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Long-distance open-water swimming is a swimming discipline which takes place in outdoor bodies of water, such as open oceans, lakes and rivers. The activity has grown in popularity. This case report describes the attempt of an Olympic Champion (Maarten van der Weijden) to swim 200 km along a route taking him to eleven Frisian cities. We describe the importance of good preparation and training but also the health problems open-water swimmers, and (medical) staff, might encounter during such an extreme event. Optimal endurance, management of dizziness and hypothermia, high caloric food intake, risk of (gastrointestinal) infections and lack of sleep are all important factors to take into account in long-distance open-water swimming.

PURPOSE: The purpose of this study was to investigate the effect of ankle bracing on proprioception of the ankle and dynamic postural control in participants with chronic ankle instability (CAI). With this knowledge, current brace methods can be optimized and compliance towards the use of braces in athletes who are at risk for an ankle sprain can be improved. METHODS: A cross-sectional observational study was conducted. Proprioception of the ankle and dynamic postural control were measured with and without a soft ankle brace in each participant in randomized order. Males and females with CAI aged 18-35 years were included in this study. Joint position sense (JPS) was measured with an Angle Reproduction Test on an isokinetic device for plantarflexion and inversion. Dynamic postural control was measured with the Y-balance TestTM (YBT). Paired t-tests were used to compare test results with and without ankle brace for both JPS and dynamic postural control. RESULTS: When participants wore the ankle brace, JPS absolute error scores were significantly lower for plantar flexion (p=0.03), in comparison without ankle brace. No significant difference was found in JPS absolute error scores for inversion (p=0.20). The YBT normalized reach distances did not significantly differ when performed with or without brace (p>0.50). CONCLUSION: Wearing a soft ankle brace has statistically significant, but small, effect on the JPS in plantar flexion of the chronically unstable ankle. Ankle bracing has no effect on JPS in inversion and dynamic postural control in participants with CAI. When advising athletes on using an ankle brace, it should be explained that the effect of bracing is probably not caused by improving proprioception, but through other mechanisms. However, athletes should still be encouraged to use an ankle brace during sports due to the preventive effect that is shown in other studies.

PURPOSE: Physical inactivity, has led to an increase in the prevalence of lifestyle-related chronic diseases on a global scale. There is a need for more awareness surrounding the preventive and curative role of a physically active lifestyle in healthcare. The prescription of physical activity in clinical care has been advocated worldwide through the ‘exercise is medicine’ (E=M) paradigm. However, E=M currently has no position in general routine hospital care, which is hypothesized to be due to attitudinal and practical barriers to implementation. This study aims to create an E=M tool to reduce practical barriers to enforcing E=M in hospital care. METHODS: Firstly, this project will perform qualitative research to study the current implementation status of E=M in clinical care as well as its facilitators and barriers to implementation among clinicians and hospital managers. Secondly, an E=M tool towards application of active lifestyle interventions will be developed, based on a prediction model of individual determinants of physical activity behavior and local big data, which will result in a tailored advice for patients on physical activity and motivation. Thirdly, the feasibility of implementing E=M-tool, as designed within this project, will be investigated with a process evaluation, conducting a pilot-study which will integrate the tool in routine care in at least four clinical departments in two Dutch hospitals. RESULTS: Results will, firstly, give insight in the current implementation status of E=M and in factors that influence the actual E=M implementation; Secondly, a E=M tool will be designed providing a tailored E=M prescription for patients as part of clinical care; Thirdly, an implementation strategy will be described of the E=M tool for clinical practice. CONCLUSION: This project envisages an extensive continuation of research on the implementation of E=M, supports the mutual decision making process of lifestyle referral of clinicians and provides insights which can be used to assist in implementing physically active lifestyle prescription in the medical curriculum.&nbsp

Numerous athletes with patellar tendinopathy (PT) use a patellar strap or sports tape during sports. This study's aim was to investigate the short-term effect of these orthoses on patellar tendon pain. Participants performed the single-leg decline squat, vertical jump test, and triple-hop test under four different conditions (patellar strap, sports tape, placebo, and control). Subsequently, participants practiced sports as usual for 2 weeks; during 1 week, they were assigned to one of the four conditions. Pain was measured with the visual analog scale (VAS). In total, 97 athletes with PT [61% male, age 27.0 (SD8.1), VISA-P 58.5 (SD12.7)] were analyzed. On the single-leg decline squat, the VAS pain score reduced significantly in the patellar strap (14 mm, P = 0.04) and the sports tape condition (13 mm, P = 0.04), compared with control, but not placebo. A significant decrease in VAS pain during sports was found in the sports tape (7 mm, P = 0.04) and placebo group (6 mm, P = 0.04). The VAS pain score two hours after sports decreased significantly in the patellar strap, sports tape and placebo group (8-mm, P

Lower leg injuries are a common problem in athletes. One-third of injuries in long-distance runners are lower leg injuries (Brewer and Gregory 2012). The spectrum of lower leg injuries in athletes contains a number of injuries with very similar presentations. In a retrospective review assessing 150 athletes with exercise-induced leg pain, 33 % had chronic compartment syndrome, 25 % had a stress fracture, 13 % had medial tibial stress syndrome and 10 % had a nerve entrapment syndrome (Clanton and Solcher 1994). Another study among 98 patients with recurrent lower leg pain reported medial tibial stress syndrome in 42 %, chronic compartment syndrome in 27 % and entrapment of the superficial peroneal nerve in 13 % of patients (Styf 1988). This chapter aims to offer a few key points that differentiate between these injuries both in clinical presentation and in imaging characteristics.

Chest pain is seldom a complaint of athletes. However sports injuries to the chest can be painful and life-threatening. Therefore it is important to choose the most reliable imaging modality to support the clinical diagnosis in the athlete with chest pain. In this chapter the role of radiology in various sports-related chest injuries is described, from the rarely described (but commonly diagnosed) costochondritis and sternal fractures to the more common rib fractures. The chest injury itself will be addressed first and then followed by the appropriate imaging modality and radiologic findings and characteristics. Traumatic as well as overuse injuries to the chest will be discussed. Emphasis will also be placed on ruling out any life-threatening complications by selecting the right imaging modality.

Background: Intensive physical load can damage epi-/apophyseal growth. Osgood-Schlatter disease is a well-known and sport-associated overuse injury of the tibial tuberosity apophysis. Long-lasting load-associated pain and a reduced ability to play sports can be the consequence. Aim of the Study: The aim of this study was to analyse the safety and effectiveness of extracorporeal shock wave therapy (ESWT) for recalcitrant Osgood-Schlatter disease. Patients and Methods: 14 adolescent patients, median age 14 (13.2-14.7) years, suffering from recalcitrant Osgood-Schlatter disease (16 symptomatic knees) were treated with radial extracorporeal shock waves. The nine boys, median age 14 (13.5-15.0) years and the five girls, median age 12 (10.8-15.2) were retrospectively followed up 5.6 (3.4-6.7) years later using the disease specific VISA-P-G questionnaire which is validated for jumper's knee. Results: At follow up the median VISA-P-G score was 100 (82.9-100.9). Twelve of 16 knees (75%) reached 100 out of 100 VISA-P-G points. Four patients changed their sports activity due to persisting problems at the distal patellar tendon insertion. Four knees had persisting tibial tuberosity pain when playing sport. Pain induced by activities of daily living (stair climbing) was stated in two cases. No side effects or long-term complications were reported. Conclusions: This pilot study demonstrates that radial ESWT is a safe and promising treatment for adolescent athletes with recalcitrant Osgood-Schlatter disease

De jumper’s knee (patellatendinopathie) is een frequent voorkomende, lastig te behandelen blessure die gekenmerkt wordt door be lastingafhankelijke pijn ter plaatse van de apex patellae. De etiologie is multifactorieel: aanleg, overbelasting en verstoringen in de spierpeesfunctie en bewegingsketen lijken een belangrijke rol te spelen. Histopathologisch is er bij een chronische patellatendinopathie sprake van een gestoord regeneratieproces (tendinose) en niet zoals vaak gedacht werd een tendinits. Vasculoneurale ingroei is mogelijk de oorzaak van de pijn. Dit heeft consequenties voor de behandelstrategie. Die moet meer gericht zijn op het bevorderen van de regeneratie en niet zozeer op het bestrijden van een inflammatoir proces. Dit verklaart mogelijk waarom in de afgelopen decennia een grote diversiteit aan (anti-inflammatoire) behandelingen met weinig succes werd toegepast.Het revalidatieprogramma van een sporter met een patellatendinopathie is een langdurig proces (3-6 maanden) waarin aanpassen van de belasting, (excentrische) oefentherapie gericht op verbetering van de spier-peesfunctie en optimalisering van de bewegingsketen zeker aan bod moeten komen. Later dienen ook meer sportspecifieke oefeningen te worden ingebouwd. Extracorporele Shockwave Therapie (ESWT) kan mogelijk een additioneel therapeutisch effect hebben. Wanneer conservatieve behandeling faalt, is operatief ingrijpen nog een optie. De resultaten zijn echter wisselend en een operatie is zeker geen garantie om snel terug te keren op het oorspronkelijke sportniveau. Op het nieuwe histopathologisch inzicht gebaseerde experimentele behandelmethoden zoals scleroseren van de neovascularisaties en toepassing van groeifactoren lijken veelbelovend maar nader onderzoek is nodig alvorens zij in de klinische praktijk kunnen worden toegepast.