Prevalence and incidence of health problems in Brazilian para athletes and muscle function and joint mobility characterisation

Team

• Juliana Melo Ocarino

• Andressa Silva

• Renan Alves Resende

Project partners

• Universidade Federal de Minas Gerais, Brazil.

• Centro de Referência Paralímpico Brasileiro, CTE-UFMG, Brazil.

• Comitê Paralímpico Brasileiro, Brazil.

Funding

The study was funded by Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)—09/2022-, Fundação de Amparo à Pesquisa do Estado de Minas Gerais (FAPEMIG)—CDS - APQ-01017-17, Coordenação de Aperfeiçoamento de Pessoal de Nível Superior—Brasil (CAPES)—Finance Code 001.

Background

Most of the studies related to the health problems epidemiology in para-athletes investigated the prevalence of injuries and illnesses during competitions, which might not detect most gradual onset injuries or less severe illnesses. The profile and occurrence rates of health problems vary between Paralympic sports modalities. For example, para powerlifting and athletics were among the ten modalities with the highest injury incidence rates, while para swimming had the lowest rates during the Rio 2016 Summer Paralympic Games. On the other hand, para-swimming had the greatest illness incidence rate. The incidence and severity of injuries and illnesses in para-athletes are higher than in athletes without impairment, which also results in a long time-loss since para-athletes have unique medical conditions related to the disability itself. Thus, the surveillance of health problems in a longitudinal follow-up study and also the characterisation of body functions and structural aspects, such as muscle function and joint mobility, may contribute to the proposal of treatment and prevention strategies in future studies.

Objectives

The project aims to investigate the prevalence, incidence and their characterisation of health problems in para-athletes. The project is organized in three phases. In a first step, a systematic review of the literature on prevalence, incidence and the profile of musculoskeletal injuries in para-athletes was conducted. The second step aimed to describe the prevalence, incidence, and severity of health problems and their characterisation in para-athletes from the modalities of para-athletics, para powerlifting and para-swimming of the Brazilian Paralympic Reference Center during a sports season. We also aim to compare the prevalence of health problems between the three modalities. In a third step, we will describe the muscle function and joint mobility of these para-athletes and also investigate how the assessment is performed by clinicians and their practical experiences in the dichotomy of an individualized and group approach with Paralympic athletes, considering the diversity of health conditions, the classification category, and the sports modality's characteristics and demands.

Understanding the Managers’ perceptions of the Sports Organizations in monitoring the health and performance departments

Background

Sports organizations have transformed into highly structured organizations to serve elite athletes. Health & performance teams in elite sports have become essential to increase the quantity and quality offered in sports science and health care.  These teams have an important role in the athletes’ performances but don’t have a way to measure such teams' impact on sports performance and health. The problem is the lack of management tools to measure the results and align these results with the strategic planning of the sports organization. That is why it is necessary to understand more about the context of the health and performance department in sports organizations. This is important to develop strategies that fit the context of managing the health and performance teams. 

Objectives

This project explores the contemporary context of health and performance management in sports organizations. Based on the narratives of the management leaders, this project aims to explore the role of the medical department in the bigger organization. The main objective will be to understand the Sports organizations’ managers (high-level managers and H&P department managers) about the management of the Health and Performance departments and the importance of incorporating management tools into strategic performance. 

Durability By Design

Funding

Royal Netherlands Marechaussee.

Team

• Evert Verhagen

• Paul Kuijer

• Paul Schermers

• Herman IJzerman

• Pablo Stegerhoek

Project Partners

Royal Netherlands Marechaussee

Background

The Royal Netherlands Marechaussee monitors the security of the Netherlands and the Caribbean part of the Kingdom of the Netherlands. The Marechaussee is deployed worldwide in places of strategic importance. From royal palaces to the outer borders of Europe. From airports in the Netherlands and the Caribbean to war and crisis areas worldwide. Therefore, the work of Royal Netherlands Marechaussee personnel is very diverse in nature. From very monotonous, long-lasting to sudden, very demanding situations. This type of work requires a lot from the personnel, both physical and mental. Wearing and carrying heavy equipment for entire shifts and dealing with highly unpredictable and stressful situations are just some of the challenges. This research project aims to develop, implement, and evaluate effective interventions to improve the sustainable work ability of the personnel. 

Objectives

The project aims to develop practical and implementable interventions that help Royal Netherlands Marechaussee deal with their demanding workloads and thereby increase their durability.

DEFENCE: Determination and Evaluation of the Frequency and Effects of myocardial damage iN patients with a SARS-CoV-2 infEction [DEFENCE]

Funding

The Netherlands Organization for Health Research and Development (ZonMw), grant number 10430102110006 DEFENCE

Team

• F.W. Asselbergs         https://orcid.org/0000-0002-1692-8669

• H.T. Jorstad                https://orcid.org/0000-0003-3617-3256

• J.J.N. Daems              https://orcid.org/0000-0002-5589-2806

Project Partners

This project is a research consortium consisting of multiple multi-centre studies

COMMIT is an ongoing, actively recruiting subcohort of the ELITE lifetime cohort, which is composed of >300 competitive elite athletes with a CMR scan prior to the COVID-19 pandemic. In individuals with a SARS-CoV-2 infection, a repeated scan is made. To date >100 CMR’s in athletes post-COVID have been performed. With this cohort, the cardiac impact of SARS-CoV-2 in healthy individuals who engage in extreme levels of physical activity, a documented second hit in general cases of myocarditis, is prospectively assessed.

COVID@Heart is an initiative established to determine the course of COVID-19 in patients that are treated by their general physician and recover from the SARS-CoV-2 infection at home. The study contains 100 subjects derived from the Nijmegen Exercise Study (NES) and Rotterdam Study (ERGO), which both are population-based cohorts that have collected extensive data before and during the first and subsequent waves of SARS-CoV-2 infections in the Netherlands.

CAPACITY-COVID consortium has established two studies: CAPACITY 1 (www.capacity-covid.eu) and CAPACITY 2. CAPACITY 1 is a retrospective cohort study/patient registry in which clinical data generated during routine clinical care has been collected from >5000 patients hospitalized in the Netherlands during the first wave of the pandemic. This number comprises ~40% of all hospitalized patients during the first wave. The ISARIC core case report form was used as a basis within CAPACITY 1 and extended with additional data collection items to capture in-depth information on the cardiovascular history and medication use, cardiac additional diagnostic tests (ECG, echocardiography, MRI) and cardiovascular complications. The manuscript of the main findings is currently under review but has been published on a preprint server.14 CAPACITY 2 is a prospective cohort study within the hospital setting that aims to harmonize clinical care pathways across sites with standard diagnostic testing for the early detection of myocardial damage to investigate cardiac complications in both the short and long-term.

COPP is a nationwide multicentre hospital-based prospective cohort study on paediatric COVID-19, including COVID-19-associated multi-system inflammatory syndrome (MIS-C) associated with severe cardiac dysfunction, myocarditis and coronary artery dilatation. In total, 125 MIS-C children are included in this registry. Near real-time automated results and analysis of MIS-C, including medical history, laboratory data, length of ICU/hospital stay, and therapy, can be found online (www.covidkids.nl). Serial echocardiographic data, ECGs, troponin and NT-proBNP levels are available in the acute phase in all MIS-C patients.

POPCORN consortium (EurQol Foundation based) collected data in the population of 8 countries (n=24.000), including the Netherlands (first wave). Subsequent waves (from April 2021) will be an individual repeat and include a major part of the CAPACITY patient outcome survey, where data will be available for reference and maximise the diagnostic value of patient outcome data.

Lifelines – The lifelines study started in 2006. Lifelines is a national long-running cohort study which collects health-related data from 167.000 participants from the North of the Netherlands in 2006. They have collected data regarding cardiovascular risk factors and utilize biobanking. They follow a large sample of long-COVID-19 patients and aim to make 100 CMR scans to investigate the possible correlation between cardiovascular abnormalities and symptoms post-COVID-19.

Background

Cardiovascular abnormalities in the context of COVID-19 are currently being investigated worldwide. Such abnormalities range from cardiac biomarker increases to increased rates of cardiovascular events and death from various causes. Myocardial involvement and myocarditis are of particular import for individuals who engage in sports and exercise, as physical activity can trigger life-threatening arrhythmias and induce chronic myocardial inflammatory states.

The DEFENCE consortium aims to collect extensive data across a range of individuals who have been diagnosed with COVID-19: from the very young to the elderly, from sedentary to elite athletes, and from asymptomatic to severely ill.

Objectives

• What is the frequency of myocardial damage in patients that have been infected with SARS-CoV-2?

• How does the frequency, extent and pattern of myocardial damage relate to COVID-19 disease severity, symptomatology and patient characteristics?

• What are the consequences of myocardial damage in the short- (<6 months) and long-term (up to 2 years)?

A Biokinetics model for the prevention of sports injuries: Lessons learned from rugby and long-distance running

Project Partners

This project is for a PhD in Health Science (Biokinetics) at the University of Johannesburg (SA). Supervised by Prof. Evert Verhagen at the VU University of Amsterdam, The Netherlands and Prof. Leon Lategan at the UJ.

Funding

None

Background

There are numerous studies that have been done on the prevention of sports injuries, but they always focus on one sporting code or type of sport, with little integration between different sports. The purpose of this study is to determine if there is an overlap in the risk factors between rugby (team, contact sport) and long-distance running (individual, non-contact sport). By identifying the potential overlap, one would develop a model which can be applied in all the different types of sport and settings. Although it is labelled as a Biokinetics model, it will be a model that can be used in various professions related to sport, wellness and orthopaedic. Biokinetics is a South African term, but appeals to physical therapy and exercise science in most other countries. 

Injury prevention is a very popular topic, but numerous approaches have failed, due to the poor compliance rate. This is something that has been noted so far in this project and with the development of this model, hoping to overcome this barrier, by ensuring that the model is specific in its goals and success. Another possible outcome for this study is to develop a model that would be sustainable for the profession and industry and to simplify matters when it comes to injury prevention. 

Study aim

The aim of the study is to establish a Biokinetic model for the prevention of sports injuries in rugby players and long-distance runners. These two sports fit into the different ends of the sporting continuum, with individual sports (long-distance running) on one end and team sports (rugby) on the other end. The model will be suited for the team, contact sports as well as individual, endurance sports. In order to reach this aim, the project is divided into different phases. A scoping review was done during the first phase to determine the prevalence of injuries in both sports, the risk factors for both sports and the current injury prevention strategies being utilized. Secondly, the Delphi process will be conducted with a panel of experts in the field of rugby, running and specialist Biokineticists, who focus on sports injuries, as well as athletic trainers or sport and conditioning specialists. Concurrently, retrospective injury surveillance will be conducted through an online injury recall questionnaire from the previous 12 months. After all the rounds of the Delphi has been completed, a draft of the model will be designed and then the last rounds of the Delphi process will be used to evaluate and critique the model. After the final model has been developed, it will be implemented at various running and rugby clubs for a 12-month period. Thereafter, another retrospective injury recall questionnaire will be distributed to the same clubs and comparative analysis will be done to determine if the implementation of the model was successful. The final step will be focus groups, to assess the effect and success of the model, to critique it if needed and to make the final changes to provide the best possible model for sports injury prevention. 

Golf Related injury Prevention Program (GRIPP)

Project Partners

• Department of Orthopaedics and Sports Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands

• Department of Orthopaedic Surgery, Amphia Hospital, Breda, The Netherlands.

Funding

• ZonMW ‘Sportinnovator Voucher’

Background

Injury prevention programs have been shown to be effective to prevent injuries in different sports. However, there is no injury prevention program available for golfers. Therefore, the Golf Related Injury Prevention Program (GRIPP) intervention is developed following the Knowledge Transfer Schema (KTS). Following the KTS we organized 3 multidisciplinary Knowledge Transfer Groups to translate evidence into practice. The efficacy of the conducted program to prevent golf-related injuries will be studied in a randomized controlled trial. 

Alongside the evaluation of its efficacy with the RCT, there is also a need to describe how the program is delivered on the golf course. Otherwise, the effect of the intervention and implementation can be over or underestimated. We developed our program for the RCT with a protocol:performance-as-imagine. But the question is: How is the program performed on the golf course:performance-as-done. Is the program performed as imagined or is something else actually happening? What is the behaviour of the golfer on the golf course with the program, what is the culture, what are contextual factors and how are the perceptions and beliefs of the golfer? Therefore, qualitative exploratory research can help to visualize the implementation and compare the performance-as-imagined and the performance-as-done on the golf course.

Study aim

The aim of this qualitative exploratory study is to explore the perceptions and experiences of golfers during their performance of the Golf Related Injury Prevention Program (GRIPP) on the golf course.

Effective Injury Prevention - A Living Systematic Review

BACKGROUND

Leading a physically active lifestyle and participating in sport are associated with many health benefits spanning physical, cognitive, and psychological/emotional domains. However, many features of well-established sports (e.g., high-speed running, landing from a jump, quickly changing direction, tackling) expose athletes to a risk of sustaining sudden-onset injuries. Because acute sports injuries can cause short-to-long-term physical impairment and functional disability, and lead to substantial healthcare and economic costs, identifying and implementing effective intervention strategies that protect athlete health and ensure safe participation in sports is imperative.

An increasingly large body of evidence on sports injury prevention strategies has emerged over the past two decades.[69,70]Such proliferation of injury prevention research has resulted in a swell of evidence syntheses to systematically appraise, synthesise, and interpret both pre-existing and newly emerging literature. By systematically mapping the quality of evidence, quantifying the preventive effect of intervention strategies, and identifying gaps for future research, rigorously performed evidence syntheses possess substantial value to inform clinical and preventive sports injury practice.

STUDY AIM

The purpose of this systematic review and meta-analysis is to

1.     perform a baseline systematic review that:

• categorises sudden-onset sports injury prevention strategies by the (i) timing of its effect relative to when the injury event/mechanism occurs (i.e., pre-event, event, post-event) and (ii) target of its effect (i.e., athlete, kinetic energy, environment);

• evaluates the pooled efficacy (i.e., interventions tested under highly controlled conditions) and effectiveness (i.e., intervention tested under pragmatic, ‘real-world’ conditions) of sports injury prevention strategies, and;

• identifies priority areas for future design and implementation of sudden-onset sports injury prevention strategies.

2.     transition to a living systematic review that:

• continually monitors emerging evidence on sports injury prevention strategies, and; 

• incorporates relevant evidence on sports injury prevention strategies into review conclusions at regular fixed time intervals.

The health of female and male professional footballers

PROJECT PARTNER

Christa Janse van Rensburg, Section Sports Medicine, University of Pretoria

FUNDING

Department of Orthopedic Surgery, Amsterdam UMC

Drake Foundation

Mehiläinen NEO Hospital Turku 

Sports Hospital Mehiläinen Helsinki 

Nea International bv. 

BACKGROUND

During their careers, professional footballers are likely to experience problems with their mental, neurocognitive and musculoskeletal health. Severe injuries and related surgeries are associated with cartilage degeneration in the hip and knee joints, and may cause early onset of osteoarthritis (OA) in the long term. Severe injuries and related surgery are also recognized as one of numerous stressors that may trigger mental health symptoms in professional footballers. When it comes to neurocognition, insight into relevant neurocognitive functions (e.g., attention, memory) among professional footballers remains limited. Amongst female professional footballers, data about gynaecological health is lacking. In order to address this knowledge gap, FIFPRO (Football Players Worldwide) and the Amsterdam UMC (University Medical Centers) have implemented a health surveillance programme in professional football aimed at gathering epidemiological evidence about the onset and course of mental, musculoskeletal, neurocognitive, cardiovascular and gynaecological (if applicable) health conditions in professional footballers during their pre- and post-retirement years.

OBJECTIVES

The overall aim of these two PhD research projects is twofold, namely (i) to present epidemiological evidence about the health (i.e., gynaecological, mental, musculoskeletal, neurocognitive) of male and female professional footballers and (ii) to explore the recovery strategies of male and female professional footballers and capture their potential needs towards additional measures.

No time to waste: moving towards a necessary health support system for retired national level rugby players

PROJECT PARTNERS

Section Sports Medicine, University of Pretoria (Prof. Christa Janse van Rensburg)

South African Rugby Legends Association (SARLA)

South African Rugby Union (SARU)

FUNDING

Department of Orthopedic Surgery, Amsterdam UMC

World Rugby

BACKGROUND

Transitioning out of professional sport is not easy and during that process, athletes might face several challenges such as adjusting to a new life and lifestyle, being suddenly ‘like everyone else’ or missing the sport atmosphere and competition. Retired professional athletes might also face health conditions affecting various domains (e.g., musculoskeletal, psychological, cardiovascular, neurocognitive). 

As high-speed collision sport, rugby union (hereinafter ‘rugby’) has been associated with post-career health risks, especially osteoarthritis, mental health symptoms and neurocognitive deficits. Despite these health conditions likely to occur after retiring from professional rugby, support measures remain lacking. Accordingly, an After Rugby Career Consultation was developed as a transitioning health examination to empower the sustainable health and quality of life of retired professional rugby players. Being implemented globally in professional football, such an approach is likely to be of added value in professional rugby.  

OBJECTIVES

The overall aim of this PhD research project is to evaluate the feasibility of the After Rugby Career Consultation in South African professional rugby. Specifically, (i) epidemiological evidence regarding the occurrence of health conditions (e.g., musculoskeletal, cardiovascular, neurocognitive, psychological) among retired professional rugby players is gathered, (ii) the feasibility of the After Rugby Career Consultation among male South African retired professional rugby players is evaluated, and (iii) the view and experience of South African retired male professional rugby players and physicians about the After Rugby Career Consultation is captured and potential additional supportive strategies explored.

The Basketball and Muscle Injury (BAMI) study: Game changing innovative sports research

PROJECT PARTNERS

None

FUNDING

· The study was funded by ‘NBA & GE Orthopedics and Sports Medicine Collaboration’

BACKGROUND

The current literature on muscle injuries in basketball is limited and there are no clinical studies in elite female basketball. To help advance the field, innovative new techniques can be utilized. Current standard MRI techniques do not allow visualization of individual muscle fiber architecture. Consequently, the quantification of both muscle pathology and muscle architecture is only indirectly estimated by measuring the extent of edema (suggesting minor injury) and hematoma (suggesting fiber disruption) with suboptimal reproducibility and unknown validity.

OBJECTIVES

The main objectives are:

1. Evaluate and monitor the injury and recovery mechanisms of the hamstrings muscles

2. Evaluate efficacy of injury prevention programs for the hamstrings and calf muscles

3. Evaluate the risk of re-injury

Using an innovative Diffuse Tensor (DT) MRI imaging technique, which allows accurate evaluation of the muscle fibers.

FURTHER INFORMATION

For further information and current updates on the project, please refer to our website (only in Dutch): www.hamstringonderzoek.nl

PRIMA Study: Platelet-Rich plasma Injection Management for Ankle osteoarthritis

PROJECT PARTNERS

· Flevoziekenhuis – Orthopaedic surgery, Almere, The Netherlands

· OLVG – Sports Medicine, Amsterdam, The Netherlands

· Spaarne gasthuis – Orthopaedic surgery, Hoofddorp, The Netherlands

· Erasmus Medical Center – Sports Medicine, Rotterdam, The Netherlands

· The Bergman Clinics – Sports Medicine, Naarden, The Netherlands

FUNDING

· The study was funded by the Dutch Arthritis Foundation

BACKGROUND

Platelet-rich plasma (PRP) is a potentially efficacious treatment for ankle osteoarthritis (OA), but its use has not been examined in high-quality studies. Systematic reviews show that PRP injections significantly decrease pain and improve function in patients with knee OA. Ankle OA is more common than hip or knee OA in the young active population; with a prevalence of 3.4%. PRP injections in ankle OA are shown to be safe and improve quality of life over time, but no randomized controlled trial has been conducted.

OBJECTIVES

Our randomized controlled trial will evaluate the efficacy of PRP injections for symptom reduction and functional improvement, compared with placebo, in the treatment of ankle (talocrural) OA, using standardized questionnaires and physical examination.

FURTHER INFORMATION

For further information and current updates on the project we refer you to the published protocol of the study or the website of the Dutch Arthritis Foundation.

ACTION Trial: The goal attainment scaling for knee arthroplasty in younger patients

PROJECT PARTNERS

· This project is a single center study performed at the Amphia hospital, Breda, The Netherlands

FUNDING

· The study was funded by Foundation NuthsOhra (grant number 1403-026).  

BACKGROUND

Knee arthroplasty (KA) has proven to be a reliable treatment to relieve pain, improve function and enhance health-related quality of life in patients suffering from knee osteoarthritis (OA). Following the increasing prevalence of knee OA, the demand for KA is expected to rise worldwide, especially in patients 55 – 65 years of age. These patients often wish to return to work and to participate in knee-demanding leisure time activities. Despite the aforementioned benefits of KA, up to 20% of patients remain dissatisfied after surgery.

Unmet expectations are the primary cause for dissatisfaction after KA, and rehabilitation likely plays a crucial role in establishing and obtaining reasonable goals. Since younger KA patients have a wide variety of activity goals and expectations, a ‘one-size-fits-all’ rehabilitation approach likely does not suffice. A possible instrument to tailor the rehabilitation to patients’ personal goals is Goal Attainment Scaling (GAS). Theoretically, GAS could prove to be a useful instrument to establish realistic goals, increase goal attainment and thus improve satisfaction in younger KA patients.

OBJECTIVES

We will investigate the effect of GAS-based rehabilitation on satisfaction in younger, active KA patients. We hypothesize that a GAS-based, personalized, goal-directed rehabilitation leads to higher satisfaction scores for postoperative performance of activities, compared to usual-care rehabilitation after KA.

FURTHER INFORMATION

Witjes S, Hoorntje A, Kuijer PP, Koenraadt KL, Blankevoort L, Kerkhoffs GM, van Geenen RC. Does Goal Attainment Scaling improve satisfaction regarding performance of activities of younger knee arthroplasty patients? Study protocol of the randomized controlled ACTION trial. BMC Musculoskelet Disord. 2016 Mar 2;17:113. doi: 10.1186/s12891-016-0965-3. PMID: 26936270

Hoorntje A, Witjes S, Kuijer PPFM, Bussmann JBJ, Horemans HLD, Kerkhoffs GMMJ, van Geenen RCI, Koenraadt KLM. Does Activity-Based Rehabilitation With Goal Attainment Scaling Increase Physical Activity Among Younger Knee Arthroplasty Patients? Results From the Randomized Controlled ACTION Trial. J Arthroplasty. 2019 Oct 23. pii: S0883-5403(19)31005-8. doi: 10.1016/j.arth.2019.10.028. [Epub ahead of print]. PMID:31740103

Witjes S, Hoorntje A, Kuijer PP, Koenraadt KL, Blankevoort L, Kerkhoffs GM, van Geenen RC. Goal Setting and Achievement in Individualized Rehabilitation of Younger Total and Unicondylar Knee Arthroplasty Patients: A Cohort Study. Arch Phys Med Rehabil. 2019 Aug;100(8):1434-1441. doi: 10.1016/j.apmr.2018.11.019. Epub 2018 Dec 22. PMID: 30582918

PHAROS: Prospective Hamstring Avulsion Registry for Outcome following Surgical and nonoperative treatment

PROJECT PARTNERS

· Amager-Hvidovre Hospital, IOC Research Center, Copenhagen, Denmark

· University college hospital, IOC Research Center, London, United Kingdom

· Aspetar Orthopedic and Sports Medicine Hospital, IOC Research Center, Doha, Qatar

FUNDING

No external funding

BACKGROUND

Full-thickness hamstring tendon injuries are severe injuries that substantially impact sports participation and activities of daily living. There is a lack of evidence to advise if and when operative or non-operative treatment is indicated. Evidence-based treatment indications and an optimal timeframe for operative intervention are unknown. These and other pressing clinical questions remain unanswered, partly due to the relative rarity of these injuries and isolated research efforts.

OBJECTIVES

PHAROS is developed to systematically gather prospective clinical data on full-thickness hamstring injury due to tendon avulsion or rupture on a large scale. By means of this international research collaboration, we expect to be able to answer the pressing clinical questions that have remained unanswered to date.

Redefining the Normal Triangular Fibrocartilage Complex in Children

PROJECT PARTNERS

· Amsterdam Movement Sciences (AMS) research institute

FUNDING

None

BACKGROUND

The triangular fibrocartilage complex (TFCC) is a soft tissue structure located between the distal ulna and carpal bones that provides distal radioulnar joint (DRUJ) stability, ulnocarpal stability, axial load distribution and enables complex movements of the wrist. Injury to this structure, chronic or acute, is considered a common cause of ulnar sided wrist pain.

Magnetic resonance imaging (MRI) is increasingly being used to diagnose TFCC injury based on signal intensity changes. However, the meaning of these signal changes is being questioned since high prevalence rates (38% up to 70%) of abnormal signal intensities are reported in asymptomatic subjects. In elite tennis players, no statistical difference in TFCC abnormalities on MRI was even found between symptomatic, asymptomatic and healthy control subjects. This implies that a substantial amount of signal abnormalities on MRI might not be associated with clinical symptoms.

Meanwhile, surgical intervention in children with suspected TFCC injury has become more prevailing. Multiple studies on surgical techniques and outcomes of wrist arthroscopy in children with TFCC injury have been published recently. Also, shorter immobilization and earlier intervention in young elite athletes with TFCC injury is encouraged in order to facilitate a more rapid return to sport, while the meaning of TFCC signal changes on MRI for this young patient group remains unclear.

OBJECTIVES

The aim of the study is to redefine the normal TFCC by studying the fetal morphologic TFCC development and systematically assessing the normal TFCC appearance on MRI in asymptomatic children and young gymnasts. By acquiring more knowledge on the normal TFCC, a better distinction can be made between pathologic and non-pathologic TFCC variations seen on diagnostic MRI and benefit the decision-making process for treatment. In order to do so, fetal TFCC development will be analyzed in a 3-dimensional manner and correlated with imaging. Also, a systematic score form will be developed and used to study normal TFCC appearance on MRI in healthy children and possible pre-pathological TFCC changes in young gymnasts. Additionally, a new MRI technique will be used to assess TFCC’s in healthy young adults, in order to study its feasibility to improve diagnostic accuracy of detecting TFCC pathology in the future.

Drake Football Study - Monitoring the health of transitioning professional footballers

PROJECT PARTNERS

· FIFPRO (Football Players Worldwide), Hoofddorp, the Netherlands

· Mehiläinen NEO Hospital, Turku, Finland

· Drake Foundation, London, UK

· Push Sports, Maastricht, the Netherlands

FUNDING

The Drake Football Study received seed funding from the Drake Foundation located in London (United Kingdom) and financial support from FIFPRO located in Hoofddorp (the Netherlands), Mehiläinen NEO Hospital located in Turku (Finland), from Sports Hospital Mehiläinen located in Helsinki (Finland) and from Push Sports located in Maastricht (the Netherlands).

BACKGROUND

Transitioning out of professional football is a challenging time in most players’ lives. During these pre- and post-retirement years, professional footballers may struggle with their mental, musculoskeletal, neurocognitive and cardiovascular health. Currently, longitudinal data about these health conditions is lacking.

OBJECTIVES

The aims of the study are (i) to gather epidemiological evidence about the onset and course of mental, musculoskeletal, neurocognitive and cardiovascular health conditions in professional footballers during their pre- and post-retirement years, comparing them to matched controls from the non-elite sport population (if applicable), and (ii) to evaluate the associations between risk indicators  and the onset and course of mental, musculoskeletal, neurocognitive and cardiovascular health conditions in professional footballers during their pre- and post-retirement years.

An observational prospective cohort study with repeated measurements over a follow-up period of 10 years is conducted among professional footballers (male). Mental health will be explored by assessing symptoms of distress, anxiety, depression, sleep disturbance, alcohol misuse, drug misuse and disordered eating. Musculoskeletal health will be explored by assessing severe joint injury and related surgery, clinical and radiological osteoarthritis, and joint function (hips, knees, ankles). Neurocognitive health will be explored by assessing concussion, brain structure and functioning, and neurocognitive functioning. Cardiovascular health will be explored by assessing blood pressure, lipid profile and electrocardiogram abnormalities.

OUTBACK Trial: Treating Osteochondral Lesions of the Talus

PROJECT PARTNERS

· Academic Center for Evidence based Sports medicine (ACES)

· Oklahoma Medical Center, Department of Orthopedic Surgery

· Flevoziekenhuis, Department of Orthopedic Surgery

· Amphia Hospital, Department of Orthopedic Surgery

· Sanquin, Diagnostic Services, Research Department

· Amsterdam UMC, Location VUmc, VU Department of Public and Occupational Health

FUNDING

· Department of Orthopedic Surgery, Amsterdam UMC

· Foundation Friends of Aces

BACKGROUND

Small osteochondral lesions of the talus that undergo bone marrow stimulation show 75% success rate on the mid- to long-term. In order to increase this success rate, bone marrow aspirate concentrate in addition to the bone marrow stimulation may be beneficial. However, no randomized, blinded study has ever proven this.

OBJECTIVES

There are multiple objectives. The main objective of the present study is to compare the clinical outcome of bone marrow stimulation alone versus bone marrow stimulation and bone marrow aspirate concentrate (BMAC) for small osteochondral lesions of the talus at 2 years follow-up. Other objectives are to study the cost-effectiveness of the study, the sport and work-outcomes of the trial, and to study the radiological outcomes as well as cell characteristics.

Why don't we treat eSports Participants as Athletes?

PROJECT PARTNERS

· Portugal Football School, Portuguese Football Federation, Oeiras, Portugal

· Research Center in Sports Sciences, Health Sciences and Human Development, CIDESD, University Institute of Maia, Maia, Portugal

· VU University Medical Center Amsterdam, The Netherlands.

FUNDING

The study has the Portugal Football School support.

BACKGROUND

eSports (or electronic sports or virtual sports) are a worldwide phenomenon. Generally, eSports comprise a number of different videogame modalities, played competitively (at professional or recreational level) on controlled environments, with structure and regulations similar to the traditional sports (e.g. leagues, ladders and tournaments), being Virtual football an example. Over the past decade, eSports have grown exponentially and now also reaches competitively into the realm of traditional sports. The time schedules, professionalization and training needed to achieve elite positions, along with the possibility of participating in major eSports events require domain-specific skills, precision, coordination and rapid response, perceptual-cognitive abilities and ethical aptness. As the popularity and stakes raise, concerns about the health and emerging risks of eSports participation might arise, since little is known about the demands of eSports competitions and continuous training. Therefore, different areas of expertise are trying to fundament and elaborate on the topic, and the field of exercise and sports medicine is not an exception.

OBJECTIVES

In this project, we aim to develop a baseline study on the quality of sports medical care in people formally engaged with eSports. For that purpose, we will study virtual football players participating in official tournaments included in the Portuguese Football Federation (FPF) agenda, during one competitive season. We expect to provide novel scientifically-based arguments on demographic characteristics, diseases and injuries, mental health, lifestyle behaviour (i.e. substances consume, physical activity, sleep, screen time) of eSports participants. Given the exponential growth of eSports, awareness on this topic is of upmost importance, and the current project can therefore open a new field for research and professional activity in sports sciences and medicine.

Breaking the High Load: Overhead Sports Injuries Management

PROJECT PARTNERS

This project is a cooperative effort between:

· Royal Netherlands Baseball and Softball Federation.

· Royal Netherlands Lawn Tennis Association.

· Vrije Universiteit Amsterdam.

· Delft University of Technology.

· Manual Fysion.

· PLUX.

FUNDING

The project is funded by the NWO Domain Applied and Engineering Sciences (AES) under project number [R/003635].

BACKGROUND

In both baseball and tennis, throwing and hitting a ball is a fast pre-planned action based on engrained motor patterns that involve the whole body. In these motions ​correct relative timing of body part motions is essential. Despite the current body of knowledge regarding hitting biomechanics on the one hand and injury-prone structures on the other, no useful guidelines regarding the prevention of overload injuries or the ‘correct’ throwing or hitting technique have been developed.

The key reasons for this are:

1. The lack of measurement systems that allow for fast and unhindered recording of motion ​timing​;

2. The missing link between motion timing and mechanical loading of anatomical structures;

3. The missing link between mechanical loading, intersegmental coordination and injury risk.

Since in tennis and baseball performance is highly dependent on (highly repetitive!) fast pre-planned full-body actions that can only marginally be modified during the action itself, pain, injury or weakness somewhere in the kinetic chain can lead to faulty coordination and related injury elsewhere in the chain, usually more distally at the level of the arm or elbow. Proper retraining of ‘correct coordination’ is essential to be able to return to the sport (RTS). While to date the focus in retraining is on identification of strength imbalance and limitations in range of motion, these are likely only secondary factors in the correct coordination. ​Correct relative timing, is believed to be the key factor​. This applies especially to the motion of the scapula, as the bridge between trunk motion (the motor) and arm motion (the ‘whip’). Up till now relative timing has had low attention in rehabilitation practice. In this project we will develop (1) a feedback system on motion timing, link this system to a platform for the monitoring of athlete health status and develop an algorithm for the (interactive) quantification of injury risk (accumulated value) and stroke or throw performance (incidental value); (2) an integrated method, requiring online monitoring of progress, for the detailed quantification of relative timing in and after upper extremity injury to improve rehabilitation, modify injury risk, and facilitate the RTS process.

OBJECTIVES

The project goal is to break the high load due to bad coordination in overhead sports injuries, by developing a system for risk identification and modification through new feedback applications based on motion timing.

FURTHER INFORMATION

For further information and current updates on the project please refer to our website: https://www.tudelft.nl/en/3me/research/check-out-our-science/playing-scientifically-sound-baseball-and-tennis/

Trailblazer: Identification of risk factors related to trail running

PROJECT PARTNERS

· VU University Medical Center Amsterdam, The Netherlands.

· Department of Physiotherapy, University of Pretoria, South Africa.

· Section Sports Medicine, University of Pretoria, South Africa.

FUNDING

· University of Pretoria, South Africa and VU University Medical Center Amsterdam, The Netherlands

BACKGROUND

Trail running involves running outdoors on varying off-road terrains. It is a highly popular and fast-growing sport. Even though running as a form of physical activity has positive health benefits, it also presents with a high risk for injury. The nature of trail running requires a specific endurance effort affected by altitude, large elevation gains/losses, distance covered and varying uneven surfaces. Therefore, the injury profile will differ between road and trail runners. A lack of literature on injuries among trail runners exists, limiting our understanding of injuries in this specific field. Trail runs are mostly hosted in remote geographical regions where medical care is challenging. A trail running injury screening tool (TRISI), based on risk factors related to trail running can help identify runners at higher risk and guide future risk management strategies.

OBJECTIVES

The aim of this project will be to develop a TRISI. The project consists of two phases. Phase 1 will aim to increase our understanding of trail running injuries through 1) prospectively recording injuries among trail runners, 2) analysing a large data set of injury data collected over three years among trail running race entrants, and 3) investigating trail runners’ opinions relating to trail running injury risk factors. The data obtained will be used to develop a TRISI. In phase two, an injury screening instrument will be developed based on the risk factors identified in phase 1. The developed screening instrument will be peer-reviewed through Human Judgement Modelling and adjusted accordingly. Phase 2 will consist of two expert panels that will firstly establish a final list of relevant risk factors, and then give weighting to each risk factor in the TRISI.

IPPON: Injury prevention and performance optimisation in judo athletes

FUNDING

• The Netherlands Organisation for Health Research and Development (ZonMw)

PROJECT PARTNERS

• Judobond Nederland

• Sportmedisch adviescentrum Jessica Gal Sportartsen

• VeiligheidNL

BACKGROUND

With a top-3 position on the priority list of sports with the highest incidence rate of injuries (4.3 per 1,000 hours) and top-5 position on both absolute number of injuries (180,000) and injuries presenting at the emergency department (4,400) in the Netherlands, combat sports should be a priority for injury prevention interventions.

For judo, the most practiced combat sports, a specific prevention program based on existing proven effective exercises has been developed by experts who are both strongly embedded in judo practice, and world leading experts in judo research: the Judo 9+. Although sport-specific neuromuscular training programs have been shown to effectively reduce injury rates in various sports, the effectiveness and implementation of the judo 9+ program has not been studied yet.

OBJECTIVES

1. Translation of the Judo 9+ exercise programme to the Dutch recreational judo practice: the NL-Judo9+

2. Evaluation of the effectiveness of the NL-Judo9+ exercise programme on injury risk profiles and injury rates

3. Preparation for national implementation of the NL-Judo9+ in recreational judo (if proven effective).

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