Common musculoskeletal impairments in postpartum runners: an international Delphi study

Abstract Background Postpartum runners report musculoskeletal pain with running. Because of inadequate research, little is known about the origin and pain-related classification. Through expert consensus, this study is the first attempt to understand the musculoskeletal impairments that these runners present with. The objective of this survey was to gather expert consensus on characteristics of reported impairments in postpartum runners that have musculoskeletal pain. Methods A web-based Delphi survey was conducted and was composed of five categories: strength, range of motion, alignment and flexibility impairments, as well as risk factors for pain in postpartum runners. Results A total of 117 experts were invited. Forty-five experts completed round I and forty-one completed rounds II and III. The strength impairments that reached consensus were abdominal, hip and pelvic floor muscle weakness. The range of motion impairments that reached consensus were hip extension restriction, anterior pelvic tilt and general hypermobility. The alignment impairments that reached consensus were a Trendelenburg sign, dynamic knee valgus, lumbar lordosis, over-pronation and thoracic kyphosis. The flexibility impairments that reached consensus were abdominal wall laxity, and tightness in hip flexors, lumbar extensors, iliotibial band and hamstrings. The risk factors for pain in postpartum runners were muscular imbalance, poor lumbopelvic control, too much too soon, life stressors, pain during pregnancy and pelvic floor trauma. Conclusion This study presents a framework for clinicians to understand pain in postpartum runners and that can be investigated in future cohort studies. Level of evidence 5

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Development of a screening tool for pelvic floor dysfunction in female athletes: protocol of a Delphi consensus

10.1101/2022.01.12.22269000 ◽

2022 ◽

Author(s):

Silvia Giagio ◽

Andrea Turolla ◽

Tiziano Innocenti ◽

Stefano Salvioli ◽

Giulia Gava ◽

...

Keyword(s):

Risk Factors ◽

Clinical Practice ◽

Pelvic Floor ◽

Delphi Study ◽

Sports Medicine ◽

Screening Tool ◽

Female Athletes ◽

Pelvic Floor Dysfunction ◽

Negative Influence ◽

Delphi Consensus

Background/aim: Several epidemiological studies have found a high prevalence of Pelvic Floor Dysfunction (PFD) among female athletes. However, according to several authors, these data could even be underestimated, both in research and clinical practice. Screening for potential PFD is often delayed and risk factors are not often evaluated. As a consequence, withdrawal from sport, negative influence on performance, worsening symptoms and unrecognized diagnosis may occur. The aim of our research is to develop a screening tool for pelvic floor dysfunction in female athletes useful for clinicians (musculoskeletal/sport physiotherapists, sports medicine physicians, team physicians) to guide referral to a PFD expert (e.g. pelvic floor/women's health physiotherapist, gynecologist, uro-gynecologist, urologist). Methods: A 2-round modified Delphi study will be conducted to ascertain expert opinion on which combination of variables and risk factors should be included in the screening tool. Conclusion: The implementation of the present screening tool into clinical practice may facilitate the referral to a PFD expert for further assessment of the pelvic floor and therefore, to identify potential dysfunction and, eventually, the related treatment pathway.

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Shoulder Stiffness – How to Treat?

Zeitschrift für Orthopädie und Unfallchirurgie ◽

10.1055/a-0853-2128 ◽

2019 ◽

Vol 157 (06) ◽

pp. 668-675

Author(s):

Davide Cucchi ◽

Sebastian Gottfried Walter ◽

Dieter Christian Wirtz ◽

Max Julian Friedrich

Keyword(s):

Risk Factors ◽

Range Of Motion ◽

Low Dose ◽

Conservative Therapy ◽

Clinical Situation ◽

Level Of Evidence ◽

Shoulder Stiffness ◽

Rehabilitation Protocol ◽

Conservative And Operative Treatment ◽

High Level

AbstractShoulder stiffness is a condition of restricted glenohumeral range of motion, which can arise spontaneously or as consequence of a known cause, including surgical procedures on the shoulder. Several approaches to shoulder stiffness have been proposed and high-level evidence is available to analyze and discuss their results. The aim of this review was to summarize the current concepts on conservative and operative treatment of shoulder stiffness and discuss the results of the available studies with a high level of evidence, which should be considered to guide clinical practice. Treatment of shoulder stiffness should be tailored to the patientʼs clinical situation and the stage of its shoulder pathology and should aim at pain reduction, restoration of range of motion, functional regain and shortening of symptoms duration. When possible, known risk factors for primary shoulder stiffness and causes of secondary shoulder stiffness should be addressed to avoid relapse. Conservative therapy is the mainstay of treatment for shoulder stiffness and should include a multimodal and activity-oriented program. Intra-articular injection of a low dose of corticosteroid is safe and effective, provides immediate benefits, and is recommended in combination to an appropriate rehabilitation protocol. In conservative refractory cases, arthrolysis and capsular release can be performed with an arthroscopic approach.

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Injury Prevention Programs for Throwing Injuries in Softball Players: A Systematic Review

Sports Health A Multidisciplinary Approach ◽

10.1177/1941738120978161 ◽

2021 ◽

pp. 194173812097816

Author(s):

Jonathan Paul ◽

Symone M. Brown ◽

Mary K. Mulcahey

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Range Of Motion ◽

Injury Prevention ◽

Prevention Program ◽

Dynamic Range ◽

Lower Extremities ◽

Prevention Programs ◽

Level Of Evidence ◽

Injury Prevention Program

Context: Throwing-related injuries occur commonly in softball players. Preventative programs can be implemented to assist in identifying and correcting risk factors that could potentially lead to injury and therefore time missed from both practice and games. Objective: The purpose of this study was to determine if position-specific injury prevention programs have been developed to decrease the risk of throwing-related injuries in softball players. Data Sources: A systematic review was performed using the PRISMA (Preferred Reporting Items of Systematic Reviews and Meta-Analyses) guidelines. PubMed, PMC, and EBSCO were searched for articles on injury prevention programs using the following key terms: softball, injury prevention, throwing injuries, pitcher, and shoulder. Study Selection: Studies that involved fast-pitch softball and included female participants as well as rehabilitation programs were included. Articles that highlighted slow-pitch softball or did not include female participants were excluded. Level of Evidence: Level 1. Data Extraction: The initial search identified 1605 articles. After implementing a filter, 131 articles remained. Thirteen articles were screened out as duplicates. After screening for inclusion criteria, 7 articles remained and were included in the systematic review. Results: Decreased range of motion (ROM) in both the upper and the lower extremities, unbalanced muscular strength, and fatigue were identified as risk factors for throwing injuries in softball players. Within the upper extremity, strength and ROM of the rotator cuff muscles, biceps, and extensors of the forearm were emphasized. The main focus of the lower extremity was the strength of the gluteal muscles and ROM of the lumbopelvic-hip complex. Only 1 study detailed an injury prevention program for softball players. The prevention program outlined was generalized for all softball players and was not position specific. Conclusion: There is a paucity of information about injury prevention programs for softball players. Of the evidence analyzed, balanced strengthening of the upper and lower extremities while maintaining dynamic range of motion was frequently utilized in developing an injury prevention program.

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Do Women have Adequate Knowledge about Pelvic Floor Dysfunctions? A Systematic Review

Revista Brasileira de Ginecologia e Obstetrícia / RBGO Gynecology and Obstetrics ◽

10.1055/s-0039-1695002 ◽

2019 ◽

Vol 41 (08) ◽

pp. 508-519 ◽

Cited By ~ 2

Author(s):

Júlia Ferreira Fante ◽

Thais Daniel Silva ◽

Elaine Cristine Lemes Mateus-Vasconcelos ◽

Cristine Homsi Jorge Ferreira ◽

Luiz Gustavo Oliveira Brito

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Urinary Incontinence ◽

Pelvic Floor ◽

Pelvic Floor Muscle ◽

Data Extraction ◽

Meta Analysis ◽

Treatment Options ◽

Cross Sectional ◽

Adequate Knowledge

Objective We sought to investigate whether women present adequate knowledge of the main pelvic floor disorders (PFDs) (urinary incontinence – UI, fecal incontinence – FI, and pelvic organ prolapse – POP). Data sources A systematic review was performed in the MEDLINE, PEDro, CENTRAL, and Cochrane databases for publications from inception to April 2018. Selection of studies A total of 3,125 studies were reviewed. Meta-analysis was not possible due to the heterogeneity of primary outcomes and the diversity of instruments for measuring knowledge. The quality of the articles included in the analysis was evaluated with the Newcastle-Ottawa Scale (NOS) adapted for cross-sectional studies. Data collection Two authors performed data extraction into a standardized spreadsheet. Data synthesis Nineteen studies were included, comprising 11,512 women. About the methodological quality (NOS), most of the studies (n = 11) presented a total score of 6 out of 10. Validated questionnaires and designed pilot-tested forms were the most frequently used ways of assessing knowledge. Some studies were stratified by race, age, or group minorities. The most used questionnaire was the prolapse and incontinence knowledge questionnaire (PIKQ) (n = 5). Knowledge and/or awareness regarding PFD was low to moderate among the studies. Urinary incontinence was the most prevalent PFD investigated, and the most important risk factors associated with the lack of knowledge of the pelvic floor were: African-American ethnicity (n = 3), low educational level (n = 4), low access to information (n = 5) and socioeconomic status (n = 3). Conclusion Most women have a gap in the knowledge of pelvic floor muscle dysfunctions, do not understand their treatment options, and are not able to identify risk factors for these disorders.

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Risk Factors for Decreased Pelvic Floor Muscle Strength: Which is More Effective?

Gynecology Obstetrics and Reproductive Medicine ◽

10.21613/gorm.2019.947 ◽

2019 ◽

pp. 1

Author(s):

Omer Demir ◽

Cihan Comba

Keyword(s):

Risk Factors ◽

Regression Analysis ◽

Muscle Strength ◽

Cigarette Smoking ◽

Pelvic Floor ◽

Pelvic Floor Muscle ◽

Binary Logistic Regression ◽

Binary Logistic Regression Analysis ◽

Pelvic Floor Muscle Strength ◽

Weak Muscle

Objective: The aim of this study was to assess whether cigarette smoking weakens the pelvic floor and to determine its effective impact relative to other factors.Study Design: Between September 2017 and September 2018, 250 patients admitted to an outpatient gynecology clinic were examined by a single physician and their anamnesis was taken. As a result of the examination, the pelvic floor muscle strength was evaluated according to the Modified Oxford Scale and the patients evaluated as 1/5 and 2/5 were grouped as having weak muscle strength and the rest were grouped as having high muscle strength. The intention was then to compare these two groups. The SPSS 21.0 for Windows program was used to perform statistical evaluations. Comparative analysis was performed with regression analysis.Results: 250 women participated in the study. 4 patients had muscle strength of 1/5; while 40 patients had muscle strength of 2/5 (17.6%). Patients with muscle strength of 1/5 and 2/5 were grouped as weak muscle strength. Advanced age, increased parity, smoking, and obesity are risk factors for a decrease in pelvic floor muscle strength (p < 0.05). Binary logistic regression analysis was performed to determine which of these factors has the greatest impact on pelvic floor muscle strength. Smoking has a 7-fold effect on decreased muscle strength (OR: 7.925) and obesity has a 5-fold impact (OR: 5.374).Conclusion: Although the mechanism of the effect of cigarette smoking on the pelvic floor is not known, it should be remembered that this effect has an adverse impact together with other factors which also have proven detrimental effects.

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Intrinsic Risk Factors for Inversion Ankle Sprains in Male Subjects: A Prospective Study

The American Journal of Sports Medicine ◽

10.1177/0363546504268137 ◽

2005 ◽

Vol 33 (3) ◽

pp. 415-423 ◽

Cited By ~ 143

Author(s):

Tine Marieke Willems ◽

Erik Witvrouw ◽

Kim Delbaere ◽

Nele Mahieu ◽

Llse De Bourdeaudhuij ◽

...

Keyword(s):

Risk Factors ◽

Muscle Strength ◽

Range Of Motion ◽

Cox Regression ◽

Ankle Sprains ◽

Running Speed ◽

Level Of Evidence ◽

Cox Regression Analysis ◽

Cardiorespiratory Endurance ◽

Male Subjects

Background Many variables have been retrospectively associated with ankle sprains. However, very little is known about factors predisposing people to these injuries. Hypothesis Measurable intrinsic factors might predispose male athletes to ankle sprains. Study Design Cohort study; Level of evidence, 2. Methods A total of 241 male physical education students were evaluated for possible intrinsic risk factors for inversion sprains at the beginning of their academic study. The evaluated intrinsic risk factors included anthropometrical characteristics, functional motor performances, ankle joint position sense, isokinetic ankle muscle strength, lower leg alignment characteristics, postural control, and muscle reaction time during a sudden inversion perturbation. Subjects were followed prospectively for 1 to 3 years. Results A total of 44 (18%) of the 241 male subjects sustained an inversion sprain; 4 sprained both ankles. Cox regression analysis revealed that male subjects with slower running speed, less cardiorespiratory endurance, less balance, decreased dorsiflexion muscle strength, decreased dorsiflexion range of motion, less coordination, and faster reaction of the tibialis anterior and gastrocnemius muscles are at greater risk of ankle sprains. Conclusion Based on our findings, it is suggested that running speed, cardiorespiratory endurance, balance, dorsiflexion strength, coordination, muscle reaction, and dorsiflexion range of motion at the ankle are associated with the risk of ankle inversion sprains in male subjects.

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Evaluation of Pelvic Floor Muscle Function(PFMF) in Cervical Cancer Patients with Querleu-Morrow type C Hysterectomy：A Multicenter Study

10.21203/rs.3.rs-116903/v1 ◽

2020 ◽

Author(s):

Shiyan Wang ◽

Hongwu Wen ◽

Yunong Gao ◽

Qiubo Lv ◽

Hongyu Li ◽

...

Keyword(s):

Risk Factors ◽

Cervical Cancer ◽

Logistic Regression ◽

Pelvic Floor ◽

Cancer Patients ◽

Muscle Function ◽

Pelvic Floor Muscle ◽

Fibre Strength ◽

Independent Risk Factors

Abstract Introduction and Hypothesis To evaluate the pelvic floor muscle function (PFMF) of cervical cancer patients after type QM-C hysterectomy and to explore the relationship between decreased PFMF and related factors.. Methods This was a multi-centered retrospective cohort study. 181 cervical cancer patients underwent type QM-C hysterectomy were enrolled from 9 tertiary hospitals. Strength of PFMF were measured by using neuromuscular apparatus (Phenix U8, French). Risk factors contributed to decreased PFMF was analyzed by univariate and multivariate ordinal ploytomous logistic regression. Results Totally 181 patients were investigated in this study.0-3 level of type I muscle fibre strength(MFSI) was 52.6%(95/181),0-3 level of type ⅡA muscle fibre strength(MFSⅡA) was 50%(91/181). Subjective stress urinary incontinence was 46%(84/181),urinary retention was 27.3%(50/181),dyschezia was 41.5%(75/181),fecal incontinence was 9%(18/181).①MFSI：Multivariate ordinal ploytomous logistic regression shows that the follow-up time(p<0.05),chemotherapy and radiotherapy (p=0.038) are independent risk factors of MFSI’s reduction after type QM-C hysterectomy.② MFSⅡA：Multivariate ordinal ploytomous logistic regression shows that the follow-up time(p<0.05) are independent risk factors of MFSⅡA’s reduction after type QM-C hysterectomy. The pelvic floor muscle strength(PFMS) increased after 9 months than in 9 months after operation, which showed that the PFMS could be recovered after operation. Conclusions We advocate for more attention and emphasis on the PFMF of Chinese female patients with cervical cancer postoperation. Contribution of the Paper The key messages of the article is that PFMF after QM-C hysterectomy have not been analyzed by current study.The new knowledge added by this study is that 3 months after radical hysterectomy patients’ should do pelvic floor rehabilitation exercises.

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Corrigenda

Vojnosanitetski pregled ◽

10.2298/vsp2007765e ◽

2020 ◽

Vol 77 (7) ◽

pp. 765-765

Author(s):

E Editorial

Keyword(s):

Risk Factors ◽

Case Report ◽

Pelvic Floor ◽

Pelvic Floor Muscle ◽

Novi Sad ◽

Font Color

1. In the original article by Katarina Parezanovic Ilic, Ljiljana Mladenovic Segedi, Aleksandra Jurisic Skevin, Ivana Zivanovic Macuzic, Vesna Grbovic, Jasmin Nurkovic, Milan Jovanovic, Dejan Jeremic: ?The influence of various risk factors on the strength of pelvic floor muscle in women? (Uticaj razlicitih faktora rizika na jacinu misica poda karlice kod zene). Vojnosanit Pregl 2017; 74(6): 557-563. (https://doi.org/10.2298/VSP150420083P), the author Ljiljana Mladenovic Segedi has an additional affiliation: University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia. 2. In the Case Report by Zorica Gajinov, Tatjana Ros, Milana Ivkov-Simic, Branislava Gajic, Sonja Prcic, Milan Matic: ?Tick-borne lymphadernopthy acquired in Serbia - report of two cases (Ubodom krpelja izazvana limfadenopatija - porikaz dve bolesnice zarazene u Srbiji). Vojnosanit Pregl 2018; 75(11): 1134-1137. (https://doi.org.10.2298/VSP161223035G), the author Sonja Prcic has an additional affiliation: University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia. Link to the corrected article <a href="http://dx.doi.org/10.2298/VSP150420083P">10.2298/VSP150420083P</a> Link to the corrected article <a href="http://dx.doi.org/10.2298/VSP161223035G">10.2298/VSP161223035G</a>

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Diseases of the cervix – non-obvious consequences of pelvic floor muscle failure

GYNECOLOGY ◽

10.26442/20795696.2021.2.200778 ◽

2021 ◽

Vol 23 (2) ◽

pp. 131-136

Author(s):

Mekan R. Orazov ◽

Liliia R. Toktar ◽

Gulirano A. Karimova ◽

Veronica Pak ◽

Ksenia Li

Keyword(s):

Risk Factors ◽

Cervical Cancer ◽

Pelvic Floor ◽

Pelvic Floor Muscle ◽

Pelvic Floor Dysfunction ◽

Intraepithelial Neoplasia ◽

The Past ◽

Cervical Diseases ◽

The Relationship ◽

Methods Of Treatment

The literature review presents domestic and foreign data on the relationship between pelvic floor dysfunction (PFD) and cervical diseases found in PubMed, Scopus, Embase and eLibrary systems over the past 10 years. This relationship is mainly realized due to alterations in vaginal biocenosis as the earliest clinical manifestation of PFD. The article describes PFD prevalence, classification, and risk factors for PFD. It also describes main methods of treatment and their side effects. The article provides data on changes in the vaginal biocenosis in PFD. Attention is paid to the risk for cervical intraepithelial neoplasia and cervical cancer in PFD.

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What Are the Effects of Remplissage on 6-Month Strength and Range of Motion After Arthroscopic Bankart Repair? A Multicenter Cohort Study

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120903283 ◽

2020 ◽

Vol 8 (2) ◽

pp. 232596712090328

Author(s):

Travis L. Frantz ◽

Joshua S. Everhart ◽

Gregory L. Cvetanovich ◽

Andrew Neviaser ◽

Grant L. Jones ◽

...

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Range Of Motion ◽

External Rotation ◽

Significant Loss ◽

Bankart Repair ◽

Return To Sports ◽

Level Of Evidence ◽

Multicenter Cohort Study ◽

Arthroscopic Bankart Repair

Background: Patients who have undergone shoulder instability surgery are often allowed to return to sports, work, and high-level activity based largely on a time-based criterion of 6 months postoperatively. However, some believe that advancing activity after surgery should be dependent on the return of strength and range of motion (ROM). Hypothesis: There will be a significant loss of strength or ROM at 6 months after arthroscopic Bankart repair with remplissage compared with Bankart repair alone. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 38 patients in a prospective multicenter study underwent arthroscopic Bankart repair with remplissage (33 males, 5 females; mean age, 27.0 ± 10.2 years; 82% with ≥2 dislocation events in the past year). Strength and ROM were assessed preoperatively and at 6 months after surgery. Results were compared with 104 matched patients who had undergone Bankart repair without remplissage, although all had radiographic evidence of a Hill-Sachs defect. Results: At 6 months, there were no patients in the remplissage group with anterior apprehension on physical examination. However, 26% had a ≥20° external rotation (ER) deficit with the elbow at the side, 42% had a ≥20° ER deficit with the elbow at 90° of abduction, and 5% had persistent weakness. Compared with matched patients who underwent only arthroscopic Bankart repair, the remplissage group had greater humeral bone loss and had a greater likelihood of a ≥20° ER deficit with the elbow at 90° of abduction ( P = .004). Risk factors for a ≥20° ER deficit with the elbow at 90° of abduction were preoperative stiffness in the same plane ( P = .02), while risk factors for a ≥20° ER deficit with the elbow at the side were increased number of inferior quadrant glenoid anchors ( P = .003), increased patient age ( P = .02), and preoperative side-to-side deficits in ER ( P = .04). The only risk factor for postoperative ER weakness was preoperative ER weakness ( P = .04), with no association with remplissage ( P = .26). Conclusion: Arthroscopic Bankart repair with remplissage did not result in significant strength deficits but increased the risk of ER stiffness in abduction compared with Bankart repair without remplissage at short-term follow-up.

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