Thesis (M.S.)--University of Michigan, 1984.

Thesis (M.S.)--University of Michigan, 1984.

Syftet med denna systematiska litteraturöversikt var att jämföra radiell mot fokuserad stötvågsbehandling samt att undersöka effekten utav stötvågsbehandling för att reducera smärta och återfå fysisk funktion vid Akillestendinopati. Litteraturöversikten har följt checklistan PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis). Inklusionskriterier till litteraturöversikten är utformade efter PICO (population, intervention, control, outcome) och databaser som använts är PubMed, SPORTDiscus, CINAHL, Scopus och Web of Science. Data har analyserats narrativt och tillförlitligheten hos utfallen har bedömts med GRADE.Sju studier inkluderades till litteraturöversikten varav fyra studier som utfört radiell och tre studier som utfört fokuserad stötvågsbehandling som intervention. En signifikant skillnad för smärtreduktion sågs i två av studierna för båda behandlingarna. När radiell stötvågsbehandling användes hade interventionsgrupperna en högre smärtreduktion än kontrollgrupperna och när fokuserad stötvågsbehandling användes hade kontrollgrupperna en högre smärtreduktion än interventionsgrupperna. En signifikant skillnad för återställande utav den fysiska funktionen i ankeln sågs i tre studier för radiell stötvågsbehandling och två studier för fokuserad stötvågsbehandling. Där radiell stötvågsbehandling användes hade interventionsgrupperna en större ökad fysisk funktion än kontrollgrupperna och där fokuserad stötvågsbehandling användes hade kontrollgrupperna en större ökad fysisk funktion än interventionsgrupperna.Radiell stötvågsbehandling verkar kunna fungera för att reducera smärta och öka fysisk funktion vid Akillestendinopati. Tillförlitligheten för utfallen vid fokuserad stötvågsbehandling är för låg för att kunna dra någon slutsats om vilken typ av stötvågsbehandling som är mest effektiv. Ifall det varit känt vilken typ av stötvågsbehandling som ger bäst resultat hade det varit en bra vägledning för vårdpersonal som arbetar med stötvågsbehandling. / The purpose of this review was to compare radial versus focused shock wave therapy and to review shock wave therapies usage to reduce pain and increase physical function for the Achilles tendinopathy.The review has followed PRISMA’s checklist while using PubMed, SPORTDiscus, CINAHL, Scopus and Web of Science databases. Data has been analyzed narratively and the evidence of the outcomes has been assessed.A significant difference in pain reduction was seen within two studies for both interventions. Where radial shock wave therapy was administered the intervention groups had a higher pain reduction than the control group. Where focused shock wave therapy was administered the control group had a higher pain reduction than the intervention group. A significant difference in the restoration of physical function was seen within three studies for radial shock wave therapy and two studies for focused shock wave therapy. Where radial shock wave therapy was administered the intervention groups had a greater increased physical function than the control groups and where focused shock wave treatment was administered the control groups had a greater increased physical function than the intervention groups.Radial shock wave therapy seems to be effective to reduce pain and increase physical function in the Achilles tendinopathy. The evidence of the results for focused shock wave therapy is too low to draw any conclusion, or allow us to compare the two methods. Had the studies allowed for a direct comparison between the two methods, this could have led to a guide for healthcare professionals.

Bakgrund: Främre korsbandsskador är en av de vanligaste idrottsskadorna, speciellt bland idrottande kvinnor. Uppkomstmekanismerna bakom främre korsbandsskador är många och skadan inträffar oftast i samband med snabba riktningsförändringar, inbromsningar eller landningar. Efter en främre korsbandsskada ökar risken för återfall samt utveckling av artros. Att förebygga denna skada är av vikt då det ofta innebär negativa konsekvenser för individen och dess idrottskarriär.  Syfte: Att genom en systematisk litteraturstudie granska studier som använt neuromuskulär träning (NMT) som preventionsåtgärd för främre korsbandsskador hos idrottande kvinnor samt utvärdera ifall någon kombination av NMT visats ha bättre effekt än annan.  Metod: Litteratursökningen genomfördes i databaserna Pubmed samt Web of Science. Randomiserade kontrollerade studier (RCT) granskades enskilt samt gemensamt av författarna enligt PEDro-skalan. Tillförlitligheten av resultatet bedömdes enskilt med hjälp av GRADEstud innan gemensam bedömning genomfördes.  Resultat: Litteratursökningen resulterade i 524 träffar, dessa granskades i relation till PICO vilket resulterade i åtta inkluderade artiklar. Samtliga artiklar bedömdes ha hög kvalitet. Gällande incidensen av främre korsbandsskador presenterade endast två studier en signifikant mellangruppsskillnad. Samtliga studier redovisade en generellt minskad incidens av främre korsbandsskador, förutom en studie. Tillförlitligheten av det sammanvägda resultatet bedömdes som begränsad (++) på grund av bristande samstämmighet samt precision. Konklusion: Denna litteraturstudie bidrar inte med ett vetenskapligt underlag som tyder på att NMT bör rekommenderas för kvinnliga idrottare för att förebygga främre korsbandsskador. Ingen slutsats kan dras gällande vilken kombination av neuromuskulära övningar som kan anses mer effektiva än andra. / Background: Anterior cruciate ligament (ACL) injury is one of the most common knee injuries among female athletes. There are multiple risk factors and the injury normally occurs with quick change of direction, decelerations or landings. The risk of reinjury and developing arthritis increases considerably after a first injury. Preventing this injury is important considering the negative effects an injured athlete and their sports career will experience.  Objective: Through a systematic review, determine the effectiveness of neuromuscular training (NMT) in preventing anterior cruciate ligament injuries among athletic females. Also, explore if any specific combination of NMT exercises does have a superior outcome. Method: A literature search was made in the databases Pubmed and Web of Science. Randomised controlled studies (RCT) were reviewed separately and then jointly by the authors according to PEDro, and for assessment of reliability, with GRADEstud.  Results: The literature search resulted in 524 articles and they all were assessed by PICO. A final number of eight articles were included and were assessed to be of good quality and the level of evidence was considered limited (++). Solely two studies presented a significant result. All studies except one, presented a reduced incidence of ACL injury.  Conclusion: This systematic review does not provide a result which implies that NMT is an effective preventative measure for the incidence of ACL injuries among female athletes. No conclusion could be drawn if any combination of NMT exercises was more effective.

Bakgrund: I Sverige uppkommer varje år runt 100 000 idrottsskador som kräver vård. Idrottsskador förekommer i stor utsträckning inom truppgymnastik, den största disciplinen inom svensk gymnastik. Fysioterapeutens roll i rehabilitering av idrottsskador syftar till att stödja läkningsprocessen men också till att försöka minimera de negativa följderna som en eventuell skadefrånvaro kan innebära, ur ett såväl fysiologiskt som psykosocialt perspektiv. Det finns i studieförfattarnas vetskap inga studier om truppgymnasters upplevelse av rehabiliteringsprocessen trots att detta är en idrott med helt unika krav. Syfte: Syftet med studien var att undersöka truppgymnasters upplevelser av rehabiliteringsprocessen för återgång till idrott efter skada. Metod: Kvalitativ deskriptiv design med semistrukturerade intervjuer. Sex tidigare skadade truppgymnaster som var aktiva på SM-nivå inkluderades i studien. Kvalitativ innehållsanalys med induktiv ansats användes som analysmetod. Resultat: Analysen resulterade i arton underkategorier indelade i fem kategorier: Tankar och känslor under rehabiliteringstiden, Utmanande faktorer vid genomförandet av rehabiliteringen, Omständigheter som påverkade genomförandet av rehabiliteringen positivt, Fysioterapeutens förmågor och insatser och Stödet från den sociala omgivningen. Slutsats: Resultatet i den här studien pekar på att såväl fysiska, psykologiska som sociala faktorer kan påverka upplevelsen av rehabiliteringsprocessen hos skadade truppgymnaster. / Background: Approximately 100 000 sport injuries that require medical care, occur in Sweden every year. Sport injuries are common in teamgym, the gymnastics discipline with the largest number of members in Sweden. In rehabilitation the physiotherapist´s role is to support the healing process and minimize negative consequences following injury absence, considering both physical and psychosocial aspects. According to the authors knowledge no study exists that examine teamgymnasts’ experience of the rehabilitation process, even though the sport has unique demands.  Aim: To explore teamgymnasts’ experience of the rehabilitation process in returning to sport after injury. Method: Qualitative descriptive design. Semistructured interviews were conducted. Six previously injured teamgymnasts competing at national level were included. Qualitative content analysis with inductive approach was used to analyze the data. Results: The analysis resulted in 18 subcategories devided into five categories: Cognitions and emotions during rehabilitation, Challenging factors during the performance of rehabilitation, Circumstances that positively influenced the performance of rehabilitation, Abilities and contributions of the physiotherapist, Support from the social environment.  Conclusion: The results of this study indicate that both physical and psychosocial factors may influence the experience of the rehabilitation process among injured teamgymnasts.

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, Durban, South Africa, 2015. / Background: The 19th Iteration of the World Transplant Games was hosted in Durban, South Africa in 2013. This biennial, international, multisport event showcases the talents of transplant athletes, whilst demonstrating the benefits of organ transplantation. To date, limited research is available on transplant athletes. This study aimed to determine the injury profile of transplant athletes who presented to the Durban University of Technology Chiropractic Treatment Facilities during the 2013 World Transplant Games. Methods: This retrospective, descriptive cohort study analysed the data collected at the Chiropractic Treatment Facilities at the 2013 World Transplant Games. For inclusion, each WTG Form required completion, reflecting all the elements of that participant’s chiropractic consultation. The data recorded on the World Transplant Games Form generated the data analysed in this study. The data described the frequency (frequency tables), nature and management of injuries treated at the Chiropractic Treatment Facilities during the 2013 World Transplant Games. In order to determine relationships cross tabulations were used. Results: There were 964 athletes registered for the 2013 World Transplant Games, of which 153 presented to the Chiropractic Treatment Facilities (an utilisation rate of 15.9%). A total of 259 consultations by the athletes (n = 223; 86.1%) and non-athletes (n = 36; 13.9%) were recorded. The majority of the treated athletes were White (n = 91; 59.5%), males (n = 109; 71.2%), in which kidney transplant recipients accounted for 37.3% (n = 58) of the total number. Track athletics had the highest injury rate (34.5% of all reported injuries). Athletes sustained injuries to 14 different anatomical regions, with the thigh (26.9%) and shin/calf (20.5%) being the most frequently injured. The majority of injuries (n = 164; 66.4%) were “overuse” injuries, with myofasciitis, muscle strains and thoracic facet syndrome being the most frequently obtained diagnoses (25.5%, 16.6% and 6.5% respectively). The most frequently employed treatment modalities were those of massage (32.1%), ischemic compression (16.3%) and manipulation (13.4%). It was noted that the most injuries sustained (88.3%) were not severe enough to result in an inability to continue current or future participation. Conclusions and Recommendations: Transplant recipient athletes injuries concur with the literature on non-transplant athletes, indicating that solid organ transplantation does not predispose the athlete to different or more serious injuries which would require different management protocols by health care personnel treating these athletes. Further investigation into individual sports is encouraged, to develop accurate, effective injury management and preventative strategies to more appropriately diagnose and treat injuries incurred by transplant athletes and then to prevent them from recurring. An informed healthcare approach towards event organising and athlete treatment will improve preventative strategies and athlete management.

O objetivo deste estudo foi verificar a incidência das principais lesões esportivas comuns em atletas jovens de 16 a 19 anos de idade, que participaram de treinamento regular ou federado no ano de 2002, nas modalidades esportivas basquetebol, futsal e voleibol. Foram identificados, também, alguns aspectos de treinamento e estrutura médica. Para isso, aplicou-se um questionário para 323 atletas e entrevistas com 26 técnicos e 8 médicos, de 20 clubes esportivos de São Paulo. Os resultados do estudo indicaram um total de 343 lesões ou 1,7 lesão/atleta/ano. No basquetebol, as lesões mais comuns foram as entorses; a região corporal mais acometida de lesão foi a do tornozelo, seguida do joelho, coluna e dedos da mão; os armadores foram os mais afetados. No futsal, a lesão mais comum foi a entorse de tornozelo e houve ocorrência de lesão nas regiões da coxa e joelho; pivôs foram os mais afetados. No voleibol, a lesão mais comum foi a tendinite, principalmente na região do joelho, seguida das entorses e lesões musculares; a posição de meio de rede foi a mais afetada. As lesões ocorreram com uma maior freqüência em situações de treinamento. Dos 20 clubes avaliados, apenas oito possuem um médico especializado plantonista. Tal fato indica que alguns fatores de risco, como medidas preventivas em situações de treinamento, exame de pré-participação esportiva e acompanhamento médico especializado, não são devidamente organizados para os atletas jovens nos clubes avaliados / The objective of this study was to evaluate the incidence of the main sports injuries commonly found in young athletes in the 16-19 year age group who participated in regular or federate trainings during 2002 in sports modalities such as basketball, futsal and volleyball. Also identified were some aspects of training and clinical structure. To obtain these data, a questionnaire was applied to 323 athletes and surveys were performed among 26 coaches and 8 physicians from 20 sports clubs located in Sao Paulo (Brazil). The results of the study showed a total of 343 injuries or 1.7 injury/athlete/year. In basketball, the most common injuries were sprains, the most affected body regions in terms of injury being the ankles, followed by knees, backbones and fingers; point guards being the most affected athletes. In futsal, the most common injuries were ankle sprains, the thigh and knee regions being also affected by injuries; pivots were the most affected among the team. In volleyball, the most common injury was tendonitis, mainly in the knee region, followed by sprains and muscle injuries; the most affected position being the forward-center\'s. The frequency of injuries was higher during trainings. Only eight of the 20 sports clubs evaluated actually hire specialized emergency physicians. This fact indicates that some risk factors such as preventive measures during trainings, sports preparation evaluation, and specialized clinical monitoring are not appropriately organized for young athletes in the assessed sports clubs

O objetivo desta pesquisa foi caracterizar o último episódio de entorse de tornozelo em atletas de voleibol de alto rendimento. Participaram inicialmente deste estudo, entre os meses janeiro de 2003 e março de 2004, 114 atletas, do sexo masculino, atuantes na categoria adulta de 9 equipes, todas participantes da Divisão Especial ou Primeira Divisão do Campeonato Paulista de Voleibol. Dos 114 atletas inicialmente analisados, 21 relataram não ter sofrido nenhuma lesão nos tornozelos, portanto, seguindo os critérios de exclusão, foram analisados 93 episódios de última entorse de tornozelo de 93 atletas. Os mesmos foram entrevistados de maneira oral e individual pelo pesquisador executante, seguindo a seqüência do questionário pré-estabelecido. Foi encontrada diferença significante na correlação entre a fase da competição e a causa da entorse bem como na relação entre a posição de atuação do atleta e o fundamento realizado no momento da lesão. Apesar dos demais itens propostos nos objetivos não terem apresentado diferença significante, os resultados indicaram que 74,2% das entorses ocorreram por mecanismo de inversão, sendo, que a maioria das recidivas também ocorreram durante este movimento. A posição oposto foi a mais acometida e o fundamento bloqueio foi o que mais ocasionou entorses. Quanto as possíveis causas do trauma, a maioria aconteceu com a participação de um segundo atleta e a fase em que mais ocorreu lesão foi o treinamento. Referente à prevenção, após o último episódio de lesão, houve um aumento no uso de proteção do tipo tornozeleira, atingindo 68,9% do total de atletas. / The purpose of this research is to characterize the last ankle sprain episode occurred with volleyball high performance athletes. From January 2003 to March 2004, 114 male athletes from 9 adult category teams of the Special and First Division of São Paulo State Volleyball Championship participated of this study. From the 114 athletes analyzed, 21 have reported no ankle sprains, thus, the last 93 episodes of ankle sprain from 93 athletes were analysed following exclusion criteria. They have been individually interviewed by the researcher, following a pre-established questionnaire. A meaningful difference was found in the correlation between the competition phase and the ankle sprain cause, as well as, in the relation between the athlete?s acting position and the movement made at the injury moment. Despite the other items proposed in the objectives have not presented any significant difference, the results indicated that 74,2% of the injuries occurred due the inversion mechanism and most of the repeated ankle sprains have also occurred during this movement. The opposite position was the most affected and the blocking movement was the one that caused the most injuries. As regards the possible causes of the injuries, most of the sprains occurred when a second athlete was involved and most of them during the training period. Concerning prevention, the use of the safety protection, such as orthesis, has increased reaching 68,9% of the total athletes.

Um grande problema em atletas com fraturas por estresse é o tempo necessário para sua recuperação completa. Nenhum método de imagem tem se mostrado eficaz em apresentar dados objetivos com relação ao tempo de recuperação dos atletas em casos de fraturas por estresse. Dois grupos foram incluídos no nosso estudo: grupo I consistente de 21 atletas com suspeita clínica de fratura de estresse (13 masculinos, idade média de 31,62 &#61617; 9,39) e grupo II consistente de 10 atletas sem sinais clínicos de fraturas de estresse (grupo controle) (seis masculinos, idade média 29,80 &#61617; 3,94). Todos os indivíduos do grupo I tiveram seguimento mínimo de seis meses e foram submetidos ao mesmo protocolo de reabilitação. Todos os atletas foram submetidos à ressonância magnética e cintilografia óssea com intervalo, entre os exames, inferior a sete dias. Um índice quantitativo foi obtido utilizando a técnica de ROI, comparando o lado afetado com o contralateral não afetado. Esta análise quantitativa foi comparada à análise semiquantitativa da ressonância magnética. Ambos os métodos mostraram 100% de sensibilidade; entretanto, sinais inespecíficos foram encontrados em 40% dos atletas assintomáticos na ressonância magnética e na cintilografia óssea. A média de captação de MDP-Tc99m na perna sintomática foi estatisticamente diferente no grupo I (2,54 &#61617; 0,77) em comparação ao grupo II (1,05 &#61617; 0,11) (p < 0,001). Um índice de 1,30 foi considerado ponto crítico onde 99% dos atletas apresentarão diagnóstico de fratura de estresse. Uma equação de regressão foi obtida, associando o tempo de recuperação necessário para o atleta e o índice calculado. Na presente amostragem de pacientes, o índice obtido por meio da cintilografia óssea nos permite obter um método objetivo para estimar o apropriado tempo de recuperação após um diagnóstico de fratura por estresse da tíbia. Entretanto, mais estudos prospectivos, com maior amostragem, são necessários para comprovar nosso achado. / A major problem in athletes with stress fractures is the length of resting time required for complete recovery. No imaging tool has been capable of offering objective data regarding the appropriate recovery time in athletes with stress fractures. Two groups of athletes were included in our study: Group I consisted of 21 athletes with clinical suspicion of tibial stress fracture (13 male; mean age + SD: 31.62 + 9.39) and, Group II consisted of 10 athletes without clinical signs of stress fracture (control group) (6 male; mean age + SD: 29.80 + 3.94). All individuals of Group I had minimum 6 months of follow up and the symptoms were recorded according to the same rehabilitation protocol. All athletes underwent to bone scintigraphy and MRI, with a mean interval between them no longer than 7 days. A quantitative index was obtained using ROI technique, comparing the affected to the non affected leg. This quantitative analysis was compared to a semi quantitative evaluation of MRI findings). Both methods showed 100% sensitivity; however, non specific signs were found in 40% of asymptomatic athletes either by MRI or by bone scan. The mean uptake of MDP-Tc99m in affected limbs were statistically different in Group I (2.54 + 0.77) in comparison to Group II (1.05 + 0.11) (p<0.001). An index of 1.30 was considered a critical point where 99% of athletes will present the clinical diagnosis of tibial stress fracture. A regression equation was obtained associating the time of recovery required for each athlete with the uptake index calculated. In the present sample of athletes the uptake index obtained through bone scintigraphy allowed us to obtain an objective method to estimate the appropriate recovering time after the tibial stress fracture diagnosis. However, more prospective studies using larger samples are needed to prove that assumption.

The aim of the study was to examine perceived challenges and coping strategies of Swedish elite show jumpers from the holistic perspective. A mixed-methodology was used with a dominant qualitative design and a supportive quantitative design. Semi-structured interviews based on the holistic athletic career model and two surveys developed from the qualitative results were used to collect the data. The participants of the study were 5 Swedish elite show jumpers between the age of 24-29 (M=26.4, SD=2.06). The qualitative findings resulted in two category profiles of perceived challenges and use of coping strategies. The quantitative findings resulted in two individual profile for each participant. The findings identified five higher order themes of perceived challenges (psychological, financial, psycho-social, athletic and vocational) and three higher order themes of coping strategies (social support, problemfocused coping and emotion-focused coping). The individual profiles showed both similar patterns and individual nuances between the participants. Major challenges for the equestrians were financial, injuries and dealing with identity foreclosure. This study represents an effort to highlight the challenges met and coping strategies used by equestrians on elite level, to prevent ineffective coping and negative consequences such as a premature dropout. / Syftet med studien var att undersöka svenska elithoppryttares upplevda utmaningar och coping strategier utifrån ett holistiskt perspektiv. En mixad metod användes med en dominant kvalitativ design och en stödjande kvantitativ design. Semistrukturerade intervjuer baserade på den holistiska karriärutvecklingsmodellen samt två enkäter utvecklade ur det kvalitativa resultatet användes för att samla in data. Deltagarna i studien utgjordes av 5 svenska elithoppryttare i åldrarna 24-29 (M=26.4, SD=2.06). Det kvalitativa resultatet gav två kategoriprofiler av upplevda utmaningar och användandet av coping strategier. Det kvantitativa resultatet gav två individuella profiler för varje deltagare. Resultatet identifierade fem överordnade teman av upplevda utmaningar (psykologiska, finansiella, psyko-sociala, idrottsliga och yrkesmässiga) och tre överordnade teman av coping strategier (socialt stöd, problemfokuserad coping och emotionsfokuserad coping). De individuella profilerna visade både liknande mönster samt individuella nyanser mellan deltagarna. De största utmaningarna för ryttarna var finansiella, skador och att hantera en sluten idrottsidentitet. Denna studie representerar ett försök till att belysa vilka utmaningar och coping strategier som används av ryttare på elitnivå, för att undvika ineffektiv coping och negativa konsekvenser så som ofrivilligt avslut av idrottskarriär.