In part one of this series, Chris Mallac explained the anatomy and complex biomechanics of the VMO and its role in relation to the patellofemoral joint. In part 2, he argues that regardless of cause and effect of the VMO on patellofemoral pain, VMO dysfunction in the presence of pain is very real, and thus exercises to rehabilitate the function of this muscle are necessary... MORE
Skating Injuries: Growing risks for synchronised skaters
Acute injuries among synchronised skaters are increasing in both incidence and severity, according to new research from Croatia. The researchers believe that these more significant injuries, including concussion and fractures, may be partly attributable to the growing physical and technical demands associated with this increasingly competitive sport (‘Injuries in synchronised skating’, International Journal of Sports Medicine DOI 10.1055/s-2005-865816).
Before and during the World Synchronised Skating Championship 2004, a questionnaire survey about frequency of injuries was given to 23 participating teams and completed by 514 women and 14 men (100% response).
The key findings were:
- 218 (42.4%) female and six (42.9%) male skaters had suffered from acute injuries during their synchronised skating careers. With more than one injury per person, the total number of injuries was 398 in women and 14 in men;
- In female skaters, 19.8% of acute injuries were to the head (a quarter being concussion), 7.1% to the trunk, 33.2% to upper extremities and 39.9% to lower extremities – the last two categories including significant numbers of fractures;
- In male skaters, 14.3% were head injuries, 28.6% upper and 57.1% lower extremity injuries, with no reports of trunk injuries;
- The number of injuries in all categories had increased during the last four skating seasons;
- Of the total number of 412 injuries reported, 82% occurred during on-ice practice and the remainder during off-ice training.
Previous reports on the incidence of head injuries in synchronised skating have been much lower: 4.6% in 1996 and 1.2% in 1998. And of the total of 81 head injuries reported in this current study, only 12 occurred more than four years ago, suggesting an increase in incidence.
In synchronised skating up to 20 skaters, mostly female, skate together in unison, performing different formations on the ice. The researchers explain that, to make the sport more attractive and competitive, more and more difficult elements, including spins, jumps, twizzles and turns, have been added into programmes. ‘Coaches and team managers are trying to maximise the difficulty of these elements in the pursuit of success and podium finishes at leading international competitions and world championships.
‘Although it is tempting to suggest,’ they write, ‘that the increase [in acute injuries] coincides with increased demands for more technically difficult elements performed by the synchronised skaters, this conclusion should be treated with caution. Nevertheless, we strongly recommend that the medical community work closely with the coaches, skaters and technical committees in future development of synchronised skating.’
Rock climbing and Dupuytren’s: is there a link?
Dupuytren’s disease is a potentially disabling condition affecting the palmar fascia (palm) of the hand and the fingers. Rock climbing is an activity that puts considerable pressure on the fascia and other soft tissues of the hand. Could there be a connection between the two (‘Can rock climbing lead to Dupuytren’s disease?’, Br J Sports Med 2005;39:639-644)?
That is the question a group of researchers from Cardiff set out to answer with a questionnaire-based study of all 1,100 members of the Climbers’ Club of Great Britain – an elite group of dedicated and experienced climbers who climb regularly and to a high standard. The detailed questionnaire sought information about known risk factors for Dupuytren’s disease (including smoking, alcohol consumption and epilepsy), climbing and injury history, and any known or potential signs of the condition, which tends to pull the fingers down towards the palm as the connective tissue of the palmar fascia thickens and shortens.
Analysis of 498 completed questionnaires from male climbers (female responses were excluded because of their small number) showed that just under 1 in 5 had developed Dupuytren’s disease – a higher prevalence than has previously been reported for most areas of the UK.
Those with the disease revealed a significantly higher lifetime intensity of climbing activity through their answers to the questionnaire than those without. Climbers with Dupuytren’s had developed it at an earlier age than normally occurs in the general population.
The study showed that the disease tends to be more severe in climbers than in the general population, with a greater proportion of finger ‘contractures’. However, specific hand injury appeared to be unrelated to the development of the disease.
The researchers suggest that: ‘the reason for the increased prevalence, earlier age of onset, and greater severity of Dupuytren’s disease in climbers is the repetitive minor trauma that occurs in the palmar fascia while climbing. This study further strengthens the hypothesis that repetitive trauma to the palmar fascia predisposes to the development of Dupuytren’s disease in men.’
Hypermobile netball players suffer more injuries
Young netball players are more likely to pick up injuries if they are hypermobile. This is the conclusion of a study conducted by Australian researchers who surveyed 200 junior netball players aged six to 16 in New South Wales (‘Hypermobility and sports injuries …’ Br J Sports Med 2005; 39:628-631).
Netball is the most popular female sport in Australia, the authors write, with about 1 million participants. The sport is also associated with a high rate of ankle injury – and as a prelude to their own investigation the authors note that sports- related ankle sprains have recently been highlighted in connection with persistent long-term symptoms in most patients.
Participants representing a cross- section of a NSW junior league completed a questionnaire covering their sporting and injury history. They were then assessed for hypermobility (general joint laxity) using the Beighton scoring system (see SIB49), categorising the results into three groups: 0-2 (not hypermobile), 3-4 (moderately hypermobile) and 5-9 (distinctly hypermobile). The mean Beighton score among the survey group was 3.99.
Sixty-nine (35%) of the girls had been injured while playing netball, with their most common injuries being ankle (42%), knee (27%) and finger (15%). Among the 70 non-hypermobiles, the injury rate during netball was 21%. The figure for the 51 moderately hypermobile was 37%, while among the 79 hypermobiles, the reported injury rate was 43%.
The authors do not know why the hypermobile girls are more injury prone, but in terms of proactive management, they say: ‘Identifying hypermobile players could prompt specific training techniques, aimed at stiffening and strengthening muscular support around susceptible joints. The use of strapping and supports to augment mechanical support and proprioception would seem reasonable.’
Why rugby mouthguard use should be compulsory
A New Zealand study on the effects of rugby mouthguards on dental injuries suggests they save players’ teeth and insurance companies’ funds (‘An evaluation of mouthguard requirements and dental injuries in New Zealand rugby union’, Br J Sports Med 2005;39:650-654).
Rugby union is a widely played physical contact sport, with a high injury rate, including injuries to the mouth and teeth. Various pieces of protective equipment, including mouthguards, are permitted in rugby but little research has been done to establish their effectiveness in preventing injuries.
The main aim of the present study was to document the effects of mouthguard use – which became compulsory during match play in New Zealand at the beginning of the 1998 season – on rugby-related dental injury claims. A secondary purpose was to estimate the relative risk of dental injury claims for wearers and non- wearers of mouthguards.
The study was described as ‘ecological’, in that it linked self- reported rates of mouthguard use with numbers of reported claims over a period of time. Key findings were:
- Over the period 1993-2003, the self-reported rate of mouthguard use among male rugby players increased by 26%. In 2003, mouthguards were reported to be worn in 93% of games, with most players also wearing them during practice, at least some of the time;
- Over a similar period, there was a 43% reduction in rugby-related dental injury claims to ACC, the public sector organisation that administers New Zealand’s 24- hour no-fault accident compensation and rehabilitation scheme. A study of rugby injuries in New Zealand carried out in 2003 indicated that injuries to the teeth and jaw made up only 1% of total injuries reported in both practices and matches;
- The cumulative number of claims saved between 1995 and 2003 is estimated at 5,839 and the cumulative savings in claim costs to ACC is estimated at NZ $1.87m, at an average cost per claim of NZ$321;
- Non-wearers of mouthguards were estimated to be nearly five times more likely to make a dental injury claim than wearers.
The researchers conclude that their findings ‘provide evidence that requiring rugby players to wear mouthguards is a simple, effective injury prevention strategy.
‘On the basis of the New Zealand experience with compulsory mouthguard use and the commensurate decrease in dental injuries, we strongly endorse mouthguard use for rugby players at all levels in both match and contact practice situations.’
Isabel Walker is the former editor of Peak Performance