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

[Effect of mental imagery on performance elite athletes' in youth and adult age groups: a randomized trial]

Athletes are usually skilled in physical aspects of sports; they are widely involved in physical conditioning, technical and tactical training. However they usually ignore the psychological and cognitive skills linked to their performance. Sport imagery is a well known fundamental skill that has a critical role in how a player performs and shows his/her competency during a real world game. On the other hand football as a complex team sport includes several skills linked to physical and psychological properties. We aimed to study the effect of cognitive imagery on elite football players through league competitions in two separate studies. Twenty two youth players and Twenty two adult players randomly assigned to imagery and control groups. Players in intervention group received 12 weeks training program for specific cognitive imagery and general cognitive imagery. Imagery training program focused on an important component of football performance as "successful passing". Players in control group were assigned to a waiting list with no intervention. In order to evaluate outcome variable we assessed successful passing in real competetions as player performance in both pre and post test occasions. Findings of study in youth participants showed that young players in intervention group improved the performance of passing compared to control players [OR=1.41, P<0.000, CI 95%: 1.17, 1.69]. In contrary, Imagery performance in adult group remained unchanged in spite of an increasing trend in performance [OR=1.07, P>0.05, CI 95%: 0.82, 1.4]. These results showed that cognitive imagery intervention can affect elite soccer players' performance. This effect is more prominent in youth age football players.

[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.

effect of an ecological imagery program on soccer performance of elite players

Despite the acknowledged impact of imagery on performance, ecologically sound studies investigating imagery and its effects on performance subcomponents in real games are surprisingly limited. The aim of this study was to investigate the effects of imagery training on passing improvement in elite soccer players. Sixty nine soccer players taking part in the national championship leagues in four age categories including U16, U19, U21 and over 21 randomly assigned to the imagery and control groups. Interventional group participants completed 8 weeks, video-aided, cognitive imagery program on how to make a perfect soccer pass. Performance analysis through close video analysis showed that successful pass rate increased significantly in intervention group compared to control [OR=1.19, P=0.002, [95%]CI=1.06, 1.33]. Further analysis revealed that the results are statistically significant in U16 and U21 but not other categories. We concluded that successful soccer passing through real competitions as a multidimensional and critical open skill could be enhanced by an ecologically sound method of mental imagery

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