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Nottingham, United Kingdom

Jackson K.A.,University of Oxford | Glyn-Jones S.,University of Oxford | Batt M.E.,Arthritis Research Center for Sport | Arden N.K.,University of Oxford | Newton J.L.,University of Oxford
BMJ Open | Year: 2015

Objective: Hip pain and injury as a result of activity can lead to the development of early hip osteoarthritis (OA) in susceptible individuals. Our understanding of the factors that increase susceptibility continues to evolve. The ability to clearly identify individuals (and cohorts) with activity-related hip pain who are at risk of early hip OA is currently lacking. The purpose of this study was to gain expert consensus on which key clinical measures might help predict the risk of early hip OA in individuals presenting with activity-related hip pain. The agreed measures would constitute a standardised approach to initial clinical assessment to help identify these individuals. Methods: This Dephi study used online surveys to gain concordance of expert opinion in a structured process of 'rounds'. In this study, we asked 'What outcome measures are useful in predicting hip OA in activityrelated hip pain?' The Delphi panel consisted of experts from sport and exercise medicine, orthopaedics, rheumatology, physiotherapy and OA research. Results: The study identified key clinical measures in the history, examination and investigations (plain anteroposterior radiograph and femoroacetabular impingement views) that the panel agreed would be useful in predicting future risk of hip OA when assessing activity-related hip pain. The panel also agreed that certain investigations and tests (eg, MR angiography) did not currently have a role in routine assessment. There was a lack of consensus regarding the role of MRI, patient-reported outcome measures (PROMs) and certain biomechanical and functional assessments. Conclusions: We provide a standardised approach to the clinical assessment of patients with activity-related hip pain. Assessment measures rejected by the Delphi panel were newer, more expensive investigations that currently lack evidence. Assessment measures that did not reach consensus include MRI and PROMs. Their role remains ambiguous and would benefit from further research. Source

Hdud I.M.,University of Nottingham | Mobasheri A.,University of Nottingham | Mobasheri A.,Medical Research Council Arthritis Research Center for Musculoskeletal Ageing Research | Mobasheri A.,Arthritis Research Center for Sport | And 3 more authors.
American Journal of Physiology - Cell Physiology | Year: 2014

The metabolic activity of articular chondrocytes is influenced by osmotic alterations that occur in articular cartilage secondary to mechanical load. The mechanisms that sense and transduce mechanical signals from cell swelling and initiate volume regulation are poorly understood. The purpose of this study was to investigate how the expression of two putative osmolyte channels [transient receptor potential vanilloid 4 (TRPV4) and large-conductance Ca2+-activated K+ (BKCa)] in chondrocytes is modulated in different osmotic conditions and to examine a potential role for MAPKs in this process. Isolated equine articular chondrocytes were subjected to anisosmotic conditions, and TRPV4 and BKCa channel expression and ERK1/2 and p38 MAPK protein phosphorylation were investigated using Western blotting. Results indicate that the TRPV4 channel contributes to the early stages of hypo-osmotic stress, while the BKCa channel is involved in responding to elevated intracellular Ca2+ and mediating regulatory volume decrease. ERK1/2 is phosphorylated by hypo-osmotic stress (P < 0.001), and p38 MAPK is phosphorylated by hyperosmotic stress (P < 0.001). In addition, this study demonstrates the importance of endogenous ERK1/2 phosphorylation in TRPV4 channel expression, where blocking ERK1/2 by a specific inhibitor (PD98059) prevented increased levels of the TRPV4 channel in cells exposed to hypo-osmotic stress and decreased TRPV4 channel expression to below control levels in iso-osmotic conditions (P < 0.001). © 2014 the American Physiological Society. Source

Olivier B.,University of Witwatersrand | Taljaard T.,University of Witwatersrand | Burger E.,University of Witwatersrand | Brukner P.,La Trobe University | And 7 more authors.
Sports Medicine | Year: 2016

Background: The high prevalence of injury amongst cricket fast bowlers exposes a great need for research into the risk factors associated with injury. Both extrinsic (environment-related) and intrinsic (person-related) risk factors are likely to be implicated within the high prevalence of non-contact injury amongst fast bowlers in cricket. Identifying and defining the relative importance of these risk factors is necessary in order to optimize injury prevention efforts. Objective: The objective of this review was to assess and summarize the scientific literature related to the extrinsic and intrinsic factors associated with non-contact injury inherent to adult cricket fast bowlers. Method: A systematic review was performed in compliance with the PRISMA guidelines. This review considered both experimental and epidemiological study designs. Studies that included male cricket fast bowlers aged 18 years or above, from all levels of play, evaluating the association between extrinsic/intrinsic factors and injury in fast bowlers were considered for inclusion. The three-step search strategy aimed at finding both published and unpublished studies from all languages. The searched databases included MEDLINE via PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Cochrane Controlled Trials Register in the Cochrane Library, Physiotherapy Evidence Database (PEDro), ProQuest 5000 International, ProQuest Health and Medical Complete, EBSCO MegaFile Premier, Science Direct, SPORTDiscus with Full Text and SCOPUS (prior to 28 April 2015). Initial keywords used were ‘cricket’, ‘pace’, ‘fast’, ‘bowler’, and ‘injury’. Papers which fitted the inclusion criteria were assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardized critical appraisal instruments from the Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI). Results: A total of 16 studies were determined to be suitable for inclusion in this systematic review. The mean critical appraisal score of the papers included in this study was 6.88 (SD 1.15) out of a maximum of 9. The following factors were found to be associated with injury: bowling shoulder internal rotation strength deficit, compromised dynamic balance and lumbar proprioception (joint position sense), the appearance of lumbar posterior element bone stress, degeneration of the lumbar disc on magnetic resonance imaging (MRI), and previous injury. Conflicting results were found for the association of quadratus lumborum (QL) muscle asymmetry with injury. Technique-related factors associated with injury included shoulder–pelvis flexion–extension angle, shoulder counter-rotation, knee angle, and the proportion of side-flexion during bowling. Bowling workload was the only extrinsic factor associated with injury in adult cricket fast bowlers. A high bowling workload (particularly if it represented a sudden upgrade from a lower workload) increased the subsequent risk to sustaining an injury 1, 3 or 4 weeks later. Conclusion: Identifying the factors associated with injury is a crucial step which should precede the development of, and research into, the effectiveness of injury prevention programs. Once identified, risk factors may be included in pre-participation screening tools and injury prevention programs, and may also be incorporated in future research projects. Overall, the current review highlights the clear lack of research on factors associated with non-contact injury, specifically in adult cricket fast bowlers. Systematic review registration number Johanna Briggs Institute Database of Systematic Reviews and Implementation Reports 1387 (Olivier et al., JBI Database Syst Rev Implement Rep 13(1):3–13. doi:10.11124/jbisrir-2015-1387, 2015). © 2015, Springer International Publishing Switzerland. Source

Davies O.G.,Loughborough University | Grover L.M.,University of Birmingham | Eisenstein N.,University of Birmingham | Lewis M.P.,Loughborough University | And 2 more authors.
Calcified Tissue International | Year: 2015

Heterotopic ossification (HO) is a debilitating condition defined by the de novo development of bone within non-osseous soft tissues, and can be either hereditary or acquired. The hereditary condition, fibrodysplasia ossificans progressiva is rare but life threatening. Acquired HO is more common and results from a severe trauma that produces an environment conducive for the formation of ectopic endochondral bone. Despite continued efforts to identify the cellular and molecular events that lead to HO, the mechanisms of pathogenesis remain elusive. It has been proposed that the formation of ectopic bone requires an osteochondrogenic cell type, the presence of inductive agent(s) and a permissive local environment. To date several lineage-tracing studies have identified potential contributory populations. However, difficulties identifying cells in vivo based on the limitations of phenotypic markers, along with the absence of established in vitro HO models have made the results difficult to interpret. The purpose of this review is to critically evaluate current literature within the field in an attempt identify the cellular mechanisms required for ectopic bone formation. The major aim is to collate all current data on cell populations that have been shown to possess an osteochondrogenic potential and identify environmental conditions that may contribute to a permissive local environment. This review outlines the pathology of endochondral ossification, which is important for the development of potential HO therapies and to further our understanding of the mechanisms governing bone formation. © 2015, Springer Science+Business Media New York. Source

Schneider S.,German Sport University Cologne | Schneider S.,University of The Sunshine Coast | Peipsi A.,Myoton AS | Stokes M.,University of Southampton | And 3 more authors.
Medical and Biological Engineering and Computing | Year: 2014

Physical exercise is important for people living under extreme environmental conditions to stay healthy. Particularly in space, exercise can partially counteract the loss of muscle mass and muscle strength caused by microgravity. Monitoring the adaptation of the musculoskeletal system to assess muscle quality and devise individual training programmes is highly desirable but is restricted by practical, technical and time constraints on board the International Space Station. This study aimed to test the feasibility of using myometric measurements to monitor the mechanical properties of skeletal muscles and tendons in weightlessness during parabolic flights. The mechanical properties (frequency, decrement, stiffness relaxation time and creep) of the m. gastrocnemius, m. erector spinae and Achilles tendon were assessed using the hand-held MyotonPRO device in 11 healthy participants (aged 47 ± 9 years) in normal gravity as well as in microgravity during two parabolic flight campaigns. Results showed significant (p < .05–.001) changes in all mechanical properties of both muscles and the Achilles tendon, indicating a more relaxed tissue state in microgravity. Recordings from a phantom rubber material with the device in a test rig confirmed that the device itself was not affected by gravity, as changes between gravity conditions that were too small (<1 %) to explain the changes observed in the tissues. It is concluded that myometric measurements are a feasible, easy-to-use and non-invasive approach to monitor muscle health in extreme conditions that prohibit many other methods. Real-time assessment of the quality of a muscle being exposed to the negative effect of microgravity and also the positive effects of muscular training could be achieved using Myoton technology. © 2014, International Federation for Medical and Biological Engineering. Source

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