for some of the most popular exercise modalities for older adults., (Copyright © 2024 by the American College of Sports Medicine.)