Recovery from ACLR

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Recovery from ACLR

 

ACLR Recovery

This post will look at some of the issues concerned with anterior cruciate ligament reconstruction (ACLR) surgery. Injuries of the anterior cruciate ligament are common in sports. These injuries have a high impact not only on the personal life of the individual, but also on their career because they have to undertake a long recovery period (Brophy et al., 2009). ACLR surgery remains the standard approach for athletes who aim to return to high-level sporting activities as soon as possible (Hewett et al., 2013)

Mechanically, anterior cruciate ligament injury occurs when an excessive tension force is applied on the ligament from contact. A non-contact anterior cruciate ligament injury occurs when a person generates greater force or movements at the knee and applies excessive loading on the ligament (Yu & Garrett, 2007).

Previous football studies have reported that the contact element in anterior cruciate ligament injuries is responsible for 16-22% of the total injuries sustained (Faunø & Wulff Jakobsen, 2006; Rochcongar et al., 2009). This data is consistent with later research by who advocates a similar figure of 15%. According to these data figures Walden et al. (2015) reports 85% of injuries are caused by non-contact. Their research indicates three distinct predominant mechanisms, which are: pressing followed by re-gaining balance, re-gaining balances after kicking, and landing after heading.

When patients are recovering from reconstruction surgery of the anterior cruciate ligament the process depends on the type of reconstruction surgery, which has occurred, in terms of anatomical graft (patellar or hamstring) and fixation strength (single / doubled blinded). Research by Webster et al. (2014) indicates that athletes returning to cutting/pivoting sports increased the odds of graft rupture by a factor of 5.

Secondary injuries are also a large factor to consider in professional sport. Paterno et al. (2014) report 29.5% of athletes suffered a second anterior cruciate ligament injury and six times greater than the control subjects in their 24-month study.

The time between the injury and the surgery may have a factor on the success of returning to sport to the previous level. However, research by Frobell et al. (2013) shows that in this time period there is no significant difference in the time frame between injury and surgery. Furthermore, returning to sport from ACLR is no guarantee of a return. MOON cohort reports that 30% of cases were unable to return to playing sport at all. Ardern et al. (2011) conducted meta-analysis which suggests that 63% return to pre-injury levels of sports, and 44% to competitive sports.

The videos below show a cross section of some of the recovery exercises and drills, which were used in returning the client back to competitive sport. These videos are a snap shot of a recovery period, which lasted a number of months.

References

Ardern, C.L., Webster, K.E., Taylor, N.F. & Feller, J.A. (2011) Return to sport following anterior cruciate ligament reconstruction surgery: a systematic review and meta-analysis of the state of play. British Journal of Sports Medicine. Vol. 45, No. 7: 596–606. [Online] Available from: http://www.ncbi.nlm.nih.gov/pubmed/21398310\nhttp://www.scopus.com/inward/record.url?eid=2-s2.0-79955880518&partnerID=40&md5=2dd70cf46204a87edc216f6fb40b9b47.

Brophy, R.H., Wright, R.W. & Matava, M.J. (2009) Cost analysis of converting from single-bundle to double-bundle anterior cruciate ligament reconstruction. The American journal of sports medicine, 37(4), pp.683–7. Available at: http://www.ncbi.nlm.nih.gov/pubmed/19204364 [Accessed March 9, 2013].ngle-bu. The American Journal of Sports Medicine. Vol. 37, No. 4: 683–7. [Online] Available from: http://www.ncbi.nlm.nih.gov/pubmed/19204364.

Faunø, P. & Wulff Jakobsen, B. (2006) Mechanism of anterior cruciate ligament injuries in soccer. International Journal of Sports Medicine. Vol. 27: 75–79.

Frobell, R., Roos, H., Roos, E., Roemer, F., Ranstam, J. & Lohmander, L. (2013) Evidence-Based Orthopaedics: Rehabilitation Plus Early ACL Reconstruction and Rehabilitation Plus Delayed Reconstruction Were Similar at 5 Years. The Journal of Bone and Joint Surgery. American Volume. Vol. 95-A: 1516.

Hewett, T.E., Di Stasi, S.L. & Myer, G.D. (2013) Current concepts for injury prevention in athletes after anterior cruciate ligament reconstruction. The American Journal of Sports Medicine. Vol. 41, No. 1: 216–24. [Online] Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3592333&tool=pmcentrez&rendertype=abstract.

Paterno, M. V, Rauh, M.J., Schmitt, L.C., Ford, K.R. & Hewett, T.E. (2014) Incidence of Second ACL Injuries 2 Years After Primary ACL Reconstruction and Return to Sport. The American Journal of Sports Medicine. Vol. 42, No. 7: 1567–73. [Online] Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=4205204&tool=pmcentrez&rendertype=abstract.

Rochcongar, P., Laboute, E., Jan, J. & Carling, C. (2009) Ruptures of the anterior cruciate ligament in soccer. International Journal of Sports Medicine. Vol. 30, No. 5: 372–378.

Walden, M., Krosshaug, T., Bjorneboe, J., Andersen, T.E., Faul, O. & Hagglund, M. (2015) Three distinct mechanisms predominate in non-contact anterior cruciate ligament injuries in male professional football players: a systematic video analysis of 39 cases. British Journal of Sports Medicine. Vol. 49: 1452-1460. [Online] Available from: http://bjsm.bmj.com/cgi/doi/10.1136/bjsports-2014-094573.

Webster, K.E., Feller, J. a, Leigh, W.B. & Richmond, A.K. (2014) Younger patients are at increased risk for graft rupture and contralateral injury after anterior cruciate ligament reconstruction. The American Journal of Sports Medicine. Vol. 42, No. 3: 641–7. [Online] Available from: http://www.ncbi.nlm.nih.gov/pubmed/24451111.

Yu, B. & Garrett, W.E. (2007) Mechanisms of non-contact ACL injuries. Br J Sports Med. Vol. 41: 47–51.

Here is the references list from the videos:

Bangsbo, J. (1999) Science and football. Journal of Sports Sciences. Vol. 17, No. 10: 755–756.

Bosco. C., Viitasalo. J.T., K.P.V. (1982) Combined effect of elastic energy and myoelectrical potentiation during stretch-shortening cycle exercise. Acta Physiol Scand. Vol. 114: 557–565.

Chmielewski. T.L., Myer. G.D., K.D. (2006) Plyometric exercise in the rehabilitation of athletes: physiological responses and clinical application. Journal of Orthopedic Sports Physical Therapy. Vol. 36: 308–319.

Cronin, J. & Sleivert, G. (2005) Challenges in understanding the influence of maximal power training on improving athletic performance. Sports Medicine. Vol. 35, No. 3: 213–234.

de Villarreal, E.S.S., González-Badillo, J.J. & Izquierdo, M. (2008) Low and moderate plyometric training frequency produces greater jumping and sprinting gains compared with high frequency. Journal of Strength and Conditioning Research / National Strength & Conditioning Association. Vol. 22, No. 3: 715–725.

Francis, C. (1997). Training for speed. Canberra, ACT: Faccioni.

García-Pinillos, F., Ruiz-Ariza, A., Moreno del Castillo, R. & Latorre-Román, P.Á. (2015) Impact of limited hamstring flexibility on vertical jump, kicking speed, sprint, and agility in young football players. Journal of Sports Sciences. Vol. 33, No. 12: 1293–7. [Online] Available from: http://www.ncbi.nlm.nih.gov/pubmed/25761523.

Helgerud, J., Rodas, G., Kemi, O.J. & Hoff, J. (2011) Strength and endurance in elite football players. International Journal of Sports Medicine. Vol. 32, No. 9: 677–682.

Lehance, C., Binet, J., Bury, T. & Croisier, J.L. (2009) Muscular strength, functional performances and injury risk in professional and junior elite soccer players. Scandinavian Journal of Medicine and Science in Sports. Vol. 19, No. 2: 243–251.

Lundin. P.E (1985) A review of Plyometric training. National Strength Condition Assocation Journal. Vol. 73: 65–70.

Chu, D. A., & Myer, G. (2013) Plyometrics. Human Kinetics.

Padulo. J., Annino. G., D’Ottavio.S., Vernillo.G., Smith. L., M.G.M. and T.J. (2013) footstep analysis at different slopes and speeds in elite race walking. Journal of Strength and Conditioning Research. Vol. 27, No. 1: 125–129.

Rabita, G., Couturier, A. & Lambertz, D. (2008) Influence of training background on the relationships between plantarflexor intrinsic stiffness and overall musculoskeletal stiffness during hopping. European Journal of Applied Physiology. Vol. 103, No. 2: 163–171.

Sayers, M. (2000). Running techniques for field sport players. Sports Coach, Autumn, pp. 26 – 27.

Sheppard, J.M. & Young, W.B. (2006) Agility literature review: Classifications, training and testing. Journal of Sports Sciences. Vol. 24, No. 9: 919–932. [Online] Available from: http://www.ncbi.nlm.nih.gov/pubmed/16882626.

Sporis, G., Jukic, I., Milanovic, L., Vucetic, V. (2010) Reliability and Factorial validity of Agility Tests for Soccer Players. Journal of Strength and Conditioning Research. Vol. 24, No. 3: 679–686. [Online] Available from: http://search.proquest.com/docview/213084686?accountid=15977\nhttp://journals.lww.com/nsca-jscr/Abstract/2010/03000/Reliability_and_Factorial_Validity_of_Agility.12.aspx.

Stefanyshyn, D.J. & Nigg, B.M. (1998) Dynamic angular stiffness of the ankle joint during running and sprinting. Journal of Applied Biomechanics. Vol. 14, No. 3: 292–299.

Thomas, K., French, D. & Hayes, P.R. (2009) The effect of two plyometric training techniques on muscular power and agility in youth soccer players. Journal of Strength and Conditioning Research / National Strength & Conditioning Association. Vol. 23, No. 1: 332–335.

Twist, P.,W. and Benicky, D.(1995) Conditioning lateral movements for multisport athletes. Practical strength and quickness drills. Strength Cond 17: 43–51.

Verheijen, R. Handbuch fu ̈r Fussballkondition. Leer, Germany: BPF Versand, 1997.

Verhoshanski. Y (1983) Depth jumping in the training of jumpers. Track Technique. Vol. 51: 1618–1619.

Walden, M., Krosshaug, T., Bjorneboe, J., Andersen, T.E., Faul, O. & Hagglund, M. (2015) Three distinct mechanisms predominate in non-contact anterior cruciate ligament injuries in male professional football players: a systematic video analysis of 39 cases. British Journal of Sports Medicine: 1–10. [Online] Available from: http://bjsm.bmj.com/cgi/doi/10.1136/bjsports-2014-094573.

Wilkerson, G.B., Colston, M.A., Short, N.I., Neal, K.L., Hoewischer, P.E. & Pixley, J.J. (2004) Neuromuscular Changes in Female Collegiate Athletes Resulting from A Plyometric Jump-Training Program. Journal of Athletic Training. Vol. 39, No. 1: 17–23.

Young, W.B., James, R. & Montgomery, J.I., (2002). Is muscle power related to running speed with changes of direction? Journal of Sports Medicine & Physical Fitness. Vol. 42. No,3: 282-288. Available at: http://articles.sirc.ca/search.cfm?id=S-845121\nhttp://ezproxy.spfldcol.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=s3h&AN=SPHS-845121&site=ehost-live\nhttp://www.minervamedica.it.

 

Arsenal SEMS

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Arsenal SEMS

This post is a repost from the twiter name ‘The Sports Physio’ aka Adam Meakins who presently is an Extended Scope Practitioner, in the NHS, however, was a former lecturer, who’s friend Tom Goom produced a guest blog on his website. So here it is below taken from the Arsenal SEMS conference 2016. This may be of interest to some of you.

A legend speaks… A guest blog by Tom Goom

 / 1 day ago 

Guest blogs are a bit like buses… You can wait six weeks for one, then two turn up together. Today’s guest blog is from a good friend of ‘The Sports Physio’ Tom Goom aka ‘The Running Physio’. Now as much as I think Tom is a legend in his own right, in his blog Tom talks about another legend and a personal hero of mine from Arsenal FC, I wont spoil the surprise instead I will let Tom take it away…

Today’s Arsenal SEMS Conference started with a surprise speaker. The room hushed and he had everyone’s attention in a split second. But this speaker wasn’t one of the multi-published, hugely impressive lecturers on the bill. He didn’t hone his skills in the clinic or the lab but on the football pitch. Despite this his insights were as valuable as any paper but then, could you expect anything less than excellence from Thierry Henry?!..

Dr Gary O’Driscoll, Arsenal’s head doctor, skillfully interviewed the Arsenal legend and his answers highlight some key issues working in elite sport. Apologies if I paraphrase Thierry’s answers a little I couldn’t write them down quickly enough!…

Pain may be part of the Process

A hugely revealing comment from Thierry was, “most of the time I was in pain.“ I was surprised to hear an elite player, so capable with a football, spent much of his career playing through pain. Later in the day England Rugby Team Doctor Nigel Jones highlighted a similar issue, “all of our players play with an injury.”

The training loads and demands of competition at the highest level make pain and injury a likely consequence. The question is, as highlighted by Nigel Jones, is the pain sufficient to prevent play? Our role as physios is to help manage this pain and help the patient understand it. Appropriate loading and adequate recovery are key. Thierry commented on this, “rest is very important…don’t underestimate sleeping for recovery.” Evidence suggests sleep is essential for performance, healing and pain.

Magic or Mental?

Thierry also made a point I’m sure Adam will enjoy, “I don’t believe in magic. I think you need to do everything you can in order to perform.” A point further emphasised by the excellent Karim Khan who warned against giving in to quick fixes that, in reality, fix very little!

Image source

Achilles issues troubled Thierry from around 2004 until the end of his career. Their effect was more than just physical. It left him unsure whether he’d be able to perform and concerned he’d be unable to help his teammates.He conceded, “The mental part is huge” and admitted to worrying about how it might affect him after his football career. We can’t underestimate the psychological load elite sport places on an athlete and how this increases when struggling with an injury. Even the very best will worry and ask ‘what if?’. We need to consider the psychological impact and foster a positive perception of return to sport with the athlete in charge. Clare Ardern’sexcellent work show’s how important this is for return to play after injury.

Take Responsibility!

Thierry’s final point highlights how the patient should be central to everything and must take responsibility, “A player needs to take care of himself… I was on a mission to make sure I could perform for the team.” We need to support an athlete’s autonomy, educate and empower them to make informed choices. Ultimately though the athlete needs to be in the driving seat.

As a lifelong Arsenal fan is was an inspiring and illuminating interview and it demonstrates just how important it is that we listen to our patients. They don’t have to be footballing legends to teach us a thing or two!

Tom

Follow Tom Goom on Twitter here and find out more about his Running Repairs workshops here which I can vouch for as having done it myself as being totally awsome. Adam

 

Cold Water Immersion (Recovery part 1)

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Cold Water Immersion (Recovery part 1)

Recovery

Recovery in sport has become a vital component in athletes of any ability. Bishop et al.(2008) research implied that athletes spend a much greater proportion of their time recovering than they do training. Kellmann,(2010) states that effective recovery from intense training loads often faced by elite athletes can often determine sporting success or failure.

This review will concentrate on just one element to aid recovery, as there are too many to delve into without diluting the evidence. Recovery takes many forms, including nutrition, massage and cold-water immersion (CWI). Recovery is categorised into three sub-sections: immediate recovery between exertions, training recovery between sets and recovery between workouts, which is the focus of this blog as it contains the most diverse forms of recovery.

The major complaint between training experienced between elite and novice athletes is delayed onset of muscle soreness (DOMS) (Cheung et al., 2003). There has been extensive research on this subject. The accepted consensus is that the recovery from DOMS takes up to 72 hours. This is supported by Hill et al. (2014) meta-analysis research. This is most commonly brought about through unaccustomed eccentric muscle action or heavy loading of the muscles, this leads to a disturbance in the connective and/or contractile tissues (Cheung et al., 2003). Lewis et al.(2012) report that this process is a result of combination of mechanisms and not just a singular mechanism.

Areas that this affects is researched by Vila-Chã et al.(2012) who show that DOMS impairs force output up to 24 hours following exercise. Strategically, most elite athletes will train on consecutive days or have multiple workouts in a day.

As stated, earlier there are various methods to combat recovery, however, this review focuses the attention on CWI. CWI derives from the broader term cryotherapy. The term cryotherapy is a nondescript term, like ‘oxygen-therapy’. Cryotherapy is a type of proven medical treatment, in which CWI is included.images-3

This recovery strategy is widely utilised among athletes of all levels in hot and normal environments in an attempt to ameliorate factors associated with exercise. (Dunne et al., 2013; Peiffer et al., 2008). Machado et al.(2016) paper states that the most effective approach remains unclear. Despite the extensive use of this strategy the research highlights that there is no one significantly successful CWI protocol to use, despite its widespread use, generally. Investigations have suggested that physiological changes are temperature dependant (White & Wells, 2013), causing alterations in the body (Wilcock et al., 2006). Critically, other studies claim the magnitude of these mechanisms depends on the intensity of the cold and how it affects the body (García-Manso et al., 2011). Chesterton et al.(2002) research reiterates response discrepancy due to alterations in the application of CWI. These differences result in positive effects in muscle blood flow reduction (Wilcock et al., 2006), which is reinforced by McGorm et al.(2015). Similar analysis was shown in nerve conduction velocity (NCV) (Algafly & George, 2007), again supported by McGorm et al .(2015).

cwi

Performance studies, conducted by researchers as early as the 1960’s examined the influence of CWI on performance recovery from sustained handgrip exercises (Clarke, 1963). Amid this early, research the literature inclines towards the aspect of performance, with less focus on physiological factors until recently.

Having already discussed some research into physiological adaptations of CWI, the next step is to review the performance research. (Brophy-Williams et al., 2011) indicate that there is a significant improvement in the next day Yoyo Intermittent Recovery Test (YRT) on immediate CWI. Similarly, this study also demonstrates that delayed CWI, has some significant, however, the time frame of the delay is 3 hours, this compared to the control group may have a benefit for exercise performance. These results are consistent with other research that employed a delayed aspect to the testing such as Lum et al., (2010). Reinforcing the factor of immediate immersion for aiding benefits to performance is research conducted by Ingram et al.(2009) and Vaile et al. (2011). Further supporting evidence in post-exercise CWI comes from Yamane et al.(2006), whose results attenuated increases in endurance and maximal strength, as well as endurance time, plus VO2. More recent research (Fröhlich et al., 2014) also reported that regular cold water immersion attenuated gains in strength.

Critically, this review may appear in principal to show a strong argument in supporting the use of CWI. Nevertheless, there is a body of evidence that refutes the positive effects of CWI, with the evidence that CWI induces nothing more than a ‘placebo effect’ (Broatch et al., 2014). The authors concluded that the placebo trial was just as effective as the CWI trial, which gives some food for thought for the current widespread use of CWI.

Further studies emphasizing the contrast, Halson et al.(2008) found no decrease in performance when they used CWI in their trial of 39 day cycling training block. Versey et al.(2013) has published an article with practical recommendations, which summarised a research in CWI along with Contrast Water Therapy. This research reports by Coffey et al.(2004); Hamlin, (2007); Howatson et al.(2009), that these authors advocate no significant effects from the intervention of CWI. One final thought for consideration is evidence, which expresses the theory that CWI has negative effects on the advances which training produces by the nature of reducing the acute satellite cell response to strength training (Roberts et al., 2015; Yamane et al.,2015). This is strengthened from earlier research by Takagi et al.(2011). However, the participants’ were rats, which showed a significantly smaller regeneration of muscle fibres, compared to not receiving treatment

The review of the literature shows whilst there is strong evidence to indicate that post-exercise CWI may enhance both short and longer-term recovery, the precise factors responsible for such improvements are unclear, with numerous mechanisms proposed. There is an equally strong support for no effects on recovery from exercise. Additional research into CWI is still required to truly understand its effects in a range of situations. As mentioned, a large amount of performance-based research exists; so future research should focus more on understanding the physiological aspects of CWI. Additionally, a dose-response relationship is yet to be determined.

 

References:

Algafly, A.A. & George, K.P. (2007) The effect of cryotherapy on nerve conduction velocity, pain threshold and pain tolerance. British Journal of Sports Medicine. Vol. 41, No. 6: 365–9; discussion 369. [Online] Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2465313&tool=pmcentrez&rendertype=abstract.

Bishop, P.A., Jones, E. & Woods, A.K. (2008) Recovery from training: a brief review: brief review. Journal of Strength and Conditioning Research / National Strength & Conditioning Association. Vol. 22, No. 3: 1015–1024.

Broatch, J.R., Petersen, A. & Bishop, D.J. (2014) Postexercise cold water immersion benefits are not greater than the placebo effect. Medicine and Science in Sports and Exercise: Vol.46,No.11:2139-2147.

Brophy-Williams, N., Landers, G. & Wallman, K. (2011) Effect of immediate and delayed cold water immersion after a high intensity exercise session on subsequent run performance. Journal of Sports Science and Medicine. Vol. 10, No. 4: 665–670.

Chesterton, L.S., Foster, N.E. & Ross, L. (2002) Skin temperature response to cryotherapy. Archives of Physical Medicine and Rehabilitation. Vol. 83, No. 4: 543–549.

Cheung, K., Hume, P. & Maxwell, L. (2003) Delayed onset muscle soreness : treatment strategies and performance factors. Sports Med. Vol. 33, No. 2: 145–164.

Coffey, V., Leveritt, M. & Gill, N. (2004) Effect of recovery modality on 4-hour repeated treadmill running performance and changes in physiological variables. Journal of Science and Medicine in Sport. Vol. 7, No. 1: 1–10.

Clarke. D.H. (1963) Effects of immersion in hot and cold water upon recovery of muscular strength following fatiguing isometric exercise. Archives of Physical Medicine and Rehabilitation. Vol. 44: 565–568.

Dunne, A., Crampton, D. & Egaña, M. (2013) Effect of post-exercise hydrotherapy water temperature on subsequent exhaustive running performance in normothermic conditions. Journal of Science and Medicine in Sport. Vol. 16, No. 5: 466–471.

Fröhlich, M., Faude, O., Klein, M., Pieter, A., Emrich, E. & Meyer, T. (2014) Strength training adaptations after cold water immersion. Journal of Strength and Conditioning Research / National Strength & Conditioning Association. Vol. 49: 2628–2633. [Online] Available from: http://www.ncbi.nlm.nih.gov/pubmed/24552795.

García-Manso, J.M., Rodríguez-Matoso, D., Rodríguez-Ruiz, D., Sarmiento, S., de Saa, Y. & Calderón, J. (2011) Effect of cold-water immersion on skeletal muscle contractile properties in soccer players. American Journal of Physical Medicine & Rehabilitation / Association of Academic Physiatrists. Vol. 90, No. 5: 356–363. [Online] Available from: http://www.ncbi.nlm.nih.gov/pubmed/21765254.

Halson, S.L., Quod, M.J., Martin, D.T., Gardner, A.S., Ebert, T.R. & Laursen, P.B. (2008) Physiological responses to cold water immersion following cycling in the heat. International Journal of Sports Physiology and Performance. Vol. 3, No. 3: 331–46. [Online] Available from: http://www.ncbi.nlm.nih.gov/pubmed/19211945.

Hamlin, M.J. (2007) The effect of contrast temperature water therapy on repeated sprint performance. Journal of Science and Medicine in Sport. Vol. 10, No. 6: 398–402.

Hill, J., Howatson, G., van Someren, K., Leeder, J. & Pedlar, C. (2014) Compression garments and recovery from exercise-induced muscle damage: a meta-analysis. British Journal of Sports Medicine. Vol. 48, No. 18: 1340–6. [Online] Available from: http://bjsm.bmj.com/cgi/doi/10.1136/bjsports-2013-092456\nhttp://www.ncbi.nlm.nih.gov/pubmed/23757486.

Howatson, G., Goodall, S. & Someren, K.A. (2009) The influence of cold water immersions on adaptation following a single bout of damaging exercise. European Journal of Applied Physiology. Vol. 105, No. 4: 615–621.

Ingram, J., Dawson, B., Goodman, C., Wallman, K. & Beilby, J. (2009) Effect of water immersion methods on post-exercise recovery from simulated team sport exercise. Journal of Science and Medicine in Sport. Vol. 12, No. 3: 417–421.

Kellmann, M. (2010) Preventing overtraining in athletes in high-intensity sports and stress/recovery monitoring. Scandinavian Journal of Medicine and Science in Sports. Vol. 20, No. SUPPL. 2: 95–102.

Lewis, P.B., Ruby, D. & Bush-Joseph, C.A. (2012) Muscle Soreness and Delayed-Onset Muscle Soreness. Clinics in Sports Medicine. Vol. 31, No. 2: 255–262.

Lum, D., Landers, G. & Peeling, P. (2010) Effects of a recovery swim on subsequent running performance. International Journal of Sports Medicine. Vol. 31, No. 1: 26–30.

Machado, A.F., Ferreira, P.H., Micheletti, J.K., de Almeida, A.C., Lemes,I.R., Vanderlei, F.M., Netto Junior, J. & Pastre, C.M. (2016) Can Water Temperature and Immersion Time Influence the Effect of Cold Water Immersion on Muscle Soreness? A Systematic Review and Meta-Analysis. Sports Medicine.Vol. 46, No, 4:503-514.

McGorm, H., Roberts, L., A., Coombes, J. S. & Peake, J.M. (2015) Cold water immersion: practices, trends and avenues of effect. Aspetar Sports Medicine Journal. Vol. 4, No. 1: 106–111.

Peiffer, J.J., Abbiss, C.R., Wall, B. A, Watson, G., Nosaka, K. & Laursen, P.B. (2008) Effect of a 5 min cold water immersion recovery on exercise performance in the heat. British Journal of Sports Medicine: 461–466. [Online] Available from: http://www.ncbi.nlm.nih.gov/pubmed/18539654.

Roberts, L.A., Raastad, T., Markworth, J.F., Figueiredo, V.C., Egner, I.M., Shield, A., Cameron-Smith, D., Coombes, J.S. & Peake, J.M. (2015) Post-exercise cold water immersion attenuates acute anabolic signalling and long-term adaptations in muscle to strength training. The Journal of Physiology. Vol. 18: n/a–n/a. [Online] Available from: http://www.ncbi.nlm.nih.gov/pubmed/26174323.

Takagi, R., Fujita, N., Arakawa, T., Kawada, S., Ishii, N. & Miki, A. (2011) Influence of icing on muscle regeneration after crush injury to skeletal muscles in rats. Journal of Applied Physiology (Bethesda, Md. : 1985). Vol. 110, No. 2: 382–8. [Online] Available from: http://www.ncbi.nlm.nih.gov/pubmed/21164157.

Vaile, J., O’Hagan, C., Stefanovic, B., Walker, M., Gill, N. & Askew, C.D. (2011) Effect of cold water immersion on repeated cycling performance and limb blood flow. British Journal of Sports Medicine. Vol. 45, No. 10: 825–829.

Versey, N.G., Halson, S.L. & Dawson, B.T. (2013) Water immersion recovery for athletes: Effect on exercise performance and practical recommendations. Sports Medicine. Vol. 43, No. 11: 1101–1130.

Vila-Chã, C., Hassanlouei, H., Farina, D. & Falla, D. (2012) Eccentric exercise and delayed onset muscle soreness of the quadriceps induce adjustments in agonist-antagonist activity, which are dependent on the motor task. Experimental Brain Research. Vol. 216, No. 3: 385–395.

White, G.E. & Wells, G.D. (2013) Cold-water immersion and other forms of cryotherapy: physiological changes potentially affecting recovery from high-intensity exercise. Extreme Physiology & Medicine. Vol. 2, No. 1: 26. [Online] Available from: http://www.extremephysiolmed.com/content/2/1/26.

Wilcock, I.M., Cronin, J.B. & Hing, W. a (2006) Physiological Response to Water Immersion. Sports Medicine. Vol. 36, No. 9: 747–765.

.Yamane, M., Teruya, H., Nakano, M., Ogai, R., Ohnishi, N. & Kosaka, M. (2006) Post-exercise leg and forearm flexor muscle cooling in humans attenuates endurance and resistance training effects on muscle performance and on circulatory adaptation. European Journal of Applied Physiology. Vol. 96, No. 5: 572–580.

Yamane, M., Ohnishi,.N. and Matsumoto, T. (2015) Does Regular Post-exercise Cold Application Attenuate Trained Muscle Adaptation? International Journal of Sports Medicine. Vol. 36, No. 8: 647–653.

 

Events

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Events

Check out the events and Conferences page of my site some interesting, worthy conference’s coming up in the near future, not to mention the one held at the University of St Mark and St John on May 6th, 2016 be quick to book your place as tickets are being snapped up rapidly

Anterior Ankle Impingement

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Anterior Ankle Impingement

Anterior Ankle Impingement

anterior-impingement140

image from www.sportsinjuryclinic.net

Introduction

Anterior ankle impingement is a common injury seen in football players and ballet dancers. Due to the repetitive nature of pile and demi-pile within ballet and striking of a ball within football, the micro trauma caused by these motions cause the athlete to be at higher risk of attaining anterior ankle impingement than any other athletes (O’Kane & Kadel, 2008) The repetitive micro trauma to the anterior aspect of the talocrural joint may cause osseous bone formation, ligament and soft tissue entrapment, and even capsulitis (Russell et al., 2012). Most commonly seen within a stereotypical anterior ankle impingement is an osseous formation (Bahr, R. & Maehlum, 2004; Brukner, P. and Khan, 2012). Hess, (2011) and Russell et al.(2012) state that osseous formations mainly occur due to the damage to the cartilage rims of the talus and tibia (talocrural joint); unlike previously suggested by Molloy et al., (2003)that the source of this osseous formation is due to the repetitive stretch which is placed onto the synovial capsule.

 

Anatomy of the Ankle Joint

Talo-crural Joint

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image from clinicalgate.com

The Talocrural joint consists of the congruent movement of the talus and the tibial plafond created by the tibia and fibula. This joint is commonly known as a hinge point due to its main movement’s only being Plantar flexion and dorsiflexion. The joint is made stable by the lateral ligaments, deltoid ligaments as well as the surrounding capsules and muscles. On an individual bases there are three ligaments which support the ankle laterally, these are; the anterior talofibular ligament, the calcaneul-fibular ligament, and the posterior talofibular ligament. Medially the deltoid ligaments consist of four individual ligaments, which consist of, the: tibio-navicular joint, talo-calacaneal ligament, anterior tibiotalar ligament, and the posterior tibiotalar ligament.

 

Sub-talar joint

Image_Jastifer_Talar_Body_Fracture_Surgery

 

image from www.aofas.org

In similarity to the talocrural joint both the lateral ligaments, the deltoid ligaments, the capsule and surrounding muscles, indirectly support the sub-talar joint. The sub-talar joint is a gliding joint, which only allows for inversion and eversion. With both the sub-talar joint and the talocrural joint working in conjunction with each other it allows for multidirectional movements such as plantar flexion and inversion as well as dorsiflexion and eversion. Commonly it is known that plantar flexion and inversion is the mechanism of injury for the tear/rupture of the anterior talofibular ligament (ATFL).Other Possible injuries to the ankle:

Retro calcaneal Bursitis. 


Achilles tendinopathy.https://www.youtube.com/watch?v=oUkmYRnHm9I

Posterior ankle impingement. 


Fractures


Muscular Tears


Ligament Tears (most common is a lateral ankle sprain of the ATFL)


Tenosynovitis of the tendon sheaths


 

Above are only a few injuries, which may happen to the ankle joint.

 

Hope you enjoy reading this blog and there will be more to follow in the coming weeks.

 

References

Bahr, R. & Maehlum, S. (2004) Clinical guide to sports injuries. Champaign, IL: Human Kinetics.

Brukner, P. and Khan, K. (2012) Brukner & Khan’s Clinical Sports Medicine. (4th Ed.) Australia: McGraw-Hill Medical.

Hess, G.W. (2011) Ankle Impingement Syndromes: A Review of Etiology and Related Implications. Foot & Ankle Specialist. Vol. 4, No. 5: 290–297.

Molloy, S., Solan, M.C. & Bendall, S.P. (2003) Synovial impingement in the ankle. A new physical sign. The Journal of Bone and Joint Surgery. British Volume. Vol. 85, No. 3: 330–3. [Online] Available from: http://www.ncbi.nlm.nih.gov/pubmed/12729103.

O’Kane, J.W. & Kadel, N. (2008) Anterior impingement syndrome in dancers. Current Reviews in Musculoskeletal Medicine. Vol. 1, No. 1: 12–16.

Russell, J.A., Kruse, D.W., Koutedakis, Y. & Wyon, M.A. (2012) Pathoanatomy of Anterior Ankle Impingement in Dancers. Journal of Dance Medicine & Science. Vol. 16, No. 3: 101–110.

Glenohumeral Joint

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Glenohumeral Joint

Gleno-Humeral Joint (GHJ)

Introduction

Within the shoulder complex, there are 3 joints, which synergistically work together to allow for movement, which is needed for sporting and generic needs. The joint in the shoulder were exploring today is the Gleno-humeral joint. The Glenohumeral joint is a ball and socket joint, which allows for a large range of motion. In general, we use this joint every day but underestimate its complexity and ability to produce the movement in which we need.

shoulder_anatomy_bones02image from www.eorthopod.com

The Anatomy of the Glenohumeral Joint.

The topographies of the Glenohumeral joint (GHJ) are: a humeral head, a fibro cartiliginous glenoid labrum (GL), glenoid cavity, ligaments and bursas. Overall, the fibro cartiliginous presence overlaying the glenoid rim adds joint stability to the GHJ due to an increase in the concavity-compression mechanism caused by the GL; therefore, causing a decrease in humeral head translation. Amongst 10% of the patient population, there have been three reported anatomical differentiations within the GHJ. Firstly, there are reports of a cord like middle Glenohumeral ligament with a non-existent presence of anterior-superior labral tissue; this is commonly known as the Buford complex. Incidences of the Buford complex is said to be 2.5% within the military population. Secondly, variations are sometimes seen with the size of the sub-labral recesses sizes. On the whole, the Gleno-humeral joint is a complex joint which has a variety of rare anatomical differences between different people of the population. Therefore, treatments and rehabilitation strategies are always changing.

The Main Movements of the Glenohumeral Joint.

Flexion 
Extension
Medial Rotation
Lateral Rotation
Abduction
Adduction
Horizontal Flexion
Horizontal Abduction
Possible Injuries to the Joint.

The shoulder is an extremely mobile joint, which allows for a large range of motion. However, with a large range of motion comes the increase in likely hood of ascertaining an injury. Common injuries to the shoulder occur in individuals who carry out daily overhead exercises on a regular basis (labourer). Moreover, in a sporting context damage to the shoulder joint commonly occurs from traumatic injuries to the area. In general, there are several types of injury, which can occur at this specific joint:

Bankart Lesion https://www.youtube.com/watch?v=-sdw465tiL4
SLAP Lesion
Bicep Tendinopathy
Rotator Cuff Tendinopathy
Multidirectional instability (caused by either or both ligament laxity and rotator cuff hypoplasia)
Bursitis of one of the four bursae’s known within the typical population.

The above list is only a few injuries, which may happen to the Gleno-humeral joint.

On the whole, the shoulder joint is a compact joint; however, it is highly susceptible to injuries due to the mobility of the joint itself.

More blogs on the shoulder to come in the future.

References
Abrams, G.D. & Safran, M.R. (2010) Diagnosis and Management of Superior Labrum Anterior Posterior Lesions in Overhead Athletes. British Journal of Sports Medicine. Vol. 44: 311–318.
Arai, R., Kobayashi, M., Toda, Y., Nakamura, S., Miura, T. & Nakamura, T. (2012) Fiber components of the shoulder superior labrum. Surgical and Radiologic Anatomy. Vol. 34, No. 1: 49–56.
Kanatli, U., Ozturk, B.Y. & Bolukbasi, S. (2010) Anatomical variations of the anterosuperior labrum: Prevalence and association with type II superior labrum anterior-posterior (SLAP) lesions. Journal of Shoulder and Elbow Surgery. Vol. 19, No. 8: 1199–1203.
Ben Kibler, W., Sciascia, A.D., Hester, P., Dome, D. & Jacobs, C. (2009) Clinical utility of traditional and new tests in the diagnosis of biceps tendon injuries and superior labrum anterior and posterior lesions in the shoulder. The American Journal of Sports Medicine. Vol. 37, No. 9: 1840–1847 .
Knesek, M., Skendzel, J.G., Dines, J.S., Altchek, D.W., Allen, A. a & Bedi, A. (2013) Diagnosis and management of superior labral anterior posterior tears in throwing athletes. The American Journal of Sports Medicine. Vol. 41: 444–60. [Online] Available from: http://www.ncbi.nlm.nih.gov/pubmed/23172004.