The potential role of prophylactic/functional knee bracing in preventing knee ligament injury.

It is estimated that knee injuries account for up to 60% of all sport injuries, with the anterior cruciate ligament (ACL) accounting for almost half of these knee injuries. These knee injuries can result in high healthcare costs, as an ACL injury is often associated with surgery, long and costly rehabilitation, differing degrees of impairment and potential long-term consequences such as osteoarthritis. The interest in ACL injury prevention has been extensive for the past decade. Over this period, many ACL (intrinsic and extrinsic) injury risk factors have been identified and investigated by numerous researchers. Although prevention programmes have shown potential in decreasing knee ligament injuries, several researchers have suggested that no conclusive evidence has been presented in reducing the rate and/or severity of ACL injuries during sporting competition. Knee braces have been available for the last 30 years and have been used to assist individuals with ACL-deficient and ACL-reconstructed knees. However, research is limited on the use of knee braces (prophylactic and functional) to potentially prevent knee ligament injury in the non-injured population. One possible explanation for the limited research could be that the use of these devices has raised concerns of decreased or impaired athletic performance. In summary, the review of subjective and some objective publications suggests that a functional knee brace may offer stability to an ACL-deficient knee joint; however, research is limited on the use of a knee brace for prophylactic use in non-injured athletes. The limited research could be a result of fear of performance hindrance that has led to poor knee brace compliance.

A prospective study of running injuries: the Vancouver Sun Run "In Training" clinics.

OBJECTIVES: Seventeen running training clinics were investigated to determine the number of injuries that occur in a running programme designed to minimise the injury rate for athletes training for a 10 km race. The relative contributions of factors associated with injury were also reported. METHODS: A total of 844 primarily recreational runners were surveyed in three trials on the 4th, 8th, and 12th week of the 13 week programme of the "In Training" running clinics. Participants were classified as injured if they experienced at least a grade 1 injury-that is, pain only after running. Logistic regression modelling and odds ratio calculation were performed for each sex using the following predictor variables: age, body mass index (BMI), previous aerobic activity, running frequency, predominant running surface, arch height, running shoe age, and concurrent cross training. RESULTS: Age played an important part in injury in women: being over 50 years old was a risk factor for overall injury, and being less than 31 years was protective against new injury. Running only one day a week showed a non-significant trend for injury risk in men and was a significant risk factor in women and overall injury. A BMI of > 26 kg/m(2) was reported as protective for men. Running shoe age also significantly contributed to the injury model. Half of the participants who reported an injury had had a previous injury; 42% of these reported that they were not completely rehabilitated on starting the 13 week training programme. An injury rate of 29.5% was recorded across all training clinics surveyed. The knee was the most commonly injured site. CONCLUSIONS: Although age, BMI, running frequency (days a week), and running shoe age were associated with injury, these results do not take into account an adequate measure of exposure time to injury, running experience, or previous injury and should thus be viewed accordingly. In addition, the reason for the discrepancy in injury rate between these 17 clinics requires further study.

A retrospective case-control analysis of 2002 running injuries.

OBJECTIVE: To provide an extensive and up to date database for specific running related injuries, across the sexes, as seen at a primary care sports medicine facility, and to assess the relative risk for individual injuries based on investigation of selected risk factors. METHODS: Patient data were recorded by doctors at the Allan McGavin Sports Medicine Centre over a two year period. They included assessment of anthropometric, training, and biomechanical information. A model was constructed (with odds ratios and their 95% confidence intervals) of possible contributing factors using a dependent variable of runners with a specific injury and comparing them with a control group of runners who experienced a different injury. Variables included in the model were: height, weight, body mass index, age, activity history, weekly activity, history of injury, and calibre of runner. RESULTS: Most of the study group were women (54%). Some injuries occurred with a significantly higher frequency in one sex. Being less than 34 years old was reported as a risk factor across the sexes for patellofemoral pain syndrome, and in men for iliotibial band friction syndrome, patellar tendinopathy, and tibial stress syndrome. Being active for less than 8.5 years was positively associated with injury in both sexes for tibial stress syndrome; and women with a body mass index less than 21 kg/m(2) were at a significantly higher risk for tibial stress fractures and spinal injuries. Patellofemoral pain syndrome was the most common injury, followed by iliotibial band friction syndrome, plantar fasciitis, meniscal injuries of the knee, and tibial stress syndrome. CONCLUSIONS: Although various risk factors were shown to be positively associated with a risk for, or protection from, specific injuries, future research should include a non-injured control group and a more precise measure of weekly running distance and running experience to validate these results.

A randomised clinical trial of the efficacy of drop squats or leg extension/leg curl exercises to treat clinically diagnosed jumper's knee in athletes: pilot study.

OBJECTIVES: To compare the therapeutic effect of two different exercise protocols in athletes with jumper's knee. METHODS: Randomised clinical trial comparing a 12 week programme of either drop squat exercises or leg extension/leg curl exercises. Measurement was performed at baseline and after six and 12 weeks. Primary outcome measures were pain (visual analogue scale 1-10) and return to sport. Secondary outcome measures included quadriceps and hamstring moment of force using a Cybex II isokinetic dynamometer at 30 degrees/second. Differences in pain response between the drop squat and leg extension/curl treatment groups were assessed by 2 (group) x 3 (time) analysis of variance. Two by two contingency tables were used to test differences in rates of return to sport. Analysis of variance (2 (injured versus non-injured leg) x 2 (group) x 3 (time)) was also used to determine differences for secondary outcome measures. RESULTS: Over the 12 week intervention, pain diminished by 2.3 points (36%) in the leg extension/curl group and 3.2 points (57%) in the squat group. There was a significant main effect of both exercise protocols on pain (p<0.01) with no interaction effect. Nine of 10 subjects in the drop squat group returned to sporting activity by 12 weeks, but five of those subjects still had low level pain. Six of nine of the leg extension/curl group returned to sporting activity by 12 weeks and four patients had low level pain. There was no significant difference between groups in numbers returning to sporting activity. There were no differences in the change in quadriceps or hamstring muscle moment of force between groups. CONCLUSIONS: Progressive drop squats and leg extension/curl exercises can reduce the pain of jumper's knee in a 12 week period and permit a high proportion of patients to return to sport. Not all patients, however, return to sport by that time.

Eccentric and concentric isokinetic moment characteristics in the quadriceps and hamstrings of the chronic isolated posterior cruciate ligament injured knee.

OBJECTIVE: Functional strength deficits associated with chronic isolated posterior cruciate ligament (PCL) insufficiency have received limited attention in the literature. The purpose of this study was to determine the eccentric and concentric isokinetic moment characteristics of the quadriceps and hamstrings in a sample of patients with isolated PCL injury. METHODS: Eccentric and concentric mean average and average peak moments were measured for 17 patients with a history of conservatively treated isolated PCL injury using an isokinetic dynamometer. Quadriceps and hamstring isokinetic moments were recorded from 10 degree to 90 degree of knee flexion. Strength ratios were calculated and compared with those reported in the literature for healthy subjects. RESULTS: The hamstrings of the involved side (eccentric/concentric (E/C) ratio = 1.06) were significantly weaker (p<0.05) eccentrically than those of the contralateral side (E/C ratio = 1.29). All hamstrings/quadriceps (H/Q) ratios were less than the universally accepted value of 0.60 and the eccentric H/Q ratio for the injured extremity was significantly lower than the non-injured (p<0.05). In a bilateral comparison, the injured/non-injured (I/N) ratio was less than 1.00 for concentric quadriceps, eccentric quadriceps, and hamstring isokinetic moments. Calculation of the E/C ratio showed that, for the quadriceps, it was 1.08 on the injured side and 1.07 on the non-injured extremity. CONCLUSIONS: Eccentric strengthening should be an integral part of functionally rehabilitating the quadriceps and hamstrings of athletes who suffer from the complications associated with chronic isolated PCL insufficiency.

Eccentric kinetic chain exercise as a conservative means of functionally rehabilitating chronic isolated insufficiency of the posterior cruciate ligament.

OBJECTIVE: To determine the efficacy of a home eccentric kinetic chain exercise program in improving isokinetic strength, knee function, and symtomatology in athletes with isolated posterior cruciate ligament (PCL) injury. DESIGN: Experimental design. SETTING: Allan McGavin Sports Medicine Centre, University of British Columbia, Vancouver, British Columbia, Canada. PARTICIPANTS: The study included 13 athletes with isolated PCL injury (n = 13) and 13 healthy sedentary subjects (n = 13). All participants were men and between 18 and 35 years of age. The group with isolated PCL injury all had been diagnosed at the Allan McGavin Sports Medicine Centre, all had been treated without surgery, and had been injured at least 6 months ago. Diagnosis was based on presentation of a positive posterior sag and posterior drawer. INTERVENTION: The group with isolated PCL injury (treatment group) underwent 12 weeks of eccentric kinetic chain exercise. The control group of healthy sedentary individuals did not undergo any form of rigorous training during the course of this study. Both groups were tested for isokinetic strength, knee function, and symptomatology at weeks 0, 6, and 12. Compliance was insured through frequent phone contact and progressive journal records of completion of daily exercise. Only those who completely executed the 12-week exercise program were included in the study. MAIN OUTCOME MEASURES: Hamstring and quadriceps isokinetic torque (Nm) at constant velocities of 60 and 120 degrees per second (degrees/s), Tegner Hop Test (meters), and Lysholm Knee Scale scores. RESULTS: A subject-versus-treatment data analysis clearly indicated significant increases in eccentric and concentric torque over the 12-week period in the treatment group. Tegner Hop Test and Lysholm Knee Scale scores also increased significantly after the eccentric squat exercise program. Quadriceps eccentric/concentric ratios at both testing velocities increased significantly after 12 weeks of rehabilitation. There were no significant differences in strength between extremities in the treatment group at any time during the course of this study. Before rehabilitation, there were no significant differences between eccentric and concentric torque values in either muscle group (quadriceps and hamstrings) of the treatment group. After the eccentric exercise program, the quadriceps in the injured extremity did exhibit significantly greater eccentric than concentric torque. The treatment group was significantly weaker than the control group in eccentric torque at both testing velocities at week 0. After the 12-week exercise program, however, there were no significant differences between groups in eccentric quadriceps strength. CONCLUSION: The results of this investigation support the eccentric squat program as a viable means of functionally rehabilitating chronic PCL insufficiency.

Effects of hyperbaric oxygen on a human model of injury.

To determine whether intermittent exposures to hyperbaric oxygen enhance recovery from delayed-onset muscle soreness of the quadriceps, we conducted a randomized, controlled, double-blinded, prospective study using 66 untrained men between the ages of 18 and 35 years. After the induction of muscle soreness, these subjects were treated in a hyperbaric chamber over a 5-day period in two phases, with four groups (control, hyperbaric oxygen treatment, delayed treatment, and sham treatment) in the first phase; and three groups (3 days of treatment, 5 days of treatment, and sham treatment) in the second phase. The hyperbaric exposures involved 100% oxygen for 1 hour per day at 2.0 atm. The sham treatments involved 21% oxygen for 1 hour per day at 1.2 atm. We monitored recovery using a leg dynamometer to test eccentric torque of the nondominant quadriceps muscle before and immediately after exercise and at 48 and 96 hours after exercise. Pain was tested daily using visual analog pain scales. In phase 1 a significant difference in recovery of eccentric torque was noted in the treatment group compared with the other groups. In phase 2, the recovery of eccentric torque for the 5-day treatment group was significantly greater than for the sham group from immediately after exercise to 96 hours after exercise. The pain data did not differ significantly in any comparison in either phase. The results suggest that treatment with hyperbaric oxygen may enhance recovery of eccentric torque of the quadriceps muscle from delayed-onset muscle soreness.

Muscle function in chronic compartment syndrome of the leg.

Chronic compartment syndrome (CCS) is a recognized cause of recurrent leg pain in the exercising patient. Decreased muscle function has been implied in this condition. This study compared the ankle dorsiflexion torque of 10 CCS patients with that of 18 control subjects during 20 repeated, maximal, isokinetic contractions at 60 degrees/sec. Peak torque, relative peak torque, and endurance data were collected. Results showed significantly lower peak torque and relative peak torque in the CCS group (p < or = 0.05), supporting the implication of muscle weakness in CCS. Paradoxically, endurance was significantly higher in the CCS group (p < or = 0.01), and there was a significant (p < or = 0.01), negative correlation (r = -0.50) between peak torque and endurance. The relationship between the findings and CCS is discussed. Strengthening may be useful in very mild cases or in postfasciotomy patients.

Exercise-induced stress injuries to the femur.

Seventy-one athletes with 74 stress injuries to the femur were studied using a case-controlled design. Forty-three were females (26.6 yrs) and 28 were males (31.2 yrs). Each patient had exercise-induced pain in the hip, groin or thigh and a Tec-99m-MDP bone scan showing focal uptake of radionuclide in the femur. Running was the most common activity at the time of injury (89.2%) followed by triathlon (4.6%) and aerobic dance (4.6%). Thirty per cent of the runners had increased their training duration immediately prior to their first symptom. Anterior thigh pain was the most frequent site of exercise-induced pain (45.9%) followed by hip pain (27%) and groin pain (8.1%). During the clinical examination, when asked to hop on the affected limb, 70.3% of the patients had pain reproduced in the hip, groin or anterior thigh. There were 39 cases (53%) involving focal uptake of radionuclide in the femoral shaft, 15 (20%) in the lesser trochanter, 11 (15%) in the intertrochanteric region between the femoral neck and the greater trochanter, 8 (11%) in the femoral neck and 1 (1%) in the greater trochanter. Two patients suffered displaced fractures, one at the femoral neck and the other in the shaft of the femur. Neither patient had previously sought medical attention for their leg pain. Of 46 plain radiographs taken, only 11 (24%) were abnormal. The mean time to diagnosis and recovery were 6.6 and 10.4 weeks respectively. Substitution of cycling and water exercise for running were the most common therapeutic interventions.

Effects of iron supplementation and discontinuation on serum copper, zinc, calcium, and magnesium levels in women.

The purpose of this study was: 1) to establish the prevalence of depleted iron stores, iron deficiency, and low serum levels for copper, zinc, calcium, and magnesium in a healthy female population; and 2) to examine the effects of iron supplementation and discontinuation on the serum levels of the above minerals. One hundred eleven healthy women between the ages of 18 and 40 yr reported for fasted morning blood sampling for iron, copper, zinc, calcium, and magnesium status. Forty-five subjects were either iron-deficient as defined by a hemoglobin level below 120 g.l-1 (four subjects) or iron deplete as defined by a serum ferritin value below 20 micrograms.l-1 (43 subjects). Two subjects fit both criteria. This subgroup continued with the study and were prescribed a normal therapeutic iron dose (320 mg elemental iron per day, taken as two Slow-Fe tablets.d-1 for a period of 12 wk). The subjects then discontinued the iron supplementation for a further 12 wk. The response of the various blood minerals was monitored at 6-wk intervals. Twenty-five subjects completed the full 24-wk treatment. The main conclusions to be made from this study were that: 1) For this sample population of women, iron depletion was quite common (39%), although low hemoglobin values (< 120 g.l-1) were only seen in 3.6%. No subjects fell below the criteria for low serum copper levels (< 13.3 mumol.l-1) nor low serum magnesium levels (< 0.6 mmol.l-1). Seven subjects (6.5%) fell below the criteria for low serum zinc levels (< 11.5 mumol.l-1) while two subjects (1.8%) were below the criteria for low serum calcium levels (< 2.20 mmol.l-1). 2) Therapeutic oral iron supplementation was successful in raising mean serum ferritin values from 15.9 micrograms.l-1 to 36.5 micrograms.l-1 but was not associated with decrements in serum copper or calcium levels. 3) The treatment did not significantly effect serum zinc and magnesium levels during the supplementation period, but a downward trend continued through the discontinuation phase so that at 18 and 24 wk serum zinc and magnesium levels were significantly lower than baseline. 4) Oral contraceptive use was associated with elevated serum copper and ferritin values and lowered serum magnesium levels.

Musculoskeletal injuries associated with physical activity in older adults.

In order to compare the clinical presentation of overuse injuries in older and younger athletes, retrospective patient chart data were obtained from cases which had been referred to an outpatient sports medicine clinic over a 5-yr period. A total of 1,407 cases were studied comprising two populations separated by significantly (P less than 0.001) different ages: 685 "old" (mean age = 56.9 +/- 6.1 yr) and 722 "young" (mean age = 30.4 +/- 8.1 yr). Although the two subpopulations demonstrated modest differences in sport activity at the time of injury, specific diagnoses, and anatomic location of injury, many similarities existed between the groups. Running, fitness classes, and field sports were more commonly associated with injury in the younger group, while racquet sports, walking, and low intensity sports were more commonly associated with injury in the older group. The frequency of tendinitis was similar in both age groups, while metatarsalgia, plantar fasciitis, and meniscal injury were more common in the older population, and patellofemoral pain syndrome (PFPS) and stress fracture/periostitis were more common in the younger population. Anatomically, injury sites in the foot were more frequent in the older group, while injury sites in the knee were more frequent in the younger group. In the older population, the prevalence of osteoarthritis was 2.5 times higher than the frequency of osteoarthritis as the source of activity-related pain. In the older group, 85% of the diagnoses were overuse injuries known to respond to conservative treatment, 14.4% of the cases required consultative referral, and only 4.1% required surgery.

The effects of prelatent/latent iron deficiency on physical work capacity.

In order to examine the effects of mild iron deficiency on physical work capacity, 40 prelatent iron-deficient female endurance runners were studied before and after 8 wk of supplementation with either oral iron (320 mg ferrous sulfate) or a matching placebo. Subjects underwent the following physical work capacity tests: the Wingate cycle ergometer test, the anaerobic speed test, the ventilatory threshold, VO2max, and maximal treadmill velocity during the VO2max test. Muscle biopsy samples pre- and post-treatment were obtained from 17 of the subjects, and these were assayed for citrate synthase and cytoplasmic alpha-glycerophosphate dehydrogenase activity. Subjects were randomly assigned to one of the treatment groups, and a double-blind method of administration of the supplements was used. The differences in improvement scores between the two groups on the work capacity and enzyme activity variables were statistically nonsignificant (P greater than 0.05). Serum ferritin values rose from a mean of 12.4 +/- 4.5 to 37.7 +/- 19.7 ng.ml-1 for the experimental group and from 12.2 +/- 4.3 to 17.2 +/- 8.9 ng.ml-1 for the controls (P = 0.0025), whereas hemoglobin levels remained fairly constant for both groups (P = 0.6). Eight weeks of iron supplementation to prelatent/latent iron-deficient, physically active females did not significantly enhance work capacity. Within the limitations of this study, the presence of a serum ferritin below 20 ng.ml-1 does not pose a significant handicap to physical work capacity.

Femoral stress abnormalities: improved scintigraphic detection with frog-leg view.

To identify a better scintigraphic imaging technique for detecting proximal femoral stress abnormalities, 51 consecutive patients with hip pain and the clinical suspicion of stress injury underwent three-phase bone scanning with technetium-99m methylene diphosphonate. Delayed scanning included anterior and frog-leg views of the hips. Fifteen patients had focal stress abnormalities of the femoral neck or lesser trochanter; all were detected with the frog-leg view, but only seven were detected with the standard anterior view. Stress abnormalities involving the lesser trochanter were depicted especially well on the frog-leg view.

The role of biomechanics in the epidemiology of injuries.

In this paper a review of the epidemiology of both traumatic and overuse injuries is presented with special emphasis on the role of biomechanics. Biomechanical analysis of injuries and the specific sports has increased in sophistication to such a degree we have a much better understanding of both aetiology and management. Particularly in the area of overuse injuries this biomechanical data can also be utilised in prevention. This paper discusses acute traumatic injuries with emphasis on knee injuries. A detailed examination of knee injuries during skiing is explored. In addition, cervical injuries in gridiron football and rugby are outlined. Overuse injuries occurring during running are next discussed. Aetiological factors including training errors, muscular dysfunction and inflexibility, footwear, running gait and lower extremity malalignment are considered. Overuse injuries in swimming, dance, gymnastics and throwing sports are briefly discussed. Biochemical analysis is felt to be important in developing strategies that lead to rule changes, alteration of training techniques and improvement in equipment and footwear.

Iron status in athletes. An update.

As more studies are done on the iron status of athletes, the significance of apparent iron deficiency remains controversial. Do observed changes in iron status in athletes indicate an actual iron deficiency or a physiological response to exercise? Iron replacement would clearly be indicated if an iron deficiency was present but would not be necessary or effective if the observed changes were simply a physiological response. There is agreement that serum ferritin and haemoglobin decrease with some exercise conditions and that some indicators of haemolysis, such as serum haptoglobin and bilirubin, change in response to exercise. Expansion of plasma volume and the shift of iron storage from bone marrow to the liver could support the claim that the apparent reduced iron status parameters occurring with exercise are misleading. Countering this concept are studies in athletes which demonstrate dietary iron intake deficiencies and blood loss in the gastrointestinal and urinary tract. Iron deficiency is common in the general population, particularly in women. Therefore, continued monitoring of iron status in athletes appears justified in the face of present knowledge. Replacement therapy, when iron deficiency is apparent, is recommended.

Non-surgical management of overuse knee injuries in runners.

Seventy-three injured runners (45 men, 28 women) who presented with 83 running-induced overuse knee injuries were managed conservatively. The regimens utilized focused on quadriceps and hamstring muscle retraining and the control of functional overpronation. Patello-femoral pain syndrome (42 cases) was by far the most common problem. The next most common problems were iliotibial band friction syndrome (10), patellar tendonitis (9) and popliteal tendonitis (5). The most frequent etiological factor was a sudden increase in training mileage. Following the initial visit and at regular intervals throughout the recovery phase, quadriceps and hamstring capacities were determined on a Cybex II isokinetic unit at 60 degrees/second and 180 degrees/second. Significant differences (p less than 0.01) in Cybex scores were observed between strong and weak extremities in males and females for both muscle groups at both velocities. The mean Cybex scores and the differences with muscle groups between strong and weak legs for the subjects were similar to those reported for healthy non-athletes. The treatment protocol followed four basic principles: control of pain; rebuilding of muscle strength and endurance; improvement of bio-mechanical efficiency and gradual reintroduction of training. No significant changes in the differences between strong and weak leg Cybex scores occurred between the initial and final evaluations, except in the male group when the hamstrings were evaluated at 60 degrees/second (p less than 0.01). In the 82 cases managed non-surgically, 1 poor, 8 fair, 36 good and 37 excellent results were obtained. The authors believe that the significance of disturbance in quadriceps and hamstring function to the etiology of overuse knee injuries may be increased in runners who over-pronate.

Stress fractures in athletes. A study of 320 cases.

We analyzed cases of 320 athletes with bone scan-positive stress fractures (M = 145, F = 175) seen over 3.5 years and assessed the results of conservative management. The most common bone injured was the tibia (49.1%), followed by the tarsals (25.3%), metatarsals (8.8%), femur (7.2%), fibula (6.6%), pelvis (1.6%), sesamoids (0.9%), and spine (0.6%). Stress fractures were bilateral in 16.6% of cases. A significant age difference among the sites was found, with femoral and tarsal stress fractures occurring in the oldest, and fibular and tibial stress fractures in the youngest. Running was the most common sport at the time of injury but there was no significant difference in weekly running mileage and affected sites. A history of trauma was significantly more common in the tarsal bones. The average time to diagnosis was 13.4 weeks (range, 1 to 78) and the average time to recovery was 12.8 weeks (range, 2 to 96). Tarsal stress fractures took the longest time to diagnose and recover. Varus alignment was found frequently, but there was no significant difference among the fracture sites, and varus alignment did not affect time to diagnosis or recovery. Radiographs were taken in 43.4% of cases at the time of presentation but were abnormal in only 9.8%. A group of bone scan-positive stress fractures of the tibia, fibula, and metatarsals (N = 206) was compared to a group of clinically diagnosed stress fractures of the same bone groups (N = 180), and no significant differences were found. Patterns of stress fractures in athletes are different from those found in military recruits. Using bone scan for diagnosis indicates that tarsal stress fractures are much more common than previously realized. Time to diagnosis and recovery is site-dependent. Technetium99 bone scan is the single most useful diagnostic aid. Conservative treatment of stress fractures in athletes is satisfactory in the majority of cases.

Scintigraphic uptake of 99mTc at non-painful sites in athletes with stress fractures. The concept of bone strain.

Stress fractures are commonly found in athletes attending sports medicine clinics for diagnosis of lower limb pain. Plain radiographs are less reliable than the 99mTc bone scan for diagnosing stress fractures because of their low sensitivity. While the heightened sensitivity of the bone scan is advantageous as a diagnostic aid, the uptake of 99mTc at non-painful sites occurs frequently in the athlete. Although the clinical significance has not been determined, asymptomatic uptake may indicate bone remodelling as part of a continuum of adaptation to physical stress. It is not known whether athletes who have uptake of 99mTc in asymptomatic areas represent a separate population from those who do not. This study retrospectively reviewed the medical charts and bone scan reports of 320 athletes diagnosed as having stress fractures, to determine the frequency of asymptomatic focal uptake at sites other than the site of pain. This group was compared with the group who had no asymptomatic uptake on a number of demographic variables and physical findings. Asymptomatic focal uptake was found in 37.5% of athletes with the average number of sites being 1.8 per person. No significant differences between groups with focal asymptomatic uptake and groups with no asymptomatic uptake were found when compared for age, height, weight, mileage in runners, times to diagnosis and recovery, frequency of tenderness, swelling, trauma history, varus alignment, and x-ray abnormalities. It is concluded that asymptomatic uptake of 99mTc occurs frequently in athletes with stress fractures and there are no significant clinical differences between the group with asymptomatic uptake and the group without. It is suggested that symptomatic uptake of 99mTc represents the remodelling response of bone to physical stress.

Iron status in Winter Olympic sports.

Iron status was surveyed amongst 92 Winter Olympic sport athletes from Nordic and Alpine skiing, figure and speed skating and ice hockey. Haemoglobin and serum ferritin values were obtained by physicians as part of a monitoring programme, since iron deficiency would have an adverse effect on maximal performance. Four (7%) of 56 men were anaemic (Hb less than 14.0 g dl-1) and three (8%) of 36 women had haemoglobin values less than 12.0 g dl-1. Nine men (16%) and 14 women (39%) had prelatent iron deficiency (serum ferritin less than 30 ng ml-1). Ice hockey had the lowest while Nordic skiing had the highest incidence of sub-optimal iron status. A total of 50% of Nordic women skiers had prelatent iron deficiency and 7% were anaemic. An equal percentage of women speed skaters were low in serum ferritin as well. Only one of 20 male ice hockey players was low in serum ferritin. These results suggest there would be value in instituting screening procedures for iron status in Winter Olympic Sports.

A Primary Care Perspective of Chronic Compartment Syndrome of the Leg.

In brief: Chronic compartment syndrome (CCS) of the leg is a recently recognized cause of recurrent leg pain in the exercising patient. Apart from rest, the only effective treatment is fasciotomy. This study reviews 39 fasciotomies that were performed on 16 patients with clinically determined CSS. Fourteen (88%) of the patients returned to full activity with few or no residual complaints. These results indicate that clinically identified features can distinguish CCS from other forms of recurrent leg pain. Compartment pressure measurements taken during exercise can confirm the diagnosis of CCS and determine the need for fasciotomy.