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Aadahl M.,Research Center for Prevention and Health | Beyer N.,Musculoskeletal Rehabilitation Research Unit | Linneberg A.,Research Center for Prevention and Health | Thuesen B.H.,Research Center for Prevention and Health | And 2 more authors.
BMJ Open | Year: 2011

Aim: To assess muscular fitness by hand grip strength (HGS) and lower limb extension power (LEP) and to explore associations with age, leisure time physical activity (LTPA) and body composition. Study population: A population-based sample of 19-72-year-old men and women were invited to participate in the health survey 'Health2006'. The response rate was 43.8% (N=3471), 55% were women, and the mean age was 49=13 years. Methods: Height, weight, waist circumference, HGS and LEP were measured and participants answered a self-administered questionnaire. LEP was measured in a subsample of subjects (n=438). Gender-stratified multiple linear regression analyses were carried out. Data were adjusted for age, height and waist circumference. Results: A large inter-individual variation was found in HGS and LEP. Both measures declined with age and were highly correlated (r=0.75, p<0.0001). LTPA was positively associated with HGS in men (p=0.0002) and women (p<0.0001) in the total sample, but in the subsample was significant in men only (p=0.004); the association between LTPA and LEP was significant in women only (p=0.02). Conclusion: In this large population-based study sample, muscular fitness declined with age and LTPA was associated with HGS in both genders. The findings emphasise the importance of maintaining a physically active lifestyle at any age.

Beyer R.,Kings College London | Beyer R.,Musculoskeletal Rehabilitation Research Unit | Ingerslev J.,Aarhus University Hospital | Sorensen B.,Kings College London | Sorensen B.,Aarhus University Hospital
Haemophilia | Year: 2010

Muscle haematoma represents 10-25% of bleeds in patients with severe haemophilia. There is limited consensus on diagnostic or treatment strategies and little knowledge about the natural history of muscle haematoma and optimal treatment goals. The aim of this review was to perform a systematic description of the natural history of muscle haematoma in healthy athletes, focusing on diagnosis, classification and treatment options. Publications and educational textbooks on management of sports injuries were used as data source. Muscle haematomas occur following contusion, strain, or laceration and can be categorized as mild, moderate, or severe. Muscle haematoma may be inter- or intramuscular. In healthy athletes, the healing process takes 20-40 days. Optimal diagnosis includes history, physical examination (inspection, palpation, active and passive range of motion (ROM) test, muscle length test, isometric strength test, biomechanical examination, full spinal examination, peripheral nerve test and slump test), ultrasound, MRI or CT. Treatment is conducted based on: (i) super-acute stage, control of the bleeding and minimizing the size of the haematoma; (ii) acute stage, restoration of pain-free ROM; (iii) subacute stage, functional rehabilitation; and (iv) gradual return to normal activity. Treatment and preventive strategies include RICE (rest, ice, compression and elevation), protected mobilization, stretching and strengthening exercises, manual therapy (articular, neural and soft tissue mobilization and massage), correction of movement dysfunction, functional rehabilitation and electro-therapeutic interventions. The study reviews the natural history of muscle haematoma and state-of-the-art diagnosis and treatment in healthy athletes. Results may be useful to optimize diagnosis and treatment of muscle haematoma in patients with haemophilia. © 2010 Blackwell Publishing Ltd.

Couppe C.,Copenhagen University | Couppe C.,Musculoskeletal Rehabilitation Research Unit | Svensson R.B.,Copenhagen University | Kongsgaard M.,Copenhagen University | And 15 more authors.
Journal of Applied Physiology | Year: 2016

Diabetic patients have an increased risk of foot ulcers, and glycation of collagen may increase tissue stiffness. We hypothesized that the level of glycemic control (glycation) may affect Achilles tendon stiffness, which can influence gait pattern. We therefore investigated the relationship between collagen glycation, Achilles tendon stiffness parameters, and plantar pressure in poorly (n = 22) and well (n = 22) controlled diabetic patients, including healthy age-matched (45-70 yr) controls (n = 11). There were no differences in any of the outcome parameters (collagen cross-linking or tendon stiffness) between patients with well-controlled and poorly controlled diabetes. The overall effect of diabetes was explored by collapsing the diabetes groups (DB) compared with the controls. Skin collagen cross-linking lysylpyridinoline, hydroxylysylpyridinoline (136%, 80%, P < 0.01) and pentosidine concentrations (55%, P < 0.05) were markedly greater in DB. Furthermore, Achilles tendon material stiffness was higher in DB (54%, P < 0.01). Notably, DB also demonstrated higher forefoot/rearfoot peak-plantar-pressure ratio (33%, P < 0.01). Overall, Achilles tendon material stiffness and skin connective tissue cross-linking were greater in diabetic patients compared with controls. The higher foot pressure indicates that material stiffness of tendon and other tissue (e.g., skin and joint capsule) may influence foot gait. The difference in foot pressure distribution may contribute to the development of foot ulcers in diabetic patients. Copyright © 2016 the American Physiological Society.

Beyer R.,Kings College London | Beyer R.,Musculoskeletal Rehabilitation Research Unit | Ingerslev J.,Kings College London | Ingerslev J.,Aarhus University Hospital | And 2 more authors.
Haemophilia | Year: 2010

Muscle haematomas (MH) represent 10-25% of all bleeds in patients with severe haemophilia. We performed a cross-sectional survey on current practice in the management of MH with participation from 22 consultants. The respondents reported 492 MH/year, corresponding an average of 25/centre, mostly associated with trauma. Iliopsoas (55%), calf (18%) and thigh (18%) bleeds were scored as most serious. Half of the respondents distinguished between contusion and strains, whereas the majority (68.2%) did not categorize bleedings as intra- or intermuscular, although 77.3% routinely used ultrasound. Half of the respondents used a standard protocol for the management of MH. Twenty of 22 (90.9%) respondents offered physiotherapy in the hospital following MH, with no clear consensus on timing and type of treatment. In a theoretical case, for a 70-kg patient with a soleus triceps haematoma, the average initial dose of factor VIII was 2730 U (range: 1750-4000) twice daily for 3-5 days. In a similar case of a patient with inhibitors, 31.8% reported first-line and only use of either recombinant factor VIIa (rFVIIa) or activated prothrombin complex concentrate (APCC), while 36.4% switched between bypassing agents. Using rFVIIa, the median dose was 100 μg/kg (range: 85-270) and with APCC, the median dose was 70 U kg-1 (range: 50-100). The majority (68.2%) did not use antifibrinolytics. Resolution of pain (81.8% & 77.3%) was regarded as the key clinical marker of arrest of bleeding as compared with diminished swelling and improved range of motion. The survey outlines limited consensus in the management of MH in patients with haemophilia and highlights potential topics for future studies. © 2010 Blackwell Publishing Ltd.

Eriksen C.,Institute of Sports Medicine | Eriksen C.,Copenhagen University | Svensson R.B.,Institute of Sports Medicine | Svensson R.B.,Copenhagen University | And 12 more authors.
Journal of Applied Physiology | Year: 2014

Tendon pathology is related to metabolic disease and mechanical overloading, but the effect of metabolic disease on tendon mechanics is unknown. This study investigated the effect of diet and apolipoprotein E deficiency (ApoE-/-) on mechanical properties and advanced glycation end product (AGE) cross-linking of non-weight-bearing mouse tail tendons. Twenty ApoE-/- male mice were used as a model for hypercholesterolemia along with 26 wild-type (WT) mice. One-half of the mice from each group was fed a normal diet (ND) and the other half was fed a high-fat diet (HFD) to induce obesity. All were killed at 40 wk, and tail tendon fascicles were mechanically tested to failure and analyzed for AGEs. Diets were also analyzed for AGEs. ApoE-/- mice displayed a 14% increase in plateau modulus compared with WT mice (P < 0.05), whereas HFD mice displayed a 13% decrease in plateau modulus (P < 0.05) and a 12% decrease in total modulus (P < 0.05) compared with ND mice. Tail tendons of HFD mice had significantly lower concentrations of AGEs [carboxymethyllysine (CML): 26%, P < 0.0001; methylglyoxal-derived hydroimidazolone 1 (MG-H1): 15%, P < 0.005; pentosidine: 13%, P < 0.0005]. The HFD had ∼44-fold lower content of CML (P < 0.01), ∼29-fold lower content of carboxyethyllysine (P < 0.005), and ∼16-fold lower content of MG-H1 (P < 0.05) compared with ND. ApoE-/- increased, whereas HFD decreased mouse tail tendon stiffness. Dietary AGE content may be a crucial determinant for accumulation of AGE cross-links in tendons and for tissue compliance. The results demonstrate how systemic metabolic factors may influence tendon health. Copyright © 2014 the American Physiological Society.

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