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Castel Guelfo di Bologna, Italy

Rees J.D.,University of Cambridge | Stride M.,Isokinetic Medical Group | Scott A.,University of British Columbia
British Journal of Sports Medicine | Year: 2014

It is currently widely accepted among clinicians that chronic tendinopathy is caused by a degenerative process devoid of inflammation. Current treatment strategies are focused on physical treatments, peritendinous or intratendinous injections of blood or blood products and interruption of painful stimuli. Results have been at best, moderately good and at worst a failure. The evidence for non-infammatory degenerative processes alone as the cause of tendinopathy is surprisingly weak. There is convincing evidence that the inflammatory response is a key component of chronic tendinopathy. Newer anti-inflammatory modalities may provide alternative potential opportunities in treating chronic tendinopathies and should be explored further.

Buckthorpe M.W.,Loughborough University | Buckthorpe M.W.,Isokinetic Medical Group | Pain M.T.G.,Loughborough University | Folland J.P.,Loughborough University
PLoS ONE | Year: 2013

Bilateral deficit (BLD) describes the phenomenon of a reduction in performance during synchronous bilateral (BL) movements when compared to the sum of identical unilateral (UL) movements. Despite a large body of research investigating BLD of maximal voluntary force (MVF) there exist a paucity of research examining the BLD for explosive strength. Therefore, this study investigated the BLD in voluntary and electrically-evoked explosive isometric contractions of the knee extensors and assessed agonist and antagonist neuromuscular activation and measurement artefacts as potential mechanisms. Thirteen healthy untrained males performed a series of maximum and explosive voluntary contractions bilaterally (BL) and unilaterally (UL). UL and BL evoked twitch and octet contractions were also elicited. Two separate load cells were used to measure MVF and explosive force at 50, 100 and 150 ms after force onset. Surface EMG amplitude was measured from three superficial agonists and an antagonist. Rate of force development (RFD) and EMG were reported over consecutive 50 ms periods (0-50, 50-100 and 100-150 ms). Performance during UL contractions was compared to combined BL performance to measure BLD. Single limb performance during the BL contractions was assessed and potential measurement artefacts, including synchronisation of force onset from the two limbs, controlled for. MVF showed no BLD (P = 0.551), but there was a BLD for explosive force at 100 ms (11.2%, P = 0.007). There was a BLD in RFD 50-100 ms (14.9%, P = 0.004), but not for the other periods. Interestingly, there was a BLD in evoked force measures (6.3-9.0%, P<0.001). There was no difference in agonist or antagonist EMG for any condition (P≥0.233). Measurement artefacts contributed minimally to the observed BLD. The BLD in volitional explosive force found here could not be explained by measurement issues, or agonist and antagonist neuromuscular activation. The BLD in voluntary and evoked explosive force might indicate insufficient stabiliser muscle activation during BL explosive contractions. © 2013 Buckthorpe et al.

McCall A.,University Of Lille Unite Of Recherche Pluridisciplinaire Sport | Carling C.,Institut Universitaire de France | Nedelec M.,University Of Lille Unite Of Recherche Pluridisciplinaire Sport | Davison M.,Isokinetic Medical Group | And 3 more authors.
British journal of sports medicine | Year: 2014

PURPOSE: Little is known about injury prevention practices in professional football clubs. The purpose of this study was therefore to determine the current perceptions and practices of premier league football clubs internationally concerning risk factors, testing and preventative exercises for non-contact injuries.METHODS: A survey was administered to 93 premier league football clubs internationally. The survey included four sections: (1) persons involved in the injury prevention programme: position, quantity, role, qualification; (2) perceptions regarding non-contact injury risk factors; (3) tests used to identify non-contact injury risk and (4) non-contact injury prevention exercises used, their perceived effectiveness and implementation strategies.RESULTS: 44 surveys were successfully returned (47%). The position of physiotherapist was the most represented position in the injury prevention programme. The top five perceived risk factors in rank order were previous injury, fatigue, muscle imbalance, fitness and movement efficiency. The five most commonly used tests to identify injury risk (in rank order) were functional movement screen, questionnaire, isokinetic dynamometry, physical tests and flexibility. The top five exercises used by clubs were (also in rank order) eccentric exercise, balance/proprioception, hamstring eccentric, core stability and, sharing the fifth position, Nordic hamstring and gluteus activation.CONCLUSIONS: The survey revealed the most common perceptions and practices of premier league football clubs internationally regarding risk factors, testing and preventative exercises. The findings can enable reduction of the gap between research and practice. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

McCall A.,University of Lille Nord de France | Carling C.,LOSC Lille Metropole Football Club | Carling C.,University of Central Lancashire | Davison M.,Isokinetic Medical Group | And 4 more authors.
British Journal of Sports Medicine | Year: 2015

Purpose: To systematically review the scientific level of evidence for the 'Top 3' risk factors, screening tests and preventative exercises identified by a previously published survey of 44 premier league football (soccer) teams. Also, to provide an overall scientific level of evidence and graded recommendation based on the current research literature. Methods: A systematic literature search (Pubmed [MEDLINE], SportDiscus, PEDRO and Cochrane databases). The quality of the articles was assessed and a level of evidence (1++ to 4) was assigned. Level 1++ corresponded to the highest level of evidence available and 4, the lowest. A graded recommendation (A: strong, B: moderate, C: weak, D: insufficient evidence to assign a specific recommendation) for use in the practical setting was given. Results: Fourteen studies were analysed. The overall level of evidence for the risk factors previous injury, fatigue and muscle imbalance were 2++, 4 and 'inconclusive', respectively. The graded recommendation for functional movement screen, psychological questionnaire and isokinetic muscle testing were all 'D'. Hamstring eccentric had a weak graded 'C' recommendation, and eccentric exercise for other body parts was 'D'. Balance/proprioception exercise to reduce ankle and knee sprain injury was assigned a graded recommendation 'D'. Conclusions: The majority of perceptions and practices of premier league teams have a low level of evidence and low graded recommendation. This does not imply that these perceptions and practices are not important or not valid, as it may simply be that they are yet to be sufficiently validated or refuted by research. © 2015, BMJ Publishing Group. All rights reserved.

Kon E.,Rizzoli Orthopaedic Institute | Filardo G.,Rizzoli Orthopaedic Institute | Berruto M.,Gaetano Pini Orthopaedic Institute | Benazzo F.,Clinica Ortopedica e Traumatologica | And 3 more authors.
American Journal of Sports Medicine | Year: 2011

Background: Soccer is a highly demanding sport for the knee joint, and chondral injuries can cause disabling symptoms that may jeopardize an athlete's career. Articular cartilage lesions are difficult to treat, and the increased mechanical stress produced by this sport makes their management even more complex.Hypothesis: To evaluate whether the regenerative cell-based approach allows these highly demanding athletes a better functional recovery compared with the bone marrow stimulation approach.Study Design: Cohort study; Level of evidence, 2.Methods: Forty-one professional or semiprofessional male soccer players were treated from 2000 to 2006 and evaluated prospectively at 2 years and at a final 7.5-year mean follow-up (minimum, 4 years). Twenty-one patients were treated with arthroscopic second-generation autologous chondrocyte implantation (Hyalograft C) and 20 with the microfracture technique. The clinical outcome of all patients was analyzed using the cartilage standard International Cartilage Repair Society (ICRS) evaluation package. The sport activity level was evaluated with the Tegner score, and the recovery time was also recorded.Results: A significant improvement in all clinical scores from preoperative to final follow-up was found in both groups. The percentage of patients who returned to competition was similar: 80% in the microfracture group and 86% in the Hyalograft C group. Patients treated with microfracture needed a median of 8 months before playing their first official soccer game, whereas the Hyalograft C group required a median time of 12.5 months (P =.009). The International Knee Documentation Committee (IKDC) subjective score showed similar results at 2 years' follow-up but significantly better results in the Hyalograft C group at the final evaluation (P =.005). In fact, in the microfracture group, results decreased over time (from 86.8 ± 9.7 to 79.0 ± 11.6, P <.0005), whereas the Hyalograft C group presented a more durable outcome with stable results (90.5 ± 12.8 at 2 years and 91.0 ± 13.9 at the final follow-up).Conclusion: Despite similar success in returning to competitive sport, microfracture allows a faster recovery but present a clinical deterioration over time, whereas arthroscopic second-generation autologous chondrocyte implantation delays the return of high-level male soccer players to competition but can offer more durable clinical results. © 2011 American Orthopaedic Society for Sports Medicine.

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