Patellofemoral pain syndrome and modifiable intrinsic risk factors; how to assess and address?

Patellofemoral pain syndrome [PFPS] is a very common disorder of the knee. Due to multiple forces influencing the patellofemoral joint, clinical management of this ailment is particularly intricate. Patellofemoral pain syndrome has a multifactorial nature and multiple parameters have been proposed as potential risk factors, classified as intrinsic or extrinsic. Some of the intrinsic risk factors are modifiable and may be approached in treatment. A number of modifiable risk factors have been suggested, including quadriceps weakness, tightness of hamstring, iliopsoas and gastrosoleus muscles, hip muscles dysfunction, foot overpronation, tightness of iliotibial band, generalised joint laxity, limb length discrepancy, patellar misalignment and hypcrinobility. In general, the routine approach of physicians to this problem docs not include assessment and modification of these risk factors and therefore, it may negatively affect the management outcomes. Changing this approach necessitates an easy and practical protocol for assessment of modifiable risk factors and effective and feasible measures to address them. In this review, we aimed to introduce assessment and intervention packages appropriate for this purpose

Pediatric flexible flatfoot; clinical aspects and algorithmic approach

Flatfoot constitutes the major cause of clinic visits for pediatric foot problems. The reported prevalence of flatfoot varies widely due to numerous factors. It can be divided into flexible and rigid flatfoot. Diagnosis and management of pediatric flatfoot has long been the matter of controversy. Common assessment tools include visual inspection, anthropometric values, footprint parameters and radiographic evaluation. Most flexible flatfeet are physiologic, asymptomatic, and require no treatment. Otherwise, the physician should treat symptomatic flexible flatfeet. Initial treatment options include activity modification, proper shoe and orthoses, exercises and medication. Furthermore, comorbidities such as obesity and ligamenous laxity should be identified and managed, if applicable. When all nonsurgical treatment options faile, surgery can be considered. Our purpose in this article is to present a clinical algorithmic approach to pediatric flatfoot

[Study of selected health and performance related parameters among football referees of Iranian premier League]

The official FIFA survey showed that there are more than 840,000 registered referees. Football refereeing is a physically challenging job. Despite the important role of referees, few studies have focused on them. However, health and fitness of football referees is a major concern due to their older ages and significance of their performance. The aim of this study was to assess the selected parameters of fitness as well as risk factors of musculoskeletal problems among all referees of Iran's Premier League during season 2009-2010. In a cross- sectional study, all referees selected for the premier league competitions were enrolled. All participants underwent preparticipation evaluation including 7 stations. Among 78 participants [32 center referees and 46 assistant], descriptive data were as below: Age: 37 +/- 3.8 y, body mass index: 23.6 [2.1], percent of body fat: 20.7 [3.9] and VO2 max: 59.9 [7.1]. Regarding musculoskeletal abnormalities, muscular tightness was observed in 35 cases, including hamstring [18], gastrocnemius [14], iliopsoas [2] and iliotibial band [1]. Nine referees showed signs of weak quadriceps femoris. Single leg balance test was abnormal in 56 cases. The average BMI is lower than values reported in similar studies, indicating good anthropometric profile. Although VO2 max has been estimated using indirect method, the average values are comparable to elite-level European referees. Furthermore, musculoskeletal problems are common. It is recommended to incorporate periodic medical evaluation in all pre-season preparations.

Hemodynamic changes after static and dynamic exercises and treadmill stress test; different patterns in patients with primary benign exertional headache?

The pathophysiology of primary benign exertional headache [EH] is not still clearly defined. Some researchers have suggested an impaired vascular response as the etiology of this disorder. In this study we investigated whether there are any differences in blood pressure [BP] and heart rate [HR] of the subjects in course of the static and dynamic exercises and the treadmill stress test between those with and without EH. From university students, 22 patients with EH [mean age: 19.8 +/- 2.10, Female to Male: 7:15] and 20 normal subjects [mean age: 19.3 +/- 1.97, Female: Male: 8:12] were recruited. All the subjects performed the static and dynamic exercises at 30 and 20 percent of the maximal voluntary contraction [MVC] and Bruce treadmill stress test according to the standard protocols. HR and BP of all the cases at the baseline and during and immediately after each test were measured. No significant difference was found between the mean rise of HR, systolic and diastolic BP of the subjects with and without EH in static and dynamic exercises and also treadmill stress test. It seems that between those with and without EH, there is no significant difference in rise of HR and BP response to static and dynamic exercises and treadmill stress test. Further studies are required to find the pathophysiology and risk factors of EH

Sudden cardiac death in young athleters; a literature review and special considerations in Asia

Sudden cardiac death [SCD] in a young athlete is rare, but catastrophic. Exercise acts as a risk factor for SCD in people with cardiovascular disease. A diversity of cardiovascular disorders including hypertrophic cardiomyopathy, congenital coronary anomalies, arrhythmogenic right ventricular dysplasia, dilated cardiomyopathy, aortic rupture due to Marfan syndrome, myocarditis, valvular disease and electrical disorders [Wolff-Parkinson-White syndrome, long QT syndrome, Brugada syndrome], as well as commotion cordis represent the common causes of SCD in young athletes. As the outcome of lethal cardiovascular disorder is not reversible except in few cases, effective measures should be addressed to reduce the burden of sudden cardiac death in young athletes. Currently, two types of recommendations are proposed by Americans and European countries. It seems that there are some special considerations in Asia, entirely different from North America or Europe, which warrant more comprehensive research on epidemiology and etiology of SCD in young Asian athletes by country and evaluation of current national preventive strategies and their achievements in decreasing the risk. Using these data and considering regional restrictions, an expert group will be able to plan a practical and feasible preventive strategy