The effects of rehabilitation on the biomechanics of patients with athletic groin pain.

This study sought to investigate the kinematic and kinetic variables that change in patients with athletic groin pain (AGP) after a successful exercise intervention. The kinematic and kinetic measures of subjects with AGP (n = 65) that completed a lateral hurdle hop, pre and post an exercise rehabilitation program were compared to a control group of matched uninjured individuals (n = 50). Analysis of Characterising Phases was used to identify differences in kinematic and kinetic measures between the groups. AGP subjects returned to pain-free participation in sport in a median time of 9.14 weeks (5.14-29.0). In total 18 different biomechanical variables were significantly different between the AGP group and the uninjured group pre-rehabilitation. Of these, seven variables were no longer significantly different between the AGP group post-rehabilitation and the uninjured group. These seven variables may represent the factors most related to return to play in this cohort and are potential targets for rehabilitation.

Is stiffness related to athletic groin pain?

Athletic groin pain (AGP) is a common injury prevalent in field sports. One biomechanical measure that may be of importance for injury risk is stiffness. To date, [corrected] however, stiffness has not been examined in AGP. The primary aim was to determine whether AGP affects vertical and joint stiffness and if so, whether successful rehabilitation is associated with a change in stiffness. Sixty-five male patients with AGP and fifty male controls were recruited to this study. Assessment included a biomechanical examination of stiffness during a lateral hurdle hop test. Subjects with AGP were tested pre- and post-rehabilitation, while controls were tested once. AGP subjects were cleared for return to play in a median time of 9.14 weeks (5.14-29.0). Stiffness was significantly different at pre-rehabilitation in comparison with controls for three [corrected] of the ten stiffness values examined: ankle plantar flexor, knee extensor, hip abductor, and vertical stiffness (P <  .05, D = 0.38-0.81). [corrected]. Despite clearance for return to play, of these four variables, only hip abductor stiffness changed significantly from pre- to post-rehabilitation (P = .05, D = 0.36) [corrected] to become non-significantly different to the uninjured group (P = .23, D = 0.23). [corrected]. These findings suggest that hip abductor stiffness may represent a target for AGP rehabilitation. Conversely, given the clearance for return to play, the lower sagittal plane and vertical stiffness in the AGP group in comparison with the uninjured controls likely represents either a compensatory mechanism to reduce the risk of further injury or a consequence of neuromuscular detraining.

Does the amount of lower extremity movement variability differ between injured and uninjured populations? A systematic review.

Movement variability during repetitive performance of a dynamic activity (eg, running, jumping, kicking) is considered an integral characteristic of optimal movement execution; however, its relationship with musculo-skeletal injury is not known. The primary aim of this study was to review published comparison trials to determine whether movement variability differs between uninjured controls and subjects with a lower limb musculo-skeletal injury. A systematic search of online databases; MEDLINE, Sports Discus, Scopus, and Web of Science was conducted from July to November 2016. Studies were selected if they (a) included participants with a lower limb injury, (b) compared injured participants to uninjured controls, (c) examined movement variability for at least one dependent variable, and (d) provided a statistical between-group comparison when comparing measures of movement variability. Studies were excluded if they (a) investigated neurological disorders, (b) examined musculo-skeletal injury in the upper extremity or spine, and (c) used nonlinear measures to examine variability (ie, complexity). A significant difference between injured and uninjured populations was reported in 73% of the included studies, and of these, 64% reported greater movement variability in the injured group. This is the first systematic review with a best-evidence synthesis investigating the association between movement variability and musculo-skeletal injury. Findings suggest that movement variability in those with a musculo-skeletal injury differs from uninjured individuals. Interestingly, there was an overall trend toward greater movement variability being associated with the injured groups, although it should be noted that this trend was not consistent across all subcategories (eg, injury type). For a clearer insight into the clinical application of variability, greater methodological homogeneity is required and prospective research is recommended.

Therapeutic drug monitoring of systemic antifungal therapy.

The use of systemic antifungal therapy has significantly increased in recent years. Individualization of antifungal therapy through the use of serum or plasma concentrations has been suggested, although no specific recommendations have been developed. The important criteria for therapeutic drug monitoring and which of these criteria are satisfied by systemic antifungal agents are presented in this review. No one antifungal is ideally suited for application of therapeutic drug monitoring, but, under certain circumstances, obtaining serum or plasma concentrations can be justified. In patients who are susceptible to flucytosine toxicity, serum flucytosine concentrations should be monitored in an effort to avoid untoward side-effects. In contrast, therapeutic drug monitoring of amphotericin B is not recommended in the clinical setting. Demonstrating that ketoconazole and itraconazole are reaching the systemic circulation by obtaining serum concentrations may be clinically useful due to the large variability in their absorption and issues of patient compliance which may be seen with these agents. The bioavailability of fluconazole is much less varied although validation of compliance is a situation where obtaining serum concentrations may provide additional information.