A randomised crossover trial on the effects of foot starting position on calf raise test outcomes: Position does matter.

BACKGROUND: This randomised crossover study with repeated measures examined the influence of the three most common foot starting positions used in conducting the calf raise test (CRT) on test outcomes. This study also accounted for the potential influence of gender, age, body mass index (BMI), and level of physical activity on test outcomes. METHODS: Forty-nine healthy individuals (59 % female, 21 ± 4 years) performed single-leg calf raise repetitions in a human movement laboratory in three randomised foot starting positions: flat, 10° incline, and step. The validated Calf Raise application was used to track the vertical displacement of a marker placed on the foot using computer vision. The application extracted the following CRT outcomes from the vertical displacement curve: number of repetitions, peak vertical height, total vertical displacement, and total positive work. Data were analysed using mixed-effects models and stepwise regression. RESULTS: There was a significant main effect (P < 0.001) of foot starting position on all outcomes, with all paired comparisons being statistically significant (P ≤ 0.023). Repetitions, total vertical displacement, and total positive work were greatest in flat and lowest in step, whereas peak vertical height was greatest in incline and lowest in step. Gender (P = 0.021; males>females) and BMI (P = 0.002; lower BMI>higher BMI) significantly influenced the number of repetitions. Gender (P < 0.001; males>females) also influenced total positive work. Age and physical activity levels did not significantly influence CRT outcomes. CONCLUSIONS: CRT foot starting position mattered and significantly affected all CRT outcomes. CRT foot starting position needs consideration when contrasting data in research and practice.

Concurrent validity and reliability of a mobile iOS application used to assess calf raise test kinematics.

BACKGROUND: Calf raise test (CRT) is used in rehabilitation and sports medicine to evaluate calf muscle function. The Calf Raise application (CRapp) uses computer-vision algorithms to objectively measure CRT outcomes and replicate laboratory-based metrics that are difficult to measure clinically. OBJECTIVE: To validate the CRapp by examining its concurrent validity and agreement levels against laboratory-based equipment, and its intra- and inter-rater reliability. DESIGN: Observational cross-sectional validation study. METHODS: CRT outcomes (i.e., repetitions, positive work, total height, peak height, fatigue index, and peak power) were assessed in thirteen individuals (6 males, 7 females) on three occasions on both legs using the CRapp, 3D motion capture, and force plate simultaneously. Data were extracted from two markers: below lateral malleolus (n = 77) and on the heel (n = 77). Concurrent validity and agreement were determined from 154 data files using intraclass correlation coefficients (ICC3,k), typical errors expressed as coefficient of variations (CV), and Bland-Altman plots to assess biases and precision. Reliability was assessed using ICC3,1 and CV values. RESULTS: Validity of CRapp outcomes was good to excellent across measures for both markers (mean ICC ≥0.878), precision plots showing good agreement and precision. CV ranged from 0% (repetitions) to 33.3% (fatigue index) and were on average better for the lateral malleolus marker. Inter- and intra-rater reliability were excellent (ICC≥0.949, CV ≤ 5.6%). CONCLUSION: CRapp is valid and reliable within and between users for measuring CRT outcomes in healthy adults. CRapp provides a tool to objectivise CRT outcomes in research and practice, aligning with recent advances in mobile technologies and their increased use in healthcare.

The Influence of Asymptomatic Hypermobility on Unanticipated Cutting Biomechanics.

BACKGROUND: Generalized joint hypermobility is an important risk factor for knee injuries, including to the anterior cruciate ligament (ACL). Examining movement patterns specific to hypermobile individuals during sport-specific movements could facilitate development of targeted recommendations and injury prevention programs for this population. HYPOTHESIS: Asymptomatic hypermobile participants will present kinematics measures suggestive of a greater risk of noncontact knee or ACL injuries. STUDY DESIGN: Cross-sectional study. LEVEL OF EVIDENCE: Level 3. METHODS: Forty-two (15 asymptomatic hypermobile and 27 nonhypermobile) individuals performed unanticipated side-step cutting on their dominant and nondominant legs. Ankle, knee, hip, pelvis, and trunk angles in all planes of motion were collected during the first 100 ms after initial contact using a 3-dimensional infrared system. Precontact foot-ground angles were also extracted. Data from hypermobile and nonhypermobile groups were compared using multiple regression models with sex as a confounder. When nonsignificant, the confounder was removed from the model. Effect sizes (Hedge g) were calculated in the presence of significant between-group differences. RESULTS: Hypermobile individuals presented with lower minimum knee valgus angles with a mean difference of 3.5° (P = 0.03, Hedge g = 0.69) and greater peak knee external rotation angles with a mean difference of -4.5° (P = 0.04, Hedge g = 0.70) during dominant leg cutting, and lower peak ankle plantarflexion angles with a mean difference of 4.5° (P = 0.03, Hedge g = 0.73) during nondominant leg cutting compared with nonhypermobile individuals. CONCLUSION: Based on current scientific evidence, however, the identified differences are not crucial biomechanical injury risk factors that could predispose asymptomatic hypermobile individuals to noncontact knee or ACL injuries. CLINICAL RELEVANCE: Further research is needed to highlight differences between hypermobility groups. Knowledge of the differences between these groups may change the physical activity recommendations, prevention of injury, and rehabilitation approaches.

Which jump-landing task best represents lower extremity and trunk kinematics of unanticipated cutting maneuver?

BACKGROUND: The double-leg jump-landing (DLJL) task is commonly used as a movement screen that can be implemented in large cohorts of athletes. However, it is debatable whether the DLJL is ecologically valid and reflects sporting requirements or injury-prone situations, such as cutting and pivoting. RESEARCH QUESTION: Which jump-landing movement variation best represents the kinematics of unanticipated side-step cutting? METHODS: Forty-two participants (25 males and 17 females) performed unanticipated side-step cutting and four jump-landing tasks: DLJL, rotated DLJL (DLJLrot), single-leg jump-landing (SLJL), and rotated SLJL (SLJLrot). Ankle, knee, hip, pelvis, and trunk angles and angular velocities, and pelvic linear accelerations were collected at initial contact and during the first 100 milliseconds after initial contact (minimum, maximum, and range values) using a three-dimensional infrared camera system and inertial measurement units. Pre-contact foot-ground angles and subjective task difficulty ratings were also recorded. Intraclass correlation coefficients (ICC) between cutting and jump-landing kinematics were calculated for each participant and jump-landing variation. Friedman tests with pairwise comparisons were then used to compare the degree of association between the four different jump-landing tasks at the specified time events and to compare the difficulty ratings. RESULTS: Considering the ICC values across the events of interest, the kinematics of the DLJL were the least associated with those of cutting (ICC = 0.00 to 0.81), and DLJLrot (ICC = 0.34 to 0.81) and SLJLrot (ICC = 0.31 to 0.80) biomechanics the most. Participants rated the perceived challenge of the single-leg tasks in a similar manner to cutting (p > 0.103), and the SLJLrot as the most difficult task (median = "neutral", mode = "neutral"). SIGNIFICANCE: Due to their biomechanical associations with cutting maneuver and subjectively-rated difficulty levels, both DLJLrot and SLJLrot may be more appropriate and ecologically valid for screening for risk of injury across a range of sports.

Factors influencing the Landing Error Scoring System: Systematic review with meta-analysis.

OBJECTIVES: Systematically review the literature addressing age, sex, previous injury, and intervention program as influencing factors of the Landing Error Scoring System. DESIGN: Systematic review with meta-analysis. METHODS: Three databases (PubMed, Web of Science®, and Scopus®) were searched on 1 April 2020. Original studies using the Landing Error Scoring System as primary outcome and exploring age, sex, previous injury, and intervention program were included, assessed for risk of bias, and critically appraised. Three meta-analyses were performed using one random and two mixed effect models with dependent variables: sex, previous injury and intervention program, respectively. Grading of Recommendations Assessment, Development and Evaluation was used to evaluate the strength of the evidence. PROSPERO registration number CRD42018107210. RESULTS: Fifty-two studies were included. Pooled data indicated that females have higher Landing Error Scoring System scores than males (p<0.001, mean difference=0.6 error). Participants with previous anterior cruciate ligament injury have higher LESS scores than healthy controls (p=0.004, mean difference 1.2 error). Neuromuscular training programs lasting a minimum of six weeks and other intervention programs decrease Landing Error Scoring System scores (p<0.001, mean difference 1.2 error and p=0.042, mean difference 0.5 error, respectively). There is limited evidence suggesting that age may influence Landing Error Scoring System scores in clinically meaningful manner. Overall, Grading of Recommendations Assessment, Development and Evaluation ratings suggest very low strength of evidence. CONCLUSIONS: History of anterior cruciate ligament injury and undertaking neuromuscular training for a minimum of six weeks meaningfully altered Landing Error Scoring System scores. These findings, however, should be interpreted cautiously considering the very low Grading of Recommendations Assessment, Development and Evaluation rating of the evidence.

The development of an instructional video for the teaching of acupressure for pain management in acute musculoskeletal injuries: A knowledge translation study.

OBJECTIVES: To survey potential stakeholders to obtain information relevant to the production of a video on teaching acupressure for sports injury management, and gain feedback from potential users on the prototype video. DESIGN: Focus groups and online survey methods nested within a knowledge translation framework. PARTICIPANTS: Four focus groups (n = 24) were conducted, two with sports medics and two with sports physiotherapists as a part of the development of a prototype video. Nineteen stakeholders viewed the prototype video and participated in the subsequent online survey. MAIN OUTCOME MEASURES: Focus groups' transcripts were analysed to develop themes using a general inductive approach. Survey data analysis incorporated quantitative and qualitative analysis. RESULTS: Three key themes concerning the design of the video emerged from the focus groups: 1) the recommendation for both demonstration and verbal instructions on the acupressure technique; 2) keeping the content of the video to a minimum; and 3) the need for professionalism in the production of the video, and highlighting the presenter's expertise and qualifications. The survey participants found the video to be clear and professional. CONCLUSIONS: Collectively these studies described the development and assessment of a user-oriented instructional video on teaching of acupressure for the management of sports injuries.

Yoga for the management of pain and sleep in rheumatoid arthritis: a pilot randomized controlled trial.

OBJECTIVE: The aim of the present study was to determine the feasibility of a relaxation-based yoga intervention for rheumatoid arthritis, designed and reported in accordance with Delphi recommendations for yoga interventions for musculoskeletal conditions. METHODS: Participants were recruited from a hospital database, and randomized to either eight weekly 75-min yoga classes or a usual care control. Feasibility was determined by recruitment rates, retention, protocol adherence, participant satisfaction and adverse events. Secondary physical and psychosocial outcomes were assessed using self-reported questionnaires at baseline (week 0), week 9 (primary time point) and week 12 (follow-up). RESULTS: Over a 3-month period, 26 participants with mild pain, mild to moderate functional disability and moderate disease activity were recruited into the study (25% recruitment rate). Retention rates were 100% for yoga participants and 92% for usual care participants at both weeks 9 and 12. Protocol adherence and participant satisfaction were high. Yoga participants attended a median of seven classes; additionally, seven of the yoga participants (54%) reported continuing yoga at home during the follow-up period. No serious adverse events were related to the study. Secondary outcomes showed no group effects of yoga compared with usual care. CONCLUSIONS: A relaxation-based yoga programme was found to be feasible and safe for participants with rheumatoid arthritis-related pain and functional disability. Adverse events were minor, and not unexpected from an intervention including physical components. This pilot provides a framework for larger intervention studies, and supports further exploration of yoga as a complex intervention to assist with the management of rheumatoid arthritis.

Adherence to Hunger Training over 6 Months and the Effect on Weight and Eating Behaviour: Secondary Analysis of a Randomised Controlled Trial.

Monitoring blood glucose prior to eating can teach individuals to eat only when truly hungry, but how adherence to 'hunger training' influences weight loss and eating behaviour is uncertain. This exploratory, secondary analysis from a larger randomized controlled trial examined five indices of adherence to 'hunger training', chosen a priori, to examine which adherence measure best predicted weight loss over 6 months. We subsequently explored how the best measure of adherence influenced eating behavior in terms of intuitive and emotional eating. Retention was 72% (n = 36/50) at 6 months. Frequency of hunger training booklet entry most strongly predicted weight loss, followed by frequency of blood glucose measurements. Participants who completed at least 60 days of booklet entry (of recommended 63 days) lost 6.8 kg (95% CI: 2.6, 11.0; p < 0.001) more weight than those who completed fewer days. They also had significantly higher intuitive eating scores than those who completed 30 days or less of booklet entry; a difference (95% CI) of 0.73 (0.12, 1.35) in body-food choice congruence and 0.79 (0.06, 1.51) for eating for physical rather than emotional reasons. Adherent participants also reported significantly lower scores for emotional eating of -0.70 (-1.13, -0.27). Following hunger training and focusing on simply recording ratings of hunger on a regular basis can produce clinically significant weight loss and clinically relevant improvements in eating behaviour.

Does Acupressure Hit the Mark? A Three-Arm Randomized Placebo-Controlled Trial of Acupressure for Pain and Anxiety Relief in Athletes With Acute Musculoskeletal Sports Injuries.

OBJECTIVES: Injuries are a common consequence of sports and recreational activity. The optimal management of symptoms is a crucial element of sports injury management. Acupressure has previously been shown to effectively decrease symptoms of musculoskeletal injury, thus may be considered a potentially useful intervention in the management of sport-related injuries. Therefore, this study was conducted to examine the effectiveness of acupressure in decreasing pain and anxiety in acutely injured athletes. DESIGN: A prospective 3-arm randomized placebo-controlled trial. SETTING: A sports injury clinic, Dunedin, New Zealand. PATIENTS: Seventy-nine athletes who sustained a sport-related musculoskeletal injury on the day. INTERVENTION: Three minutes of either acupressure, sham acupressure, or no acupressure. MAIN OUTCOME MEASURES: The primary outcomes of pain and anxiety intensity were measured before and immediately after the intervention on a 100-mm visual analog scale (VAS). Pain and anxiety relief, satisfaction with treatment, willingness to repeat a similar treatment, and belief in the effect of acupressure were secondary outcomes measured on Likert scales after the intervention. RESULTS: The acupressure group reported 11 mm less pain (95% CI: 5-17) on average than the sham acupressure group, and 9 mm less (95% CI: 3-16) than the control group as a result of the intervention (P < 0.05). There was no difference between groups in: anxiety levels, or in any of the secondary outcome measures. CONCLUSIONS: Three minutes of acupressure was effective in decreasing pain intensity in athletes who sustained an acute musculoskeletal sports injury when measured on the VAS, but did not change anxiety levels.

Psychological and Lifestyle Factors That Influence the Serial Reporting of Postconcussion-like Symptoms in a Non-concussed Population.

BACKGROUND: Symptoms related to concussion are generally nonspecific in nature, as they are also reported by non-concussed individuals. What is currently not known is whether the symptoms vary over time, and whether they are also influenced by a multitude of factors. OBJECTIVE: The aim of this study was to investigate the potential influence of psychological, lifestyle, and situational factors on the change in postconcussion-like symptoms reported over 7 consecutive days in a cohort of normal individuals. DESIGN: This was a longitudinal observational study. SETTING: The setting was a real-world context. PARTICIPANTS: A convenience sample of 180 non-concussed university students were enrolled. Of these, 110 participants provided data for the entire period of the study. METHODS: An experience-sampling methodology was used to document the symptoms reported over time. Stepwise multivariate linear mixed-effects modeling was performed to identify the predictors contributing to the serially reported symptoms. INDEPENDENT VARIABLES: Independent variables considered were gender, time of the day, location, primary activity, and type of interactant (person) of the participant, physical activity status, trouble sleeping, alcohol consumption, caffeine consumption, stress, anxiety, depression, mental and physical fatigue, and life stressors. MAIN OUTCOME MEASURES: The key outcome measures were the change in total symptom score (TSSchange) and symptom severity score (SSSchange) reported over 7 consecutive days. RESULTS: The predictors of location at the time of reporting, physical fatigue (estimate: -0.98, P < .001) and mental fatigue (estimate: -0.53, P < .001) contributed to the TSSchange. Post hoc analysis of the variable of location at the time of reporting revealed that participants reported increased TSSchange when they were at a café/restaurant compared to a flat/college or university. CONCLUSIONS: A number of factors within the context of daily life influenced the postconcussion-like symptoms reported over time. These findings indicate that clinicians need to be cautious when interpreting the serially assessed symptom scores to track the recovery profile of a concussed athlete to make decisions on return-to-play. Additional investigation is warranted to examine the change in symptom scores reported over time by concussed individuals, considering that this study was conducted in a nonconcussed cohort. LEVEL OF EVIDENCE: Not applicable.

Day-to-day variability of post-concussion-like symptoms reported over time by a non-concussed cohort.

PRIMARY OBJECTIVE: To explore the change (trend) in post-concussion-like symptoms reported over time. RESEARCH DESIGN: Longitudinal study. METHODS AND PROCEDURES: University students aged 18-30 years self-reported their symptoms experienced on a daily basis. Each participant was contacted via a text message each day during one of three pre-defined time zones to complete the Sport Concussion Assessment Tool 2 (SCAT2) post-concussion symptom scale on 7 consecutive days. MAIN OUTCOMES AND RESULTS: One hundred and ten (26 males and 84 females) students completed the study on all 7 days. Only two meaningful clusters emerged and comprised of a total of 105 participants. The primary cluster included 85 participants who showed a relatively stable pattern in their symptoms reported over time. Meanwhile, a second cluster comprised of 20 participants who demonstrated a decreasing trend in the reported symptom scores. CONCLUSIONS: The data indicated that non-concussed participants exhibited considerable individual variability in the symptom scores reported over time. However, some participants showed a systematic decreasing trend in their symptom scores reported over the 7 days. Caution must be exercised in interpreting the serial symptom scores that are obtained following a concussion, given that this study was conducted in a non-concussed cohort.

The Influence of Psychological and Lifestyle Factors on the Reporting of Postconcussion-Like Symptoms.

Self-reported symptoms are an integral part of the assessment and management of a sports-related concussion. However, postconcussion-like symptoms are reported by non-concussed individuals. Moreover, the current best practice in the reporting of symptoms does not take into account the potential influence of psychological and lifestyle factors. This study aimed to explore the influence of these factors on the reporting of postconcussion-like symptoms. University students (N= 603) completed the Sport Concussion Assessment Tool 2 postconcussion symptom scale along with other predictor variables via a cross-sectional web-based survey. Linear regression analyses revealed six modifiers contributing to the total symptom score with the strongest being alcohol consumption (Estimate = 2.75, p < .001). Following these findings, clinicians need to exercise caution when interpreting the symptom scores for making decisions on the return-to-play (RTP). A failure to do so may lead the health professional to either prematurely RTP or not clear the concussed athlete to resume their sport.

Gunshot residue preservation in seawater.

Little is known about the persistence of gunshot residue (GSR) in soft tissue and bones during decomposition in marine environments. For a better understanding, qualitative and quantitative data were obtained on GSR retention on soft tissue and bony gunshot wounds (GSWs). A quantity of 36 fleshed and 36 defleshed bovine ribs were shot at contact range with 0.22 calibre hollow point ammunition using a Stirling 0.22 calibre long rifle. Bone specimens in triplicate were placed in three environments: submerged, intertidal and in supralittoral zone. Sets of triplicates were recovered on day 3, 10, 24 and 38, and analysed with scanning electron microscopy with energy dispersive X-ray spectrometry (SEM-EDX), and inductive coupled plasma mass spectrometry (ICP-MS). The SEM-EDX recorded GSR-indicative particles surrounding the bullet entrance on all bone types (fleshed and defleshed) in all environments throughout the study. GSR-unique particles were only detected on the supralittoral bones. The ICP-MS analysis showed faster GSR loss on submerged than intertidal and supralittoral defleshed specimens. Fleshed specimens showed a faster GSR loss on intertidal than submerged and supralittoral specimens. In conclusion, the GSR disappeared faster from submerged and intertidal than non-submerged specimens. The difference of detection of GSR between analysed specimens (defleshed versus fleshed) disappeared upon defleshing. This study highlights the potential of finding evidence of GSR in a submerged body and the potential of microscopic and analytical methods for examining suspected GSW in highly decomposed bodies in marine habitats.

What "CAM" we learn about the level of evidence from 60 years of research into manipulative and body-based therapies in sports and exercise medicine?

OVERVIEW: Complementary and alternative medicine (CAM) is becoming increasingly accepted in modern western society, including amongst amateur and professional athletes, however, it has not yet been determined how CAM is reflected in scientific publications in sports and exercise medicine (SEM). AIM: The aim of this study was to identify trends in the levels of evidence for manipulative and body-based therapies within the SEM literature. METHODS: The literature was systematically searched with no language restrictions in seven databases and retrieved articles were screened and classified according to their study design using the Oxford Centre for Evidence-Based Medicine system. RESULTS: From 6088 retrieved articles, 395 were retained for evaluation and these included 180 on massage, 96 on acupuncture and 95 on manipulation. The majority of the articles were published in English, with 88 in non-English languages. Level-1 evidence was available for acupuncture, manipulation, massage, and Pilates. From the nineteen-seventies onwards, a decreasing trend was observed for low evidence articles with a corresponding increasing trend for clinical trials. After the year 2000, over 50% of the published articles were clinical trials, RCTs or systematic reviews. CONCLUSIONS: This review revealed an increase in the quantity and quality of published manipulative and body-based therapy articles in SEM over the last 60 years with the evidence level varying considerably between therapies. The timeframe associated with the development of evidence in CAM may reflect the move to provide scientific support for therapies previously justified primarily by anecdotal evidence, or traditional and cultural use.

Comparison of rates of referral and diagnosis of axial spondyloarthritis before and after an ankylosing spondylitis public awareness campaign.

The objective of this research is to measure the effect of a national ankylosing spondylitis (AS) public awareness campaign on numbers of referrals for suspected AS and numbers of cases diagnosed with axial spondyloarthritis (SpA). A television advertising campaign was conducted by Arthritis New Zealand in 2011 to raise public awareness of AS. A retrospective analysis was made of referrals received by the three rheumatology services 3 months before the campaign started and 3 months after the campaign ended. The age, gender, number of referrals for suspected AS and number of referrals resulting in a diagnosis of axial SpA were recorded. Independent analysis showed that the awareness campaign reached 82 % of the primary target audience. In the 3 months after the awareness campaign, there was a significant increase in referrals for suspected AS compared with the 3 months before the campaign (54 vs. 88, 63 %, p = 0.0056). Referrals for other conditions did not change. The number of referrals resulting in a diagnosis of axial SpA also increased (27 vs. 44, 63 %, p = 0.0576). The mean ages of the patients referred and of those diagnosed with axial SpA did not change. The male/female ratio was 1:1 among the referrals for suspected AS and 2:1 in referrals diagnosed with axial SpA, before and after the campaign. The Arthritis New Zealand AS public awareness campaign was associated with a significant increase in referrals to rheumatology services for suspected AS and an increase in the diagnosis of axial SpA in clinics.

A comparison between rib fracture patterns in peri- and post-mortem compressive injury in a piglet model.

OBJECTIVES: Forensic biomechanics is increasingly being used to explain how observed injuries occur. We studied infant rib fractures from a biomechanical and morphological perspective using a porcine model. METHODS: We used 24, 6th ribs of one day old domestic pigs Sus scrofa, divided into three groups, desiccated (representing post-mortem trauma), fresh ribs with intact periosteum (representing peri-mortem trauma) and those stored at -20°C. Two experiments were designed to study their biomechanical behaviour fracture morphology: ribs were axially compressed and subjected to four-point bending in an Instron 3339 fitted with custom jigs. Morphoscopic analysis of resultant fractures consisted of standard optical methods, micro-CT (µCT) and Scanning Electron Microscopy (SEM). RESULTS: During axial compression fresh ribs did not fracture because of energy absorption capabilities of their soft and fluidic components. In flexure tests, dry ribs showed typical elastic-brittle behaviour with long linear load-extension curves, followed by short non-linear elastic (hyperelastic) behaviour and brittle fracture. Fresh ribs showed initial linear-elastic behaviour, followed by strain softening and visco-plastic responses. During the course of loading, dry bone showed minimal observable damage prior to the onset of unstable fracture. Frozen then thawed bone showed similar patterns to fresh bone. Morphologically, fresh ribs showed extensive periosteal damage to the tensile surface with areas of collagen fibre pull-out along the tensile surface. While all dry ribs fractured precipitously, with associated fibre pull-out, the latter feature was absent in thawed ribs. CONCLUSIONS: Our study highlights the fact that under controlled loading, fresh piglet ribs (representing perimortem trauma) did not fracture through bone, but was associated with periosteal tearing. These results suggest firstly, that complete lateral rib fracture in infants may in fact not result from pure compression as has been previously assumed; and secondly, that freezing of bone during storage may affect its fracture behaviour.

Symptom response following acute bouts of exercise in concussed and non-concussed individuals - a systematic narrative review.

BACKGROUND: Athletes suspected of being concussed are frequently evaluated on the side-line for self-reported symptoms which guide subsequent management and return-to-play decisions. Concussion-like symptoms have been shown to be influenced by prior participation in physical activity; however, the potential contribution of acute exercise on symptoms is not well understood. OBJECTIVE: The purpose of this study was to systematically review the literature in order to further understand the acute effects of exercise on documented self-reported symptoms in both concussed and non-concussed individuals. DESIGN: Systematic narrative review. METHODS: Nine electronic databases were systematically searched using keywords and MeSH terms that included; self-reported symptoms, sports-related concussion, brain concussion, exercise and athletic injuries. In addition, an extensive search of the grey literature was conducted. RESULTS: Of the 785 articles retrieved, only five met the inclusion criteria comprising a total of 295 concussed and non-concussed participants. In general, the mean symptom scores increased from pre-exercise to post-exercise levels immediately following acute bouts of exercise in both concussed and non-concussed individuals. CONCLUSION: Although the symptom scores increased following exercise in both concussed and non-concussed participants, this increase was only maintained for a relatively short duration. Thus, the application to real world situation is still to be established.

The thickness of parietal bones in a new zealand sample of cadaveric skulls in relation to calvarial bone graft.

Objectives To evaluate the average thickness of the parietal bones in their different regions to identify the ideal site(s) for calvarial bone graft harvest. Methods and Materials Thickness of the parietal bones of 25 wet cranial vaults of New Zealand European origin was measured in 135 different locations using an electronic caliper. Analyses to identify the ideal harvest sites were conducted so that the sites fit the features of an ideal harvest site described in the literature as: (1) 6 mm of minimum thickness and (2) 2 cm away from the midline. Results and Conclusion The overall average thickness was 6.69 ± 0.22 mm. The average thickness at different sites within the same bone ranged from 2.85 to 6.93 mm. In keeping with previous studies, the report observed a progressive thickening of the parietal bone in medial and posterior directions. Of the 135 different locations measured, only 20% exceeded an average thickness of 6 mm as well as being 2 cm away from the sagittal midline. These locations were mainly located between 6 to 11 cm posterior to the coronal suture and 2 to 5 cm away from the sagittal suture. Conclusion Harvesting the calvarial bone graft in the area 6 to 11 cm posterior to the coronal suture and 2 cm away from the midline is recommended based on our study using cadaveric cranial vaults of New Zealand Europeans.