Spine & Sports Institute

Abstract

Heat stroke in athletes is entirely preventable. Exertional heat illness is generally the result of increased heat production and impaired dissipation of heat. It should be treated aggressively to avoid life-threatening complications. The continuum of heat illness includes mild disease (heat edema, heat rash, heat cramps, heat syncope), heat exhaustion, and the most severe form, potentially life-threatening heat stroke. Heat exhaustion typically presents with dizziness, malaise, nausea, and vomiting, or excessive fatigue with accompanying mild temperature elevations. The condition can progress to heat stroke without treatment. Heat stroke is the most severe form of heat illness and is characterized by core temperature >104°F with mental status changes. Recognition of an athlete with heat illness in its early stages and initiation of treatment will prevent morbidity and mortality from heat stroke. Risk factors for heat illness include dehydration, obesity, concurrent febrile illness, alcohol consumption, extremes of age, sickle cell trait, and supplement use. Proper education of coaches and athletes, identification of high-risk athletes, concentration on preventative hydration, acclimatization techniques, and appropriate monitoring of athletes for heat-related events are important ways to prevent heat stroke. Treatment of heat illness focuses on rapid cooling. Heat illness is commonly seen by sideline medical staff, especially during the late spring and summer months when temperature and humidity are high. This review presents a comprehensive list of heat illnesses with a focus on sideline treatments and prevention of heat illness for the team medical staff.

1. Allyson S. Howe, MD† and
2. Barry P. Boden, MD‡

Abstract

Background: Tendon injuries that occur at the osteotendinous junction are commonly seen in clinical practice and range from acute strain to rupture. Nonsteroidal anti-inflammatory drugs are often prescribed in the treatment of these conditions, but the effect that these agents may have on the healing response at the bone-tendon junction is unclear.

Hypothesis: In response to an acute injury at the osteotendinous junction, the healing patellar tendon will have inferior biomechanical properties with administration of anti-inflammatory drugs as compared with acetaminophen and control.

Study Design: Controlled laboratory study.

Methods: A total of 215 Sprague-Dawley rats underwent transection of the patellar tendon at the inferior pole of the patella, which was subsequently stabilized with a cerclage suture. The animals were then randomized into 7 groups and administered 1 of the following analgesics for 14 days: ibuprofen, acetaminophen, naproxen, piroxicam, celecoxib, valdecoxib, or control. At 14 days, all animals were sacrificed, and the extensor mechanism was isolated and loaded to failure. Biochemical analysis of the repair site tissue was performed. Animal activity throughout the study was monitored using a photoelectric sensor system.

Results: The control group demonstrated greater maximum load compared with the celecoxib, valdecoxib, and piroxicam groups (P < .05). The acetaminophen and ibuprofen groups were also significantly stronger than the celecoxib group (P < .05) but not statistically different than the control group. A total of 23 specimens had failure of the cerclage suture with the following distribution: control (0/23), ibuprofen (0/23), acetaminophen (0/24), naproxen (3/24), piroxicam (4/24), celecoxib (6/22), and valdecoxib (10/24). The difference in distribution of the failures was significant (P < .001).

Conclusions: Anti-inflammatory drugs, with the exception of ibuprofen, had a detrimental effect on healing strength at the bone-tendon junction as demonstrated by decreased failure loads and increased failures of the cerclage suture. Acetaminophen had no effect on healing strength. The biomechanical properties paralleled closely with the total collagen content at the injury site, suggesting that these agents may alter healing strength by decreasing collagen content.

Clinical Relevance: Selective and nonselective cyclooxygenase (COX) inhibitors should be used judiciously in the acute period after injury or surgical repair at the bone-tendon junction.

1. Scott T. Ferry, MD,
2. Laurence E. Dahners, MD,
3. Hessam M. Afshari, and
4. Paul S. Weinhold, PhD*

Abstract

Background: Injuries to the hip account for approximately 10% of all injuries in football, but definitive diagnosis is often challenging. Although these injuries are often uncomplicated contusions or strains, intra-articular lesions are increasingly found to be sources of hip pain.

Purpose: The objective was to define the incidence and etiologic factors of intra- and extra-articular hip injuries in the National Football League (NFL).

Study Design: Descriptive epidemiology study.

Methods: The NFL Injury Surveillance System was used to define all hip-related injuries from 1997 to 2006. Injuries were included if the athlete missed more than 2 days. All hip and groin injuries were included for evaluation. The authors also report on NFL players with intra-articular injuries seen at their institution outside of the NFL Injury Surveillance System.

Results: There were a total of 23 806 injuries from 1997 to 2006, of which 738 were hip injuries (3.1%) with an average of 12.3 days lost per injury. Muscle strains were the most common injury. Intra-articular injuries resulted in the most time lost. Contact injuries most likely resulted in a contusion, and noncontact injuries most often resulted in a muscle strain. In the authors’ institutional experience, many of the athletes with labral tears have persistent adductor strains that do not improve despite adequate therapy.

Conclusion: Hip injuries represent a small but substantial percentage of injuries that occur in the NFL. A majority of these injuries are minor, with a return to play within 2 weeks. Intra-articular injuries are more serious and result in a significant loss of playing time. The “sports hip triad” (labral tear, adductor strain, and rectus strain) is described as a common injury pattern in the elite athlete.

1. Brian T. Feeley, MD*,
2. John W. Powell, PhD†,
3. Mark S. Muller, MD*,
4. Ronnie P. Barnes, ATC‡,
5. Russell F. Warren, MD*, and
6. Bryan T. Kelly, MD*,§

Abstract

Background: Fractures to the fifth metatarsal metaphyseal-diaphyseal junction (Jones fracture) have high nonunion rates. Surgical intramedullary screw fixations have excellent results but a high refracture rate. This has been associated with inadequate screw size and too early return to activity.

Hypothesis: Varus hindfoot alignment overloads the lateral column of the foot and acts as a predisposing factor to the development of and failure of treatment of Jones fractures.

Study Design: Case series; Level of evidence, 4.

Methods: Twenty-one primary Jones fractures (20 patients) treated surgically with a 4.5-mm cannulated screw were retrospectively reviewed. Detailed clinical and radiographic data and outcomes were recorded, including measurements of hindfoot alignment.

Results: A 100% union rate with return to prior activity level and no refractures were found at a mean follow-up of 49 months. Clinical varus was present in 16 feet, whereas radiographic measurements revealed 18 of 21 hindfeet to be in varus. The mean calcaneal pitch angle was 28.5°, and the mean Meary angle was 13° convex upward. Patients with varus alignment were fitted postoperatively with lateral hindfoot and forefoot posted orthotic inserts to correct alignment.

Conclusion: The majority of patients sustaining Jones fractures have evidence of varus hindfoot alignment. This may be a predisposing factor to developing the fracture or refracture after fixation. Postoperative varus unloading (lateral hindfoot and forefoot posting) orthotic insert appears to be helpful in preventing reinjury or refracture of Jones fractures.

1. Steven M. Raikin, MD†,*,
2. Nicholas Slenker, MD‡, and
3. Brian Ratigan, MD‡

Abstract

Background: Torsional joint stiffness is thought to play a role in the observed sex bias in noncontact anterior cruciate ligament injury rates.

Hypothesis: Women will exhibit lower torsional stiffness values of the knee in response to varus/valgus and internal/external rotations than will men.

Study Design: Controlled laboratory study.

Methods: Knee kinematics of 20 university students (10 men, 27.3 ± 3.4 years, 177.3 ± 6.8 cm, 81.1 ± 7.0 kg; 10 women, 22.9 ± 1.5 years, 169.0 ± 7.1 cm, 66.1 ± 11.4 kg) were measured while 0 to 10 N · m of varus and valgus torques were applied with the subject nonweightbearing and while 0 to 5 N · m of internal and external torques were applied with the subject nonweightbearing and weightbearing with the use of a custom joint testing device. Joint stiffness values were calculated at 1-N · m increments.

Results: When low magnitudes of torque were applied to the knee, women had significantly lower stiffness values than did men. With the exception of applied external torque with the joint weightbearing and varus torque with the joint nonweightbearing, women demonstrated an increase in joint stiffness as the magnitude of torque increased from lower to higher magnitudes. In contrast, for the men, joint stiffness values remained unchanged as the magnitude of applied torque increased.

Conclusion: Women exhibited lower knee stiffness in response to low magnitudes of applied torque compared to men and demonstrated an increase of joint stiffness as the magnitude of applied torque increased.

Clinical Relevance: The decreased stiffness behavior of the knee in response to low torques that was observed for women may have a role in detrimentally affecting knee biomechanics and resulting neuromuscular function, particularly when an individual transitions from nonweightbearing to weightbearing.

1. Randy J. Schmitz, PhD, ATC†,*,
2. Travis K. Ficklin, MS†,
3. Yohei Shimokochi, PhD, ATC‡,
4. Anh-Dung Nguyen, PhD, ATC†,
5. Bruce D. Beynnon, PhD§,
6. David H. Perrin, PhD, ATC†, and
7. Sandra J. Shultz, PhD, ATC, CSCS†,*

Abstract

Background: Eccentric exercises (EEs) are recommended for the treatment of Achilles tendinopathy, but the clinical effect from EE has a slow onset.

Hypothesis: The addition of low-level laser therapy (LLLT) to EE may cause more rapid clinical improvement.

Study Design: Randomized controlled trial; Level of evidence, 1.

Methods: A total of 52 recreational athletes with chronic Achilles tendinopathy symptoms were randomized to groups receiving either EE + LLLT or EE + placebo LLLT over 8 weeks in a blinded manner. Low-level laser therapy (λ = 820 nm) was administered in 12 sessions by irradiating 6 points along the Achilles tendon with a power density of 60 mW/cm² and a total dose of 5.4 J per session.

Results: The results of the intention-to-treat analysis for the primary outcome, pain intensity during physical activity on the 100-mm visual analog scale, were significantly lower in the LLLT group than in the placebo LLLT group, with 53.6 mm versus 71.5 mm (P = .0003) at 4 weeks, 37.3 mm versus 62.8 mm (P = .0002) at 8 weeks, and 33.0 mm versus 53.0 mm (P = .007) at 12 weeks after randomization. Secondary outcomes of morning stiffness, active dorsiflexion, palpation tenderness, and crepitation showed the same pattern in favor of the LLLT group.

Conclusion: Low-level laser therapy, with the parameters used in this study, accelerates clinical recovery from chronic Achilles tendinopathy when added to an EE regimen. For the LLLT group, the results at 4 weeks were similar to the placebo LLLT group results after 12 weeks.

1. Apostolos Stergioulas, PT, PhD*,
2. Marianna Stergioula, PT*,
3. Reidar Aarskog, PT, MSc†,
4. Rodrigo A. B. Lopes-Martins, MPharm, PhD‡, and
5. Jan M. Bjordal, PT, PhD†,||,§

Abstract

Background: Conservative treatment is recommended for the early stage of osteochondrosis of the humeral capitellum. However, the outcome of conservative treatment has not been well documented.

Hypothesis: Osteochondrosis of the humeral capitellum detected at an early stage responds well to conservative treatment.

Study Design: Cohort study; Level of evidence, 3.

Methods: We retrospectively reviewed 176 patients with osteochondrosis of the humeral capitellum. There were 134 lesions that were stage I (radiolucent area) in patients with a mean age of 11.5 years and 42 lesions that were stage II (nondisplaced fragments) in patients with a mean age of 13.9 years based on anteroposterior radiographs of the elbow in 45° of flexion. Conservative treatment was performed on 101 patients. The remaining 75 patients did not follow the authors’ advice. Conservative treatment consisted of discontinuation of heavy use of the elbow for at least 6 months. Follow-up radiographs were taken at 1-month intervals. At a mean follow-up of 24 months, all patients were evaluated clinically and radiographically.

Results: Conservative management produced healing in 90.5% of stage I lesions and 52.9% of stage II lesions. The mean period required for healing was 14.9 months in stage I and 12.3 months in stage II. Sixty-six of 84 (78.6%) stage I patients and 9 of 17 (52.9%) stage II patients returned to competitive-level baseball. Of the 75 patients who did not follow our advice, healing was observed in 17 (22.7%). The healing rate was higher for the 101 patients who followed our advice as opposed to the 75 patients who did not.

Conclusion: Osteochondrosis of the humeral capitellum can be successfully treated conservatively if treatment is begun in an early stage of the disease.

1. Tetsuya Matsuura, MD†,*,
2. Shinji Kashiwaguchi, MD‡,
3. Takenobu Iwase, MD§,
4. Yoshitsugu Takeda, MD||, and
5. Natsuo Yasui, MD†

Abstract

Background

The purpose of the present study was to examine the acute effects of a thermogenic nutritional supplement containing caffeine, capsaicin, bioperine, and niacin on muscular strength and endurance performance.

Methods

Twenty recreationally-active men (mean ± SD age = 21.5 ± 1.4 years; stature = 178.2 ± 6.3 cm; mass = 76.5 ± 9.9 kg; VO_{2 PEAK} = 3.05 ± 0.59 L/min^-1) volunteered to participate in this randomized, double-blinded, placebo-controlled, cross-over study. All testing took place over a three-week period, with each of the 3 laboratory visits separated by 7 days (± 2 hours). During the initial visit, a graded exercise test was performed on a Lode Corival cycle ergometer (Lode, Groningen, Netherlands) until exhaustion (increase of 25 W every 2 min) to determine the maximum power output (W) at the VO_{2 PEAK} (Parvo Medics TrueOne^® 2400 Metabolic Measurement System, Sandy, Utah). In addition, one-repetition maximum (1-RM) strength was assessed using the bench press (BP) and leg press (LP) exercises. During visits 2 and 3, the subjects were asked to consume a capsule containing either the active supplement (200 mg caffeine, 33.34 mg capsaicin, 5 mg bioperine, and 20 mg niacin) or the placebo (175 mg of calcium carbonate, 160 mg of microcrystalline cellulose, 5 mg of stearic acid, and 5 mg of magnesium stearate in an identical capsule) 30 min prior to the testing. Testing included a time-to-exhaustion (TTE) ride on a cycle ergometer at 80% of the previously-determined power output at VO_{2 PEAK} followed by 1-RM LP and BP tests.

Results

There were no differences (p > 0.05) between the active and placebo trials for BP, LP, or TTE. However, for the BP and LP scores, the baseline values (visit 1) were less than the values recorded during visits 2 and 3 (p ≤ 0.05).

Conclusion

Our findings indicated that the active supplement containing caffeine, capsaicin, bioperine, and niacin did not alter muscular strength or cycling endurance when compared to a placebo trial. The lack of increases in BP and LP strength and cycle ergometry endurance elicited by this supplement may have been related to the relatively small dose of caffeine, the high intensity of exercise, the untrained status of the participants, and/or the potential for caffeine and capsaicin to increase carbohydrate oxidation.

Abstract

Background

High-intensity interval training has been shown to be a time-efficient way to induce physiological adaptations similar to those of traditional endurance training. Creatine supplementation may enhance high-intensity interval training, leading to even greater physiological adaptations. The purpose of this study was to determine the effects of high-intensity interval training (HIIT) and creatine supplementation on cardiorespiratory fitness and endurance performance (maximal oxygen consumption (VO_2PEAK), time-to-exhaustion (VO_2PEAKTTE), ventilatory threshold (VT), and total work done (TWD)) in college-aged men.

Methods

Forty-three recreationally active men completed a graded exercise test to determine VO_2PEAK, VO_2PEAKTTE, and VT. In addition, participants completed a time to exhaustion (TTE) ride at 110% of the maximum workload reached during the graded exercise test to determine TWD (TTE (sec) × W = J). Following testing, participants were randomly assigned to one of three groups: creatine (creatine citrate) (Cr; n = 16), placebo (PL; n = 17), or control (n = 10) groups. The Cr and PL groups completed four weeks of HIIT prior to post-testing.

Results

Significant improvements in VO_2PEAK and VO_2PEAKTTE occurred in both training groups. Only the Cr group significantly improved VT (16% vs. 10% improvement in PL). No changes occurred in TWD in any group.

Conclusion

In conclusion, HIIT is an effective and time-efficient way to improve maximal endurance performance. The addition of Cr improved VT, but did not increase TWD. Therefore, 10 g of Cr per day for five days per week for four weeks does not seem to further augment maximal oxygen consumption, greater than HIIT alone; however, Cr supplementation may improve submaximal exercise performance.