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All Sports Medicine jobs for Tue Feb 7 2012

Sports Medicine jobs in "Metro St. Louis" - MO

Local hosptial system in St. Louis County is seeking a Physical Medicine and Rehab physician to join the staff at a 60 bed Rehab center that delivers the clinical expertise and national experience in

Sports Medicine jobs in "Centre" - SC

PMR Medical Director Needed Mary Black Memorial Hospital (209 Beds) in Spartanburg, S.C. is actively seeking a Medical Director for an 18 bed unit, with approval to expand to 24 beds. This position

Sports Medicine jobs in "Long Island" - NY

Sports Internal Medicine or Family Medicine -Long Island NY - Seeking a full time Internal Medicine team leader to join our exceptional team. Clinical responsibilities will

Sports Medicine jobs in "Vicksburg" - AL

Work with a large Orthopedic Group. Have the opportunity to work extensively with High School and College athletes. Hospital employed. Trinity Medical Center (formerly Montclair Baptist) is a 560-bed,

Sports Medicine jobs in Michigan

All Sports Medicine jobs in Michigan for Tue Feb 7 2012

Sports Medicine jobs in "Florence" - SC

Physical Medicine & Rehabilitation Position near Myrtle Beach, SC Carolinas Hospital System (400 Beds) in Florence, S.C. is actively seeking a PM & R physician to be employed by the hospital. This position

Sports Medicine jobs in "Central" - MD

Multispecialty group in Maryland that is interested in a non-interventional Physiatrist/ Sports, and, or a Primary Care Sports physician to join the group. The group consists of four Neurosurgeons,

Hamstring issues in sports: still a major clinical and research challenge

It will not be long until the Olympic 100 metre competitions. As certain as death, taxes and politicians' lies, more than one athlete's 4-year dream will vanish as his or her hamstring tears. This injury remains a great challenge in clinical practice and academic research. This issue of BJSM, with its striking cover, provides insights into the mechanisms that underpin hamstring injuries, guidance for clinical practice and suggestions for future research. Debate – when do hamstring tears occur? Hamstring tears occur during high-speed running but which phase of the gait cycle is the culprit? In Head to Head, Elizabeth S Chumanov and colleagues (see page 90) from the Universities of Wisconsin and Melbourne provide the conventional wisdom that hamstrings are frequently injured during eccentric overload at the end of the swing phase. Serial iconoclast John W Orchard (see page 88) argues that the early...

Hamstring strain injuries: are we heading in the right direction?

Acute hamstring injuries are the most prevalent muscle injuries reported in sport. Despite a thorough and concentrated effort to prevent and rehabilitate hamstring injuries, injury occurrence and re-injury rates have not improved over the last three decades. This failure is most likely due to the following: (1) a lack of studies with high level of evidence into the identification and prevention of hamstring injuries and (2) a reductionist approach of the current literature. The objectives of this article are to review and critique the current literature regarding isolated risk factors, and introduce a new concept for a more comprehensive scientific understanding of how multiple risk factors contribute to hamstring strain injury. The authors hope that this new conceptual model can serve as a foundation for future evidence-based research and aid in the development of new prevention methods to decrease the high incidence of this type of injury.

High-speed running type or stretching-type of hamstring injuries makes a difference to treatment and prognosis

Hamstring muscle strains are frequent in different sports and are the single most common injury in professional football.1 Several studies have indicated that hamstring strains are frequent in track and field as well, especially among sprinters and jumpers.2 The re-injury rate is high,1 3 which in most cases probably indicates inadequate rehabilitation programme and/or a premature return to sport.4 Hamstring strains are a heterogeneous group, especially in terms of the different types of injuries, injury location and size.1 5–11 A majority of the strains are located in the proximal part of the hamstring muscles/tendons and the anatomy is complex, characterised by overlapping tendons and structural interrelations between the hamstrings muscles.12 13 Different sports put different demands on the hamstrings,...

Hamstrings are most susceptible to injury during the early stance phase of sprinting

The first publications which considered the time of onset in the gait cycle for hamstring strains concluded that early stance was the highest risk period.12 The rationale proposed was that external joint moments were much higher in stance phases than swing (table 1) because of the presence of high hip and knee joint reaction forces secondary to the ground reaction force (GRF).3–6 Ralph Mann's original argument has been rejected by many subsequent authors, perhaps because of the dogma that muscles probably strain during eccentric contractions (table 1). This is a widely held belief despite experimental muscle strains being able to be produced during concentric (shortening) contractions.7 Table 1 shows that the high knee flexion moment (sum of angular forces) in late swing occurs because the hamstrings are highly active...

Hamstrings are most susceptible to injury during the late swing phase of sprinting

It is well recognised that the hamstrings are susceptible to acute strain injury during high-speed running. However, the particular phase of the sprinting gait cycle at which hamstring injury occurs remains a debated topic. Video footage and athlete anecdotes have contributed to the discussion, but do not provide sufficient temporal resolution to fully answer the question. In this paper, we briefly review: (A) biomechanical data obtained from healthy athletes; (B) case studies of injuries during biomechanical experiments; and (C) clinical outcomes from intervention studies. We believe all of these support the premise that late swing phase is the likely time when the biarticular hamstrings are most vulnerable to injury. Early sprinting (ie, high-speed running) biomechanics research showed that during initial stance phase, a sprinter experiences large hip extension and knee flexion moments, leading to the proposition that contact loads may contribute to hamstring injury risk.1 While hip...

The Hjelp24 NIMI Ringerike obesity clinic: an inpatient programme to address morbid obesity in adults

An inpatient programme for the treatment of morbidly obese patients is described. The programme targets physical training, nutrition and coping strategies for behaviour change management. The patients spend 14 weeks at the clinic followed by two 1-week visits 16 and 32 weeks postdischarge. Preliminary data from the 166 patients treated during 2006 are given.

Risk factors for injury in rugby union football in New Zealand: a cohort study

Objective To identify risk factors for injury in amateur club rugby. Design Prospective cohort design; with follow-up over the 2004 season. Setting Amateur club rugby in New Zealand. Participants Seven hundred and four male rugby players, aged 13 years and over. Assessment of risk factors The study investigated the independent effect on injury incidence of age, ethnicity, rugby experience, height, weight, body mass index, physical activity, cigarette smoking, previous injury, playing while injured, grade, position, training, time of season, warm-up, foul play, weather conditions, ground conditions and protective equipment. Generalised Poisson regression was used to estimate the effect of each factor after adjusting for all other factors. Main outcome measures Game injury, defined as ‘any event that resulted in an injury requiring medical attention or causing a player to miss at least one scheduled game or team practice’. Results A total of 704 players, representing 6263 player-games, contributed information on injury and exposure. Evidence was obtained of the effect on injury incidence of increasing age, Pacific Island versus Maori ethnicity (injury rate ratio (IRR)=1.48, 1.03–2.13), ≥40 h strenuous physical activity per week (IRR=1.54, 1.11–2.15), playing while injured (IRR=1.46, 1.20–1.79), very hard ground condition (IRR=1.50, 1.13–2.00), foul-play (IRR=1.87, 1.54–2.27) and use of headgear (IRR=1.23, 1.00–1.50). Conclusions Opportunities for injury prevention might include promoting injury-prevention measures more vigorously among players of Pacific Island ethnicity, ensuring injured players are fully rehabilitated before returning to play, reducing the effects of ground hardness through ground preparation and stricter enforcement of the laws relating to foul play.

Therapeutic interventions for acute hamstring injuries: a systematic review

Background Despite the high rate of hamstring injuries, there is no consensus on their management, with a large number of different interventions being used. Recently several new injection therapies have been introduced. Objective To systematically review the literature on the effectiveness of therapeutic interventions for acute hamstring injuries. Data sources The databases of PubMed, EMBASE, Web of Science, Cochrane Library, CINAHL and SPORTDiscus were searched in May 2011. Study eligibility criteria Prospective studies comparing the effect of an intervention with another intervention or a control group without intervention in subjects with acute hamstring injuries were included. Data analysis Two authors independently screened the search results and assessed risk of bias. Quality assessment of the included studies was performed using the Physiotherapy Evidence Database score. A best evidence synthesis was used to identify the level of evidence. Main results Six studies were included in this systematic review. There is limited evidence for a positive effect of stretching, agility and trunk stability exercises, intramuscular actovegin injections or slump stretching in the management of acute hamstring injuries. Limited evidence was found that there is no effect of non-steroidal anti-inflammatory drugs or manipulation of the sacroiliac joint. Conclusions There is a lack of high quality studies on the treatment of acute hamstring injuries. Only limited evidence was found to support the use of stretching, agility and trunk stability exercises, intramuscular actovegin injections or slump stretching. Further research is needed using an appropriate control group, randomisation and blinding.

External devices (including orthotics) to control excessive foot pronation

Cheung RT, Chung RC, Ng GY. Efficacies of different external controls for excessive foot pronation: a meta-analysis. Br J Sports Med 2011;45:743–51. Background Foot pronation during the early stance phase of gait allows the foot to accommodate to the irregularities of the ground surface and to attenuate ground reaction forces. Pronation involves multiple joint movements at the rearfoot and midfoot, and may influence more proximal segments leading to internal rotation of the lower limb and hip.1 Excessive foot pronation may promote non-physiological stresses on bone and musculo-tendinous structures of the lower limb and subsequent injury.2 Several overuse injuries have been attributed to excessive foot pronation. Injuries might occur at the foot level, such as plantar fasciitis, as well as at more proximal segments, such as medial tibial stress syndrome and patellofemoral pain. Foot orthoses, motion control footwear or therapeutic adhesive taping have...

Hamstring muscle injuries in professional football: the correlation of MRI findings with return to play

Background Hamstring injury is the single most common injury in professional football. MRI is commonly used to confirm the diagnosis and provide a prognosis of lay-off time. Objective To evaluate the use of MRI as a prognostic tool for lay-off after hamstring injuries in professional football players and to study the association between MRI findings and injury circumstances. Methods Prospective cohort study where 23 European professional teams, were followed between 2007 and 2011. Team medical staffs recorded individual player exposure and time-loss injuries. Radiological grading was performed using a modified Peetrons classification into four grades where grades 2 and 3 represent fibre disruption. Results In total, 516 hamstring injuries occurred and 58% of these were examined by MRI. Thirteen per cent were grade 0 injuries, 57% grade 1, 27% of grade 2 and 3% of grade 3. Grade 0 and 1 injuries accounted for 56% (2141/3830 days) of the total lay-off. The lay-off time differed between all four radiological grades of injury (8±3, 17±10, 22±11 and 73±60 days, p<0.0001). Eighty-three per cent of injuries affected the biceps femoris while 11% and 5% occurred to the semimembranosus and semitendinosus, respectively. Re-injuries (N=34/207) constituted 16% of injuries. All re-injuries occurred to the biceps femoris. Conclusion MRI can be helpful in verifying the diagnosis of a hamstring injury and to prognosticate lay-off time. Radiological grading is associated with lay-off times after injury. Seventy per cent of hamstring injuries seen in professional football are of radiological grade 0 or 1, meaning no signs of fibre disruption on MRI, but still cause the majority of absence days.

Altered muscle activation following hamstring injuries

Objective The purpose of this study was to compare the electromyographic (EMG) activity of gluteal and thigh muscles of sportspeople with a recent hamstring injury with uninjured controls during a weight-bearing task. Study design Cross-sectional. Setting University laboratory. Participants 16 participants with a hamstring injury (hamstring-injured group, HG) and 18 control participants (control group (CG)) participated in the study. Main outcome measure The EMG activity of gluteal, quadriceps and hamstring muscles was recorded during a movement from double- to single-leg movement using surface electrodes. Results The EMG onsets of biceps femoris and medial hamstrings were significantly earlier for the HG injured and the uninjured sides in preparation for single-leg standing when compared with the CG average. There were no differences in onsets for the gluteal and quadriceps muscles when comparing the injured or uninjured legs of the HG to the bilateral average of the CG. Conclusion The earlier onset of the injured and the uninjured hamstrings in preparation for single leg stance of the HG in comparison with the CG suggests an alteration in the motor control of these muscles. Altered neuromuscular control following a hamstring injury may be a factor to be considered in the rehabilitation of hamstring injuries.

Risk factors of recurrent hamstring injuries: a systematic review

Background Although recurrent hamstring injury is a frequent problem with a significant impact on athletes, data on factors determining the risk for a recurrent hamstring injury are scarce. Objective To systematically review the literature and provide an overview of risk factors for re-injury of acute hamstring muscle injuries. Study design Prospective studies on risk factors for re-injury following acute hamstring injuries were systematically reviewed. Medical databases and reference lists of the included articles were searched. Two reviewers independently selected potential studies and assessed methodological quality; one reviewer extracted the data. A best-evidence synthesis of all studied risk factors was performed. Results Of the 131 articles identified, five prospective follow-up studies fulfilled our inclusion criteria. These studies reported a recurrence incidence of 13.9–63.3% in the same playing season up to 2 years after initial injury. Limited evidence for three risk factors and one protective factor for recurrent hamstring injury was found; patients with a recurrent hamstring injury had an initial injury with a larger volume size as measured on MRI (47.03 vs 12.42 cm3), more often had a Grade 1 initial trauma (Grade 0: 0–30.4%; Grade 1: 60.9–100%; Grade 2: 8.7%) and more often had a previous ipsilateral anterior cruciate ligament (ACL) reconstruction (66.6% vs 17.1%) independent of graft selection. Athletes in a rehabilitation programme with agility/stabilisation exercises rather than strength/stretching exercises had a lower risk for re-injury (7.7% vs 70%). No significant relationship with re-injury was found for 11 related determinants. There was conflicting evidence that a larger cross-sectional area is a risk factor for recurrent hamstring injury. Conclusions There is limited evidence that athletes with a larger volume size of initial trauma, a Grade 1 hamstring injury and a previous ipsilateral ACL reconstruction are at increased risk for recurrent hamstring injury. Athletes seem to be at lower risk for re-injury when following agility/stabilisation exercises.

Clustered metabolic risk and leisure-time physical activity in adolescents: effect of dose?

Objectives The authors studied the association of leisure-time physical activity (LTPA) with clustered and individual metabolic risk factors in adolescents taking into account diet and pubertal status. The authors also studied whether screen time was associated with clustered risk. Methods Self-reported LTPA and screen time, lipids, lipoproteins, apolipoproteins, high-sensitivity C reactive protein, blood pressure, body mass index (BMI), pubertal status and diet were assessed in 13-year-old adolescents (n=542) participating in an atherosclerosis prevention study (Special Turku Coronary Risk Factor Intervention Project for Children). Activity groups were formed according to sex-specific LTPA index tertile cut-off points. BMI, high-density lipoprotein cholesterol (HDL-C), triglycerides and blood pressure comprised the cluster. Results An increase in LTPA was associated with a decreased risk for clustered metabolic risk in girls. When sedentary and highly active adolescents were compared, an increase in LTPA decreased clustering of risk factors in boys as well. Little extra benefit on clustered risk was obtained by increasing LTPA from 30 MET h/week (eg, 4–5 h/week bicycling or playing soccer) to 50 MET h/week (eg, 7–8 h/week bicycling or playing soccer). LTPA was beneficially associated with BMI, HDL-C, systolic blood pressure and HDL-C/total cholesterol in girls and HDL-C in boys. Diet and pubertal status were similar in all activity groups. In girls, screen time >2 h/day was associated with an increased risk for clustered risk, independent of LTPA. Conclusion Sedentary adolescents had an increased risk for clustered metabolic risk compared with physically more active peers. Only minor extra benefit was obtained when LTPA increased over 30 MET h/week. Focus in the prevention of clustered risk should especially be on avoiding sedentary lifestyle.

Injury in elite county-level hurling: a prospective study

Objective To determine the incidence, prevalence and nature of sports injuries in elite male hurling players. Design Prospective study of county-grade hurling teams. Incidence, prevalence and descriptions of injuries were collated. Setting Four county teams during the 2007 season; January to September inclusive. Participants A total of 127 male players were followed over 34 weeks. Data were collected on a median (IQR) of 31 (30–32) players per team per week. The mean age was 23.3±2.5 years. Results There were 204 injuries to 104 players (82%, 95% CI (74 to 88)). Injury incidence rate during match-play (102.5 (84.4 to 123.2)) was 19 times higher than for training (5.3 (4.2 to 6.5)) (RR=19.5 (14.8 to 25.6)). The mean weekly prevalence of injury was 13.9% (12.5 to 14.8). Most injuries were new (n=170, 83.3%, (77.6 to 87.8)) and acute (n=165, 80.9% (74.9 to 85.7)). Muscle strain (n=86) accounted for 42.2% (35.6 to 49) of the total. 71% of injuries were to the lower limb (n=143, (63.5 to 76.0)) with hamstring strain (n=33, 16.5% (11.8 to 21.8)) predominating. Fractures constituted 7.4% injuries (n=15, 95% CI (4.5 to 11.8)), 12 of which were to the upper limb. There were three (1.5% (0.5 to 4.2)) eye injuries and one concussion injury (0.5% (0.1 to 2.7)). Conclusions These results provide data on hurling injuries using definitions that reflect international consensus statements. Injury incidence from match-play in particular is high compared with other sports. These findings have relevance for clinicians and coaches.

A report of the medical team activity at the 2009 Special Olympics GB

Objective To quantify and categorise medical workload from the 2009 Special Olympics GB (SOL GB) which involved 2500 athletes with learning disabilities across 21 different sports supported by nearly 9000 family members, volunteers and staff over a 7-day period. Design and participants Prospective survey of all medical contacts that took place at the 2009 SOL GB with subsequent analysis of consultation rates, medical problems and medical activity. Results 581 medical consultations occurred during the 2009 SOL GB, with 95% of these for athletes. The majority of the athlete consultations were for musculoskeletal disorders, followed by skin wound care. Most athletes were judged fit to participate following their consultation. Conclusion A large multisport event for athletes with learning disabilities carries a significant medical workload that has not been studied previously, with different sports having different individual risks and demands. The vast majority of consultations are for systemically well athletes that can be managed locally without necessity for hospital admission. This study identifies the quantity and nature of medical consultations undertaken during this event in an attempt to inform planning for future events.

Sleep quality evaluation, chronotype, sleepiness and anxiety of Paralympic Brazilian athletes: Beijing 2008 Paralympic Games

Objective The objective of this study was to evaluate the sleep quality, sleepiness, chronotype and the anxiety level of Brazilian Paralympics athletes before the 2008 Beijing Paralympic Games. Design Cross-sectional study. Setting Exercise and Psychobiology Studies Center (CEPE) and Universidade Federal de São Paulo, an urban city in Brazil. Participants A total of 27 Paralympics athletes of both genders (16 men and 11 women) with an average age of 28±6 years who practised athletics (track and field events) were evaluated. Main outcome measures Sleep quality was evaluated using the Pittsburgh Scale and the Epworth Sleepiness Scale to evaluate sleepiness. Chronotype was determined by the Horne and Östberg questionnaire and anxiety through the State-Trait Anxiety Inventory. The evaluations were performed in Brazil 10 days before the competition. Results The study's results demonstrate that 83.3% of the athletes that presented excessive daytime sleepiness also had poor sleep quality. The authors noted that 71.4% were classified into the morning type and 72% of the athletes who presented a medium anxiety level also presented poor sleep quality. Athletes with poor sleep quality showed significantly lower sleep efficiency (p=0.0119) and greater sleep latency (p=0.0068) than athletes with good sleep quality. Athletes who presented excessive daytime sleepiness presented lower sleep efficiency compared to non-sleepy athletes (p=0.0241). Conclusions The authors conclude that the majority of athletes presented poor sleep quality before the competition. This information should be taken into consideration whenever possible when scheduling rest, training and competition times.

A-Z of nutritional supplements: dietary supplements, sports nutrition foods and ergogenic aids for health and performance--Part 29

Introductory remarks Part 29 includes two supplements which are traditionally paired (phlogenzym and wobenzym) and which have been popular in the Eastern Bloc countries though hardly, if at all, used by athletes in the UK and USA. Phosphatidylserine (a phospholipid present in cell membranes) and plant sterols (several of which have been dealt with in the previous issues of this series) are also discussed here. Phlogenzym and WobenzymM K Ranchordas The active ingredients found in phlogenzym are the hydrolase trypsin, the endopeptidase bromelain and the bioflavonoid rutin. Trypsin is a digestive enzyme produced by the pancreas and secreted into the small intestine, where it hydrolyses proteins. Bromelain is a proteolytic enzyme obtained from pineapples, and rutin is a bioflavonoid found in many plants, fruits and vegetables but the richest source is buckwheat. Similarly, wobenzym also contains trypsin, bromelain and rutin but also includes the proteolytic...