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.

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.

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 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.

The value of performance diagnostcs in orienteering

Endurance testing has a long tradition in the Swiss Orienteering Federation. It has become an important tool in monitoring effectiveness of training and in assessing endurance performance. The vast majority of athletes and coaches indicate that sport science is meaningful and endurance testing is of high informative value for them. Endurance testing is regularly done in the lab, but also field tests are carried out each year. They particularly empower and support athletes in their specific preparation for important competitions. Also in the future new competition formats can be prepared and training may be monitored by a new format of specific tests. In various endurance sports physiological demands may be similar. Therefore an improved exchange of knowledge, skills, and other insights between different sport federations about endurance testing is mostly desirable. In Switzerland this knowledge transfer should be further enhanced.

Sex differences in thigh muscles characteristics: a systematic review

Objective: To determine differences between male and female subjects in the thigh muscles characteristics, separated into architectural (pennation, thickness, and/or fascicle length), mechanical (mass, strength, power, and/or stiffness), neuromuscular (activity) and fatigue aspects, in order to better understand the sex-related differences in the risk of muscle injuries. Methods: A systematic literature search on Pubmed was performed with different keywords: skeletal muscle AND sex characteristics AND muscle contraction, with the following limits: humans and adults (19–44 years old). Studies dealing with hamstring and quadriceps muscles, in physiological condition, and comparison between male and female healthy adult subjects were included. Studies dealing with other skeletal muscles, injuries or physiopathology situation were excluded. Thigh muscular architectural, mechanical, neuromuscular and fatigue characteristics have been analysed to determine differences between male and female subjects. Results: Seventeen studies were included, reporting significant sex-related differences for thigh muscles architecture and mechanical characteristics and muscle fatigue, and especially quadriceps, while for thigh muscles neuromuscular characteristics the results were not consensual, and few information was available regarding hamstring muscles. Conclusions: Sex-related differences in thigh muscles characteristics, and especially quadriceps, have been reported for mechanical characteristics and muscle fatigue, while for neuromuscular characteristics sex-related differences were found to be moderate. Although several macroscopic muscle characteristics have been reported to be different between male and female healthy adult subjects, it is difficult to conclude on its exact relationship with higher muscle injury rates reported in male athletes during international athletics championships.

Recommendations for cardiovascular evaluation in athletes – a viewpoint

Traditionally, cardiovascular screening has been recommended mostly for competitive athletes younger than 35 years. The perception that only young competitive athletes at top level are at increased risk, has changed in the last years. Theoretically, we advocate a voluntary cardiovascular screening for all athletes who exercise vigorously, independent of their competitive status, and age. Although, this should be based on an individual estimation of the athlete’s risk. Physical examination, medical history and an ECG should be the baseline investigations for all athletes. Ideally, an echocardiography should be performed once at the beginning of the athletic career to rule out congenital coronary and valvular abnormalities-although addition of an echocardiography has not yet been established routinely due to lacking evidence. We advocate to repeat the ECG every 1–2 years in athletes < 30–35 years. For older athletes, we recommend to assess their individual CV risk profile (particularly with inclusion of lipid profile) and their previous training history. Depending on the assessment, further investigations should be implemented such as an exercise stress test and/or Coronary CT scan.