Radial extracorporeal shockwave therapy (rESWT) for coccydynia: a prospective study of 14 patients.

Background: Coccydynia is defined as pain in the coccyx. We investigated the effect of radial extracorporeal shockwave therapy (rESWT) in the management of coccydynia. Methods: In this prospective study, patients (≥18 years) diagnosed with coccydynia at a sports clinic located in Thessaloniki, Greece, were eligible for rESWT treatment when they reported a visual analogue scale (VAS) pain level ≥6. Treatment sessions were once weekly and ended when VAS pain levels decreased to ≤3. Recurrence rates were documented at 3-month and 12-month follow-ups. Results: Fourteen patients were treated using rESWT. The mean age and symptom duration of our cohort was 33.6±7.9 (range: 20-45) years and 9.4±8.5 (range: 3-36) months, respectively. The mean number of treatment sessions per patient was 6.4±1.6 (range: 4-8). The mean device pressure, frequency, and number of pulses was 1.2±0.1 (range: 1-1.4) bar, 5.0±0.1 (range: 5-6) Hz, and 2082±74.8 (range: 2000-2300) pulses, respectively. Treatment alleviated pain in all patients, and no recurrence of symptoms was reported during follow-up. There was a positive correlation between symptom duration and the number of treatment sessions (r=0.701, P=0.005). Pairwise comparison highlighted significant reductions in VAS pain levels between each stage of treatment (P<0.001). Conclusion: Our study affirms the safety and efficacy of rESWT in managing coccydynia.

High-rate settlement and unconsciousness with shime-waza in young judo athletes from a video analytic study in Judo World Championships.

OBJECTIVES: We aimed to investigate the incidence rate of unconsciousness related to shime-waza and the accompanying symptoms by age categories using video analysis of the Judo World Championships. DESIGN: Observational retrospective study. METHODS: We included 6918 elite judo athletes and 7426 bouts from the Judo World Championships between 2015 and 2021. Incidence rates of matches settled using shime-waza and unconsciousness were calculated by age categories: cadet, junior, and senior. Furthermore, in cases of unconsciousness resulting from shime-waza, the duration of choking initiation and release, unconsciousness, and awareness were recorded from video analysis and compared by the presence of post-awareness symptoms. A relationship between the duration of shime-waza and the post-awareness symptoms was investigated using receiver operating characteristic analysis. RESULTS: Shime-waza was used to settle 307 (4.1 %) bouts comprising 6.0 %, 4.4 %, and 3.0 % of the cadet, junior, and senior bouts, respectively (p < 0.001). The unconsciousness rates were 18.9 %, 14.6 %, and 4.3 % in the cadet, junior (p = 0.008), and senior bouts (p < 0.001), respectively. Among the 39 unconsciousness cases, 24 (61.5 %) showed convulsions or staggers after awareness. The duration from unconsciousness to choking release in cases with and without symptoms was 5.0 ±â€¯3.5 s and 2.4 ±â€¯2.0 s, respectively (p = 0.009); moreover, this duration was significantly correlated with the duration from unconsciousness to awareness (ρ = 0.480, p = 0.002). The cut-off point for symptom occurrence was a duration from unconsciousness to choking release of ≥4 s (area under the curve = 0.746, p = 0.003, odds ratio = 6.7). CONCLUSIONS: Considering the risk of unconsciousness and accompanying symptoms resulting from shime-waza, appropriate education and responses are required.

A Systematic Review on the Biomechanics of Breakfall Technique (Ukemi) in Relation to Injury in Judo within the Adult Judoka Population.

OBJECTIVES: To investigate the biomechanics of Ukemi in relation to head and neck injury in adult judokas with varying skill sets. DESIGN: Narrative systematic review. METHODS: An extensive literature search was performed using PubMed, Google Scholar, Science direct and EMBASE from inception to April 2021. Studies were included if they: (1) reported biomechanical analysis of judo throws and Ukemi; (2) were on adult judoka populations; (3) discussed injury related to judo technique. The included studies were assessed for risk of bias using a five-part modified STROBE checklist. A narrative synthesis was performed due to the heterogeneity of included studies. RESULTS: 173 titles and abstracts were screened with 16 studies (158 judokas, 9 of which were female) included. All studies used 3D biomechanical analysis to assess Ukemi. Ukemi implementation produced reduced kinematic data in comparison to direct occipital contact, which was always below the injury threshold. Analysis of lower limb and trunk kinematics revealed variances in Ukemi between novice and experienced judoka. Whilst no significant differences were seen in neck flexion angles, hip, knee and trunk angle time plots revealed greater extension angles in experienced judokas. CONCLUSIONS: Ukemi is essential in preventing head and neck injuries; however, technique differs between experienced and novice judoka. Larger flexion angles of the hip, knee and trunk are seen in novice judoka, which correlate with increased kinematic data. The association of greater neck muscle strength with improved Ukemi is weak. However, a negative correlation was established between fatigue and breakfall skill by one study.

Rotational head acceleration and traumatic brain injury in combat sports: a systematic review.

BACKGROUND: Traumatic brain injury (TBI) in combat sports is relatively common, and rotational acceleration (RA) is a strong biomechanical predictor of TBI. This review summarizes RA values generated from head impacts in combat sport and puts them in the context of present evidence regarding TBI thresholds. SOURCES OF DATA: PubMed, EMBASE, Web of Science, Cochrane Library and Scopus were searched from inception to 31st December 2021. Twenty-two studies presenting RA data from head impacts across boxing, taekwondo, judo, wrestling and MMA were included. The AXIS tool was used to assess the quality of studies. AREAS OF AGREEMENT: RA was greater following direct head strikes compared to being thrown or taken down. RA from throws and takedowns was mostly below reported injury thresholds. Injury thresholds must not be used in the absence of clinical assessment when TBI is suspected. Athletes displaying signs or symptoms of TBI must be removed from play and medically evaluated immediately. AREAS OF CONTROVERSY: Methodological heterogeneity made it difficult to develop sport-specific conclusions. The role of headgear in certain striking sports remains contentious. GROWING POINTS: RA can be used to suggest and assess the effect of safety changes in combat sports. Gradual loading of training activities based on RA may be considered when planning sessions. Governing bodies must continue to work to minimize RA generated from head impacts. AREAS TIMELY FOR DEVELOPING RESEARCH: Prospective research collecting real-time RA data is required to further understanding of TBI in combat sports.

Judo Injuries Frequency in Europe's Top-Level Competitions in the Period 2005-2020.

BACKGROUND: The present study assesses the frequency of injury in Europe's top-level judokas, during top-level competitions, and defines risk factors. METHODS: The members of the EJU Medical Commission collected injury data over the period of 2005 to 2020 using the EJU Injury Registration Form at Europe's top judoka tournaments. RESULTS: Over the 15 years of the study, 128 top-level competitions with 28,297 competitors were included; 699 injuries were registered. Of all competitors, 2.5% needed medical treatment. The knee (17.4%), shoulder (15.7%), and elbow (14.2%) were the most common anatomical locations of injury. Sprains (42.2%) were by far the most frequent injury type, followed by contusions (23.1%). Of all contestants, 0.48% suffered an injury which needed transportation to hospital. There was a statistically significant higher frequency of elbow injuries in female athletes (p < 0.01). Heavy-weight judokas suffered a remarkably low number of elbow injuries, with more knee and shoulder injuries. Light-weight judokas were more prone to elbow injuries. CONCLUSIONS: We found there was a low injury rate in top-level competitors, with a greater frequency of elbow injuries in female judokas. During the 15 years of injury collection data, an injury incidence of 2.5% was found, with a remarkable high injury rate in the women's -52 kg category, and statistically significantly more elbow injuries in women overall.

The European Association for Sports Dentistry, Academy for Sports Dentistry, European College of Sports and Exercise Physicians consensus statement on sports dentistry integration in sports medicine.

Sports medicine has a multidisciplinary character which allows different medical specialties to investigate the prevention, etiology, and treatment of athletes' diseases. This leads to a decreased risk of injury and a faster return to play as well as an improvement in the overall health and well-being of athletes of any level and in all sports around the world. The oral health of athletes is now the subject of great attention internationally because of the increased prevalence and incidence of health issues such as dental caries and erosion, periodontal disease, defective occlusion, temporomandibular joint disorders, and orofacial injuries. Scientific evidence and research on these issues have also intensified over recent years. The best way to maintain player's health and performance is to include oral health in sports medicine with physicians and dentists working closely together at the individual level as well as with the cooperation between local and international sports medicine and dentistry associations. The European Association for Sports Dentistry, the Academy for Sports Dentistry, and the European College of Sports and Exercise Physicians are leading the way and have worked together to develop a consensus statement describing the main pillars of oral health integration into sports medicine based on the most common oral diseases found in athletes and linked to exercise, sports, and performance.

Effect of poor cooperation between coaching and medical staff on muscle re-injury in professional football over 15 seasons.

BACKGROUND: Muscle injury is the most common type of injury in football. Previous research has focused on traditional risk factors (eg, age, injury history, muscle imbalance/inflexibility) contributing to muscle re-injury. The effect of poor cooperation between the coaching and medical teams on the risk of re-injury remains unexplored in the sports medicine football literature. PURPOSE: Examine the effect of poor cooperation between coaching and medical teams on muscle re-injury in professional football. METHODS: Retrospective review of the medical files of 97 footballers of a professional team in Dubai over 15 consecutive seasons (2002-2017). Medical team recorded all injuries in each player's file. Data on the perceived level of cooperation between coaching and medical teams were available in the daily meeting notes from the head of the medical team. The level of perceived cooperation was ranked on a three-point Likert scale by the head of the medical team and depended on whether the coaching team accepted the player injury (excellent cooperation), brought some suggestion after discussion with the medical team (normal cooperation) or rejected it (poor cooperation). RESULTS: In total, 338 indirect muscle injuries (21 re-injuries) were recorded during 15 consecutive seasons., There was a significant increase in the mean number of total injuries (mean ± SE, 95% CI; 16±2, 12-21; P<0.0001), mean number of indirect muscle injuries (12±1, 95% CI 10-14; P<0.0001), and indirect muscle re-injuries (4±1, 95% CI 3-5; P<0.0001) during seasons with a poor perceived level of cooperation compared to seasons with a normal/excellent perceived level of cooperation. CONCLUSION: Findings suggest that poor cooperation between coaching and medical teams may increase the risk of muscle re-injury in professional football. Future studies conducted in different clubs, leagues, countries, and even sports are required to further explore the effect of cooperation between coaching and medical teams on the risk of re-injury.

Validation study of the Functional Assessment Scale for Acute Hamstring injuries in Spanish professional soccer players.

OBJECTIVE:: To cross-culturally adapt and validate the Functional Assessment Scale for acute hamstring injury for professional Spanish-speaking soccer players. DESIGN:: Clinical measurement study. Cross-cultural adaptation was conducted following international recommendations. Indicators of validity, reliability and responsiveness are provided. SUBJECTS:: The Spanish version of the Functional Assessment Scale for acute hamstring injury scale was administered to 165 participants: 45 professional soccer players with acute hamstring muscle injury diagnosis, 40 healthy subjects, 40 individuals at-risk for a hamstring muscle injury and 40 patients with injuries of the lower limb other than hamstring muscle injury. MAIN MEASURES:: The Functional Assessment Scale for acute hamstring injury. REFERENCE MEASURES:: Spanish version of the Quality of Life Short-Form 36 questionnaire (SF-36) and the Lower Limb Functional Index (LLFI). RESULTS:: Cronbach's alpha (internal consistency) for the Spanish version of the Functional Assessment Scale for acute hamstring injury scale was >0.8. The intraclass correlation coefficient using the two-way random model (ICC2,1) (test-retest) was 0.993 (95% confidence interval (CI): 0.991-0.995; P < 0.05). In the exploratory factor analysis, a one-factor solution explained 85% of the variance. Subjects with hamstring muscle injury scored significantly lower than the other groups in the Spanish version of the Functional Assessment Scale for acute hamstring injury scale ( P < 0.001). The Spanish version of the Functional Assessment Scale for acute hamstring injury scale score within the hamstring muscle injury group showed moderate and significant correlations with SF-36 physical components (Spearman's rs > 0.6; P < 0.001), and LLFI score at baseline ( rs = 0.42; P < 0.01). The standard error of measurement (SEM) and minimum detectable change threshold (MDC95%) were 2.6 and 7.2 points, respectively. The responsiveness indicators have an effect size of 3.62, and the standardized response mean is 3.24. CONCLUSION:: The Spanish version of the Functional Assessment Scale for acute hamstring injury scale showed satisfactory psychometric properties. It can be considered a reliable and valid instrument to assess the functional impact of acute hamstring muscle injury in professional Spanish-speaking football players.

Tensor Fasciae Suralis Muscle: Report of a Symptomatic Case With Emphasis on Imaging Findings.

We report a case of a symptomatic tensor fasciae suralis (TFS) muscle in an elite jumper, with a very rare tear in its origin. The TFS muscle must be recognized and differentiated from other pathologic entities in the popliteal region. The magnetic resonance imaging (MRI) and ultrasound (US) can reliably identify this variant and its pathology.

Soft tissue pseudotumours: a pictorial review with emphasis on MRI.

BACKGROUND: Several tumour-like conditions of the soft tissues may be encountered in clinical practice, or when patients undergo radiologic examinations. Al-though advances in cross sectional imaging (ultra-sound, MDCT and MRI) play a pivotal role in the correct evaluation of tumour-like lesions, a systematic approach is needed to achieve a definitive diagnosis or limit the differential diagnosis. Clinical history, physical examination and anatomic location are of paramount importance. METHODS: In this pictorial essay we review some of the most frequent benign soft tissue conditions which may be mistaken for malignancy and thus lead to need-less referrals, unnecessary biopsies and great anxiety to the patients and their carers. LEVEL OF EVIDENCE: IV.

Para-articular extraskeletal chondroma mimicking first metatarsophalangeal synovitis.

Extraskeletal chondroma is a rare benign tumor with symptoms that could mimic other common musculoskeletal pathological entities. We present a rare case of an extraskeletal para-articular chondroma of the first metatarsophalangeal joint which was initially misinterpreted as joint synovitis, based on magnetic resonance imaging findings. Histology revealed benign chondroma of the foot, which was finally treated with radical surgical excision. More than 2 years postoperatively, no recurrence of the tumor has been encountered.

Sesamoid osteonecrosis treated with radial extracorporeal shock wave therapy.

Sesamoid osteonecrosis is a disabling condition resulting in severe forefoot pain, for which there are limited treatment options. We present a 52-year-old man with 1-year history of pain, aggravated by walking and playing tennis. On examination, pain was localised to plantar aspect of the first metatarsophalangeal joint. Imaging revealed evolving end-stage avascular necrosis of lateral sesamoid with early secondary degenerative changes. Previous exhaustive conservative treatment had been unsuccessful in alleviating his pain. As an alternative to surgery, radial extracorporeal shock wave therapy (rESWT) was proposed. Treatment protocol was 2000 pulses at frequency of 5 Hz, and pressure was varied from 1.2 to 1.8 bar according to patient tolerance. A total of eight sessions were delivered. At completion of treatment, the patient reported minimal discomfort to no pain and was able to return to playing tennis with no recurrence. We propose rESWT to be an effective novel conservative treatment for sesamoid osteonecrosis.

Prevalence, techniques and knowledge of rapid weight loss amongst adult british judo athletes: a questionnaire based study.

BACKGROUND: No investigation has analysed the RWL approaches since new rules by the International Judo Federation (IJF) regarding weigh-ins have been implemented in international competitions in 2014. The current study analyses the prevalence, most common methods and knowledge surrounding the effects of rapid weight loss (RWL) amongst adult UK judo athletes. Additionally, it examines differences in rapid weight loss behaviour (RWLB) between gender, weight-class, competitive level, age RWL began and "high"/"low" knowledge athletes. METHODS: A previously validated questionnaire developed to assess RWL in judo athletes was modified by adding a knowledge section and revalidated for content. The questionnaire provided a RWLB score (higher score equated to more aggressive RWL) and a knowledge score (out of 10). 256 athletes (189 males and 66 females, aged 18-67 years) completed the questionnaire between February and April 2015. Unpaired t test, one-way ANOVA-tests and Chi-squared tests were used to test differences of mean RWLB scores and prevalence between groups. RESULTS: The prevalence of RWL was 84%. The most common methods of RWL were increased exercise and decreased food/fluid intake. The mean knowledge score was 6.2±2.8, with most incorrect answers regarding physiological effects of RWL. No significant differences in RWLB scores were found between gender, "high"/"low" knowledge athletes or weight-classes. Statistically significant differences in RWLB scores were found between different competitive levels (p=0.014) and age RWL began (p<0.01) in males but not in females. CONCLUSION: RWL is highly prevalent in the UK adult judo population and athletes have moderate knowledge surrounding its effects. In males, RWLB is most aggressive in elite level athletes and those that began RWL at a younger age. Therefore, updated rulings to target elite and youth level athletes should be implemented to reduce dangerous RWL. LEVEL OF EVIDENCE: IV.

Muscle Injuries in Sports: A New Evidence-Informed and Expert Consensus-Based Classification with Clinical Application.

Muscle injuries are among the most common injuries in sport and continue to be a major concern because of training and competition time loss, challenging decision making regarding treatment and return to sport, and a relatively high recurrence rate. An adequate classification of muscle injury is essential for a full understanding of the injury and to optimize its management and return-to-play process. The ongoing failure to establish a classification system with broad acceptance has resulted from factors such as limited clinical applicability, and the inclusion of subjective findings and ambiguous terminology. The purpose of this article was to describe a classification system for muscle injuries with easy clinical application, adequate grouping of injuries with similar functional impairment, and potential prognostic value. This evidence-informed and expert consensus-based classification system for muscle injuries is based on a four-letter initialism system: MLG-R, respectively referring to the mechanism of injury (M), location of injury (L), grading of severity (G), and number of muscle re-injuries (R). The goal of the classification is to enhance communication between healthcare and sports-related professionals and facilitate rehabilitation and return-to-play decision making.

Radial extracorporeal shockwave therapy for the treatment of finger tenosynovitis (trigger digit).

INTRODUCTION: Stenosing tenosynovitis that is characterized by the inability to flex the digit smoothly, usually leads to prolonged rehabilitation or surgery. STUDY DESIGN: This case series is a retrospective cohort study. PURPOSE: The aim of this case series was to evaluate the effectiveness of radial extracorporeal shockwave therapy (rESWT) for the treatment of stenosing tenosynovitis of the digital flexor tendon (trigger digit). METHODS: A retrospective analysis of 44 patients (49 fingers) treated with an individually adapted rESWT protocol was conducted. Trigger digit pain and function were evaluated at baseline and 1-, 3-, and 12-months posttreatment. Recurrence and pretreatment symptom duration were analyzed. RESULTS: Significant reductions in pain scores and functional improvement were found between baseline and all follow-up assessments (P<0.001). Pretreatment symptom duration was significantly correlated with the number of rESWT sessions required (r=0.776, P<0.001) and 1-year posttreatment pain score (r=0.335, P=0.019). CONCLUSION: This study provides initial evidence that rESWT is an effective treatment for trigger digit, but randomised controlled trials are required to provide further evidence of this effect.

Validation of the FASH (Functional Assessment Scale for Acute Hamstring Injuries) questionnaire for German-speaking football players.

BACKGROUND: The FASH (Functional Assessment Scale for Acute Hamstring Injuries) questionnaire has been recently developed as a disease-specific self-administered questionnaire for use in Greek, English, and German languages. Its psychometric qualities (validity and reliability) were tested only in Greek-speaking patients mainly representing track and field athletes. As hamstring injuries represent the most common football injury, we tested the validity and reliability of the FASH-G (G = German version) questionnaire in German-speaking footballers suffering from acute hamstring injuries. METHODS: The FASH-G questionnaire was tested for reliability and validity, in 16 footballers with hamstring injuries (patients' group), 77 asymptomatic footballers (healthy group), and 19 field hockey players (at-risk group). Known-group validity was tested by comparing the total FASH-G scores of the injured and non-injured groups. Reliability of the FASH-G questionnaire was analysed in 18 asymptomatic footballers using the intra-class coefficient. RESULTS: Known-group validity was demonstrated by significant differences between injured and non-injured participants (p < 0.001). The FASH-G exhibited very good test-retest reliability (intra-class correlation coefficient = 0.982, p < 0.001). Internal consistency was excellent (α = 0.938). Compared with the results presented in the original publication, no statistical differences were found between healthy athletes (p = 0.257), but patients' groups and at-risk groups presented scoring differences (p = 0.040 and <0.001, respectively). CONCLUSIONS: The FASH-G is a valid and reliable instrument to assess and determine the severity of hamstring injuries in German footballers.

Historical ESWT Paradigms Are Overcome: A Narrative Review.

Extracorporeal Shock Wave Therapy (ESWT) is a conservative treatment modality with still growing interest in musculoskeletal disorders. This narrative review aims to present an overview covering 20-year development in the field of musculoskeletal ESWT. Eight historical paradigms have been identified and put under question from a current perspective: energy intensity, focus size, anesthesia, imaging, growth plates, acuteness, calcifications, and number of sessions. All paradigms as set in a historical consensus meeting in 1995 are to be revised. First, modern musculoskeletal ESWT is divided into focused and radial technology and the physical differences are about 100-fold with respect to the applied energy. Most lesions to be treated are easy to reach and clinical focusing plays a major role today. Lesion size is no longer a matter of concern. With the exception of nonunion fractures full, regional, or even local anesthesia is not helpful in musculoskeletal indications. Juvenile patients can also effectively be treated without risk of epiphyseal damage. Further research is needed to answer the question about if and which acute injuries can be managed effectively. Treatment parameters like the number of sessions are still relying on empirical data and have to be further elucidated.

Success and Recurrence Rate after Radial Extracorporeal Shock Wave Therapy for Plantar Fasciopathy: A Retrospective Study.

Background and Aims. The exploration of an individualised protocol of radial extracorporeal shock wave therapy (rESWT) for plantar fasciopathy, assessing success rates and the recurrence rate over a 1-year period after treatment, is not yet identified in literature. Methods and Results. Between 2006 and 2013, 68 patients (78 heels) were assessed for plantar fasciopathy. An individualised rESWT treatment protocol was applied and retrospectively analysed. Heels were analysed for mean number of shock wave impulses, mean pressure, and mean frequency applied. Significant mean pain reductions were assessed through Visual Analogue Scale (VAS) after 1-month, 3-month, and 1-year follow-up. Success rates were estimated as the percentage of patients having more than 60% VAS pain decrease at each follow-up. 1-year recurrence rate was estimated. The mean VAS score before treatment at 6.9 reduced to 3.6, 1 month after the last session, and to 2.2 and 0.9, after 3 months and 1 year, respectively. Success rates were estimated at 19% (1 month), 70% (3 months), and 98% (1 year). The 1-year recurrence rate was 8%. Moderate positive Spearman's rho correlation (r = 0.462, p < 0.001) was found between pretreatment pain duration and the total number of rESWT sessions applied. Conclusions. Individualised rESWT protocol constitutes a suitable treatment for patients undergoing rESWT for plantar fasciitis.