What sports medicine practitioners should know about imaging for femoro-patellar pathologies

Clinical imaging in patellofemoral disorders is fundamental for the understanding of the pathology, and to find the adequate treatment option. Anatomical risk factors such as trochlear dysplasia, patella alta, lateralized tibiale tubercle (measured by the tibiale tubercle trochlear groove distance), torsional or coronal lower limb alignment that are the origine of patellar maltracking or even patellar dislocation, can be assessed with high reliability on conventional radiographs combined with MR imaging. The conservative and surgical treatment will highly rely on these findings. The importance of clinical imaging in unspecific anterior knee pain is less clear. It is mostly performed to exclude structural injuries, however is rarely reliable to diagnose the painful structure. Critical appraisal of morphological risk factors is necessary especially in the treatment of anterior knee pain, since fortuitous pathological findings are frequent.

Physical examination of the patellofemoral joint

Patients with a patellofemoral pain are either in an acute state after a patellofemoral dislocation or are suffering from a chronic anterior knee pain (AKP), whereas AKP might be accompanied by patellar instability without dislocation. Whereas the acute state after a dislocation is mostly clear and its examination limited, the examination of a AKP is much more complex. A profound knowledge of the anatomy, the painful structures and patellofemoral biomechanics is essential in order to find the underlying pathology within the heterogeneous and diverse etiologies. Furthermore, a meticulous and precise examination is key to find the adequate treatment for AKP.

From sedentary and physical inactive behaviors to the Race Across America (RAAM): a case report

This case report presents the evolution of physiological and psychological health parameters of a former sedentary and physically inactive nursing student during an 18 months period (three academic semesters), during which she first took part to a one-semester institutional physical activity (PA) program offered by her University, before being selected to participate in relay to the Race Across America (RAAM) with a team of the University. The four months before the RAAM, she followed a cycling specific training program. After the RAAM, she was followed-up the next eight months. Results show that each step of the study had an important impact on health parameters of the subject and that sedentary and physical inactive behaviors are not irreversible. Institutional PA program, including training education in addition to concurrent strength and endurance training could lead to physiological and psychological health improvements. Moreover, in some individuals organising a challenge might contribute to improve motivation and long-term adherence to PA participation, while in others this could have the opposite effect. An individualised approach should be considered in future interventions aiming to improve PA promotion. Finally, in the specific context of a University of Health Sciences, this kind of initiative could positively influence the general population’s health, by educating students as actors in PA promotion.

Editorial 2/2019

Der Begriff «Sportkardiologie» ist manchmal umstritten und wirft Fragen auf. Ist es wirklich notwendig, medizinische Subspezialitäten, zumindest semantisch, mit der Sportmedizin zu vermischen? Das ist es, meiner Meinung nach, absolut. Selbstverständlich ist es in der heutigen Zeit der unzähligen Subspezialisierungen und Nischenbildungen in der Medizin nicht sinnvoll, eine an sich breite, weit über die verschiedensten Fachrichtungen übergreifende Disziplin wie die Sportmedizin künstlich zu kategorisieren. Aber dies geschieht auch nicht.

Clinical examination in back pain

Back pain has become one of the most frequent sports-related health problems. Up to 80% of the Swiss population experience at least one episode per year up to several times per week. It affects athletes of all age groups and all levels of activity equally. The causes of acute and chronic back pain are plentiful, but can be easily appreciated with a thorough and comprehensive history, concise clinical examination, and adequate imaging.

Physical activity in secondary stroke prevention

After having a stroke the main challenges are reducing the risk of recurrent stroke, improving impaired brain function, quality of life, independence in activities of daily living and reintegration into the community. [1] Lesion-induced impairment of brain function also has, besides its effects on e.g. motor, sensory, visual and speech function, an influence on e.g. cognition and mood, all of which are determinants of post-stroke physical activity. The evidence for a benefit of physical activity in secondary stroke prevention is increasing and treatment strategies aimed at factors which are limiting physical activity are more and more recognized.

Developmental relations between motivation types and physical activity in elementary school children (1)

Objectives: The objectives of this study were to observe the developmental trajectories of motivation types among young children from 8 to 12 years using a more comprehensive scale of physical education motivation. We also tested the relations between these trajectories and objective physical activity during this period. Design: Students in grades 5–7 (n=1202; 51.2% boys) were recruited from 17 elementary schools. Three cohorts completed the motivation questionnaire four times and objective physical activity was measured up to four times over a two years school period. Method: Measurement invariance of the scale was tested across cohorts and occasions. Multiple group multiple cohort growth models were estimated to determine motivation types trajectories. Regression models were then built to predict children’s slope of MVPA during this period. Results: We provided strong measurement invariance to a new and more comprehensive scale of PE motivation. Latent growth curve modeling indicated trajectories that decrease on average for all forms of motivations at this early age. Results also revealed some relations between motivation’s scores and objective physical activity trajectories, especially with autonomous motivation. Conclusions: Our study revealed the earliest decline of motivation towards physical education to have ever been highlighted in elementary school children. Relations between trajectory of intrinsic stimulation and PA behavior permitted us to highlight the possible role of autonomous motivation in minimizing the decline of children’s PA behavior during PE lesson.

The effects of long-term vigorous endurance exercise on the coronary arteries

Moderate endurance training is known to improve cardiovascular risk factors, and prolongs life expectancy. On the other hand, there has been some discussion whether “too much” exercise might have a contrarious effect by accelerating coronary atherosclerosis. The goal of this review was to evaluate the current literature on the effects of long-term vigorous endurance training on the coronary vasculature. In summary, data point to an increased calcium score, and a higher burden of atherosclerotic plaque in male athletes compared to sedentary controls. However, the plaques found in athletes were more prone to be calcified. The pathogenesis and clinical relevance of this athlete coronary artery disease phenotype remains incompletely understood and represents an area of important future work.

The effects of long-term vigorous endurance exercise on the coronary arteries

Moderate endurance training is known to improve cardiovascular risk factors, and prolongs life expectancy. On the other hand, there has been some discussion whether “too much” exercise might have a contrarious effect by accelerating coronary atherosclerosis. The goal of this review was to evaluate the current literature on the effects of long-term vigorous endurance training on the coronary vasculature. In summary, data point to an increased calcium score, and a higher burden of atherosclerotic plaque in male athletes compared to sedentary controls. However, the plaques found in athletes were more prone to be calcified. The pathogenesis and clinical relevance of this athlete coronary artery disease phenotype remains incompletely understood and represents an area of important future work.

The International (Seattle) Criteria

Through continuous improvement of diagnostic accuracy of ECG criteria for athletes sensitivity as well as specificity have grown so much that foregoing this screening tool is not feasible anymore. The most updated guidelines, the so-called “International (Seattle) Criteria” globally exhibit the most important reference publication, currently. The criteria were created with the purpose that particularly “non-cardiologists” should be able to use them before clearly pathological findings lead to further follow-up examinations at a specialist. On the other hand, physiologic ECG findings should not prompt expensive further evaluations, as it used to happen quite frequently.