How to promote physical activity during pregnancy : A systematic review.

INTRODUCTION: Sedentary lifestyles and physical inactivity have been shown to increase during pregnancy and are a cause of obstetric comorbidity. The objective of this study was to conduct a systematic review of interventions aiming to promote physical activity during pregnancy. MATERIAL AND METHODS: Databases were searched from January 2008 to September 2019. Selection criteria included randomized controlled trials evaluating the efficacy of interventions promoting physical activity during pregnancy. RESULTS: In total, 256 articles were extracted from databases. 202 articles were excluded. Finally, 15 articles were included in the study. 5633 patients were included from various populations. Six studies rated physical activity (PA) as the primary outcome. Five studies suggested promoting physical activity through individual interviews which in two studies showed an increase in PA. Three studies evaluated an intervention based on group interviews and one of these reported a significant increase in PA. Two studies evaluated the use of a Smartphone application to promote physical activity but they did not conclude that they were effective because they were designed with low statistical power. CONCLUSION: The practice of regular PA during pregnancy reduces obstetrical comorbidity. However, interventions seem to have a low impact on the promotion of PA during pregnancy. New intervention strategies need to assessed, such as the use of mobile health interventions.

Interest of rehabilitation in healing and preventing recurrence of ankle sprains.

UNLABELLED: To assess the impact of rehabilitation on healing and recurrence rate of ankle sprain, 1year apart, 111 patients, who suffered an ankle sprain (67 men and 44 women; 17 mild sprains, 67 medium and 27 severe), were included by emergency physicians of four emergency rooms (ER) of Finistère. The physician was free to prescribe, or not, further investigations. He prescribed systematically to patients RICE (rest, ice, compression, elevation) protocol, put an ankle brace, and gave a prescription of standardized rehabilitation. The prescription was the same for the four ER. All patients were recalled to 1year. Of the 111 patients initially included, 21 patients were excluded for lack of response after three phone calls. In the end, 90 patients were assessable (56 men and 34 women), mean age 31.4±12.6years (range 15-55) at the time of initial trauma. Emergency physicians had diagnosed, initially, 16 mild sprains (17.8%), 56 medium sprains (62.2%) and 18 severe sprains (20%). Of the 90 patients, 73 patients have been rehabilitated (81.1%). Of the 44 accidents of everyday life, 31 were rehabilitated (70.5%). Of the 27 sports accidents, 25 were rehabilitated (92.6%). Of the 19 work-related injuries, 17 were rehabilitated (89.5%). There is no significant relationship between rehabilitation and no recurrence (P=0.45) nor between rehabilitation and full recovery of the ankle (P=0.59). CONCLUSION: We find no association between rehabilitation and prevention of recurrence, nor between rehabilitation and healing of patients. However, our study is limited by the small size of the non-rehabilitated group.

Adherence and effectiveness of rehabilitation in acute ankle sprain.

OBJECTIVE: To estimate adherence to and effectiveness of rehabilitation after acute ankle sprain. METHOD: Patients with acute ankle sprain attending four emergency departments were recruited between February and July 2009. After the initial examination (classification of the severity of the sprain), each patient received an Aircast(®) ankle brace and the same, standardized rehabilitation program. Between two and three months later; the patient was contacted by phone (always by the same investigator) in order to find out whether he/she had performed the prescribed rehabilitation, establish whether the physiotherapist had complied with the prescribed rehabilitation programme and assess subjective recovery. If a patient failed to respond to three phone calls, he/she was excluded from the study. RESULTS: Of the 245 patients initially included, 111 (67 men and 44 women; 17 mild sprains, 67 moderate sprains and 27 severe sprains) answered the "phone questionnaire". In terms of treatment adherence by the patient, 92 patients (82.9%) performed their rehabilitation (beginning an average of 13.8 days after the injury). In terms of prescription compliance by the physiotherapist, 88 patients (95.6%) received massage, 71 (77.2%) underwent physiotherapy, 83 (90.2%) performed weight training and 87 (94.5%) received proprioceptive training. Eighty-two patients said that they had received manipulative therapy that was not part of the prescribed programme. Impact on recovery: 61 patients (55%) considered that their injury had healed (10 mild, 42 medium and nine severe sprains), whereas 50 had not healed (seven mild, 25 medium and 18 severe sprains). There was no statistically significant association between recovery and compliance with rehabilitation. However, the application of massage (p=0.004) and proprioceptive training (p=0.017) were significantly associated with recovery, while physiotherapy, weight training and manipulative therapy were not. CONCLUSION: In acute ankle sprain, adherence with rehabilitation is good and the treating physiotherapists comply with the prescription. However, there was no statistically significant link between rehabilitation compliance and subjective recovery at 3 months. Revaluation of these patients at one year may be necessary for estimating the impact of rehabilitation on ankle function and the rate of injury recurrence.

Treatment of muscle trauma in sportspeople (from injury on the field to resumption of the sport).

OBJECTIVE: Muscle trauma mainly results from sporting activities and accounts for 10 to 55% of sports injuries. However, information on optimal muscle trauma management is scarce. The present study sought to assess the initial treatment of muscle injury in sportspeople, evaluate rehabilitation programs and observe the impact on healing. METHODS: We included consecutive patients consulting for severe muscle pain with a physician at the Questel Sports Medicine Surgery in the city of Brest (western France). The study examined the circumstances of the injury, possible antecedents and the initial treatment (with the RICE protocol). After clinical and ultrasound examinations, each patient was referred to the physiotherapist of his/her choice with an identical recovery program (muscle strengthening exercises, cycling on an exercise bike and guidance on resuming sport). The patient was subsequently interviewed by phone at two time points: four months after the injury, to ascertain the date of resumption of gentle sporting activity (e.g., jogging) or return to the pre-injury sporting level (i.e., full recovery) and to establish whether the patient and the physiotherapist had respectively complied with the prescribed treatment and 15 months after the injury, to investigate any re-injury and/or any other muscle injuries. The patients were classified into two groups: those who were able to resume full sporting activity within 40 days (minor muscle injuries: Group 1) and those who were also able to resume full sporting activity but only after more than 40 days (major muscle injuries: Group 2). We, then, compared the two groups in order to identify factors potentially related to recovery. RESULTS: Ninety-five cases were included in the study; this corresponded to 93 patients, two of whom had two different injuries each. The RICE protocol: sport was immediately discontinued in 90 cases and shortly afterwards in five cases. Ice was applied in 57 cases (60%) and compression was applied in 17 cases (17.8%). There were 34 patients (35.8%) in Group 1, with an average return to gentle sporting activity (jogging) on day 11 post-injury and full resumption of their sport on day 23. There were 61 cases (64.2%) in Group 2, with an average return to jogging on day 39 and full resumption of their sport on day 69. Compliance with the prescription: rehabilitation was performed in only 62 cases (64.5%), with no major difference between the two groups. In terms of the physiotherapist's compliance with the prescription, 40 of the 62 patients did some weight training, 29 performed cycling and 58 were given advice on the resumption of sporting activity. Resumption of sport: in both groups, the duration of incapacity did not depend on whether rehabilitation had been performed or not. The second phone interview yielded a total of 84 replies (88%): seven patients (8%) had suffered re-injury in the same muscle group (no difference between Groups 1 and 2) and 22 patients (26%) had incurred injuries in another muscle group. CONCLUSION: The RICE protocol might give better results if compression were to be used more extensively. In terms of rehabilitation, therapeutic compliance is rather weak and physiotherapists do not fully comply with physician's prescription. However, for both minor and major injuries, rehabilitation (to the extent that it was implemented by the physiotherapists in the present study) did not lead to quicker recovery.

[Chronic instability in the ankle area]. / Instabilité chronique autour de la cheville.

For ankle sprains, the initial radiological work-up must include weight-bearing AP and lateral stress views of the sprained and healthy ankle. Films are taken in auto-varus. Other explorations included arthroMRI, arthroscanner or MRI which can be indicated preoperatively to confirm suspected cartilage injury or an associated ligament tear. These techniques should be employed when pertinent information can be expected according to the clinical situation and the operator's experience. In the emergency setting, ultrasonography can provide a simple low-cost confirmation of joint hematoma which is more precise than x-rays with a positive predictive value of nearly 100%. The objective and subjective clinical outcome after surgical anatomic repair or ligamentoplasty are quite similar. The two principal differences relate to persistent subjective instability and post-operative surgical complications. Thus there are advantages and disadvantages for each option advantage for anatomical repair because of the low rate of surgical complications and advantage for ligament repairs which stabilize the subtalar joint with a low rate of residual instability.

Contralateral spondylolysis and fracture of the lumbar pedicle in an elite female gymnast: a case report.

STUDY DESIGN: The case of an elite female gymnast whose pathology started in her 12th year and whose evolution has been exceptional is reported. OBJECTIVE: To present a fracture of the right lumbar pedicle showing complete spontaneous consolidation despite gymnastic practice 15 hours a week. SUMMARY OF BACKGROUND DATA: Lumbar pain, which has an incidence of approximately 75% among young athletes, often results from diseases of the posterior arch of vertebrae in gymnasts, including spondylolysis. The association between unilateral spondylolysis and fracture of the contralateral lumbar pedicle in young athletes is poorly described. METHODS: An elite young female gymnast underwent clinical examination and lumbar radiographs (as systematically required by the French Federation for high-level gymnasts) from 1994 to 1997 to join a sports program in gymnastics. RESULTS: Clinical examination and lumbar radiographs systematically required of an asymptomatic female gymnast allowed the condensation of the right pedicle to be observed before lysis of the left isthmus of L5 in 1994, unilateral lysis of the left isthmus of L5 in 1995, a right pedicular fracture of L5 in 1996, and healing of the pedicular fracture in 1997. CONCLUSION: Inconsistency between radiographs and clinical observations can be noted, and spontaneous consolidation of pedicular fractures can occur despite the practice of the gymnastics 15 hours a week.

Are tennis players at increased risk for low back pain and sciatica?

OBJECTIVE: Tennis practiced intensively is generally held to be a risk factor for low back pain. The objective of our study was to evaluate the prevalence of low back pain with or without sciatica during the last week in tennis players versus controls. PATIENTS AND METHODS: During an international tennis competition held in Brest, France, ten physicians or medical students interviewed 633 spectators older than 18 years and divided them into tennis players and controls. The sample size was selected to allow detection of a twofold increase in the risk of low back pain in tennis players (with alpha = 5% and 1-beta = 80%). RESULTS: Of the 633 subjects, 388 were and 245 were not tennis players. There were 421 men with a mean age of 37 +/- 13.7 years and 212 women with a mean age of 34.3 +/- 12.7. Among the men, 49 of the 281 tennis players (17.4%) reported low back pain during the last week versus 26 of the 140 controls (18.6%). Corresponding figures in women were 20 of 107 tennis players (18.7%) and 29 of 105 controls (27.6%). Sciatica was not more common in tennis players (men, 20 of 281 tennis players [7.1%] versus 6 of 140 controls [4.3%]; women, 8 of 107 tennis players [7.5%] versus 10 of 105 controls [9.5%]). None of the differences between tennis players and controls were significant. The number of hours spent playing tennis per week was similar in tennis players with and without low back pain. CONCLUSION: Our interview-based cross-sectional study found no evidence that playing tennis involves a higher risk of low back pain with or without sciatica.