OA Sports Medicine http://www.oapublishinglondon.com/oa-sports-medicine OA Sports Medicine The aspect of nationality in participation and performance in ultra-marathon running - A comparison between 'Badwater' and 'Spartathlon'. http://www.oapublishinglondon.com/article/307 The aim of the study was to investigate participation and performance trends regarding the nationality of successful finishers in single stage ultra-marathons of more than 200 km. The association between sex and nationality with running speed was investigated in ‘Badwater’ (217 km) held in North America with 208 women and 818 men and ‘Spartathlon’ (246 km) held in Europe with 206 women and 1,814 men between 2000 and 2012. In ‘Badwater’, most of the finishes were achieved by athletes from the USA, followed by athletes from Germany and Great Britain. In ‘Spartathlon’, the highest number of finishes was obtained by athletes from Japan, followed by athletes from Germany and France. In ‘Badwater’, women from USA were the fastest (7.7±0.4 km/h), followed by women from Canada (6.2±0.6 km/h). For men, the fastest finishes were achieved by competitors from the USA (8.6±0.4 km/h), followed by athletes from Mexico (8.2±1.0 km/h) and Canada (7.0±0.8 km/h). In ‘Spartathlon’, the fastest female finishes were obtained by women from Japan (9.6±0.3 km/h), followed by women from Germany (9.1±0.4 km/h) and USA (8.8±0.3 km/h). In men, the fastest finishes were achieved by runners from Greece (11.7±0.8 km/h), followed by athletes from Japan (11.4±0.4 km/h) and Germany (11.1±0.3 km/h). These results show that American ultra-marathoners dominated both participation and performance in ‘Badwater’ in the USA. In ‘Spartathlon’ in Europe, however, both female and male runners from Japan were dominating participation whereas male ultra-marathoners from Greece and female ultra-marathoners from Japan dominated performance. Future studies need to investigate participation and performance trends for Japanese ultra-marathoners in other races such as 100 km and 100 miles ultra-marathons. 07/20/2020 11:19:27 am Musculoskeletal injuries among professional players of the Nigeria female basketball league: A need for intervention. http://www.oapublishinglondon.com/article/388 Introduction: Despite the enormous growth in the game of basketball in Nigeria, there appears to be little attention on players’ health even at the professional level. Studies to justify the need for injury prevention and management at the professional level are limited in Nigerian basketball. This study therefore sought to assess the pattern of musculoskeletal injuries in these players. Methods: A retrospective cross-sectional survey of all registered players of the Nigeria Female Basketball League was carried out at the end of the 2010/2011 league season. Information on any musculoskeletal injuries and time-loss injuries among others in the past 12 months were collected through a structured self administered questionnaire. Data were analyzed using descriptive and inferential statistics. Results: A total of 108 injuries were sustained by 58 players (aged 18.2 ± 2.66 years) with a 12-month injury prevalence of 55.8%. The prevalence of time-loss injuries was 33.3%. Frequency of occurrence of injuries during matches and training did not differ significantly (p = 0.330). Sprains (34; 31.5%) and strains (21; 19.4%) were the most common types of injuries while head injuries (4; 3.70%) were the least type of injuries. Injuries predominantly occurred in the lower limbs, with the knee (29; 27.0%) and ankle (26; 24.1%) having the highest prevalence. Point guards sustained more injuries than players in other positions (14; 24.1%). The severity of time-loss injuries were mostly mild (20; 37.0%) and moderate (18; 33.3%). Conclusion: There was a considerably high prevalence of injury among professional female basketball players in Nigeria and 1 out of 3 players suffered a time-loss injury during a league season. The pattern of injury was mostly consistent with previous reports on basketball injuries. This study suggests the need for further studies and appropriate injury prevention and management strategies among the players of the Nigeria Female Basketball League. 07/20/2020 11:19:27 am Proteomics of exercise-induced skeletal muscle adaptations. http://www.oapublishinglondon.com/article/565 The systems biological analysis of dynamic protein constellations and the determination of proteome-wide alterations due to physiological adaptations play an increasing role in modern sports medicine. Several large-scale studies on the effect of physical training in humans and relevant animal models have decisively improved our global understanding of the molecular and cellular mechanisms involved inskeletal muscle changes during exercise. In the past, the adaptive potential of voluntary muscle fibres has been thoroughly analysed by histological, physiological and biochemical approaches. Building on this extensive knowledge of conventional exercise biology, refined protein biochemical and mass spectrometric technologies can now be employed to study subtle changes in protein concentration, isoform expression patterns, protein-protein interactions and/or post-translational modifications following physical activity. Besides being a key method for the elucidation of fibre plasticity and muscle transformation, the systematic application of mass spectrometry-based proteomics promises to play a prevalent role in the establishment and evaluation of preventative exercise regimes to counter-act skeletal muscle wasting and metabolic disturbances in common disorders with muscular involvement such as diabetes, obesity, cardiovascular disease, cancer cachexia or sarcopenia of old age. In this review the impact of recent proteomic profiling studies of physical exercise is critically examined and its implications for our molecular understanding of skeletal muscle adaptations discussed. 07/20/2020 11:19:27 am Risk factors to sport-related concussion for junior athletes. http://www.oapublishinglondon.com/article/566 As more than just an enjoyable activity, team sport offers a range of invaluable benefits to players and has the potential to provide personal, physical, and social growth.  Despite the many benefits of team sport participation, these benefits do not come without some cost.  While there are strict rules and guidelines in all contact sports, the risk of injuries such as concussion are impossible to prevent completely.  Sport-related concussion is a growing concern in contact sport, however the underlying risk factors and epidemiology of sport-related concussion in junior athletes is not well understood.  The notable cognitive, hormonal, and neurophysiological changes occurring during development throughout late childhood and adolescence potentially places paediatric athletes at greater risk of sustaining and experiencing enduring effects of brain injury.  While research is inconsistent, there have been some suggestions of specific individual variables functioning as possible antecedents that increase risk of sustaining a concussion, such as prenatal testosterone exposure, executive function, and sensation seeking behaviour.  The growing body of inconclusive and speculative studies on this issue highlights the need for more research into both the prolonged effect of cognitive disruption following concussion as well as what specific factors may place an individual athlete at higher risk of sustaining a concussion in the first place. 07/20/2020 11:19:27 am Patellar instability. http://www.oapublishinglondon.com/article/683 Patellar instability is most common among adolescent female athletes, although anyone can be affected. The etiology of patellar instability is multifactorial and often the result of abnormal patellofemoral biomechanics and anatomy, as well as traumatic in origin. Diagnosis and management begins with physical examination and imaging such as radiographs, CT, or MRI. The management of patellar instability is non-operative for primary dislocations with operative management reserved for patients with recurrent patellar instability. There are a variety of operative procedures including osseous realignment procedures as well as soft-tissue procedures aimed to correct predisposing factors contributing to patellar instability. The approach to patellar instability should be individualized and tailored to each patient’s symptoms, anatomy, and physical demands in order to obtain the highest levels of success in this patient population. 07/20/2020 11:19:27 am Achilles tendon epidemic among elite Ethiopian athletes. http://www.oapublishinglondon.com/article/684 The purpose of this study was to investigate the cause/s of Achilles tendon injury among elite Ethiopian middle and long distance athletes. The subjects of the study are 11{3 female and 8 male} athletes age ¯x=24.63, all reported to our center complaining Achilles tendon pain.Assassment card was used to carefully register the subjective and the objective findinings.Different therapeutic procedures, such as massage{manual and machine},paraffin wax, American plaster, etc was used. Most of them recovered from their pain and demonstrated full range of motion. The most probable cause is found to be training terrain and poor coaching. It can be concluded that coaches should give due attention while training on rough and tough trainees {hilly, ups and downs}. 07/20/2020 11:19:27 am Autologeous matrix-induced chondrogenesis for treating articular cartilage defects of the lower limb: a clinical overview. http://www.oapublishinglondon.com/article/685 Cartilage damage of the lower limb is a frequent problem and represents a predisposition for osteoarthritis which in consequence leads to a manifest loss of quality of life. The low intrinsic healing capacity of human articular cartilage is a well-known problem in orthopedic surgery and so a variety of surgical techniques have been developed to treat cartilage defects. The AMIC technique (Autologeous Matrix Induced Chondrogenesis) combines  microfractures with a collagen I/III scaffold (Chondro-Gide®, Geistlich Pharma AG, Switzerland) and represents an established treatment for full-thickness cartilage defects. This article reviews clinical outcome studies of the AMIC technique and gives an outlook on the upcoming modification of this technique. Material and Methods PubMed and the Cochrane database were searched to identify relevant studies. We used a comprehensive search strategy with no date or language restrictions to locate studies that examined the AMIC technique. Search keywords included cartilage, AMIC, hip, knee, ankle, Chondro-Gide. Besides this, we included our own experiences in the context of the AMIC and study authors were contacted if more and non published data were needed. Clinical studies Current studies regarding the AMIC technique for treating cartilage defects in the knee, ankle, hip and first metatarsophalangeal joint are presented. All clinical follow-up studies showed a significant increase of functional outcome scores and decline of pain scores. Summary The AMIC technique represents an effective and safe method of treating full-thickness chondral defects of the knee, ankle, hip and first metatarsophalangeal joint in selected cases. Further studies with long-term follow-up are needed whether the grafted area will maintain functional improvement and structural integrity over time. 07/20/2020 11:19:27 am A sportomic follow-up of a muscle injury succeeded by acetaminophen hepatotoxicity. http://www.oapublishinglondon.com/article/686 Purpose: To communicate the diagnosis followed by a successful treatment and rapid evolution from a silent liver injury due to the use of self-medication with large doses of acetaminophen (APAP), without a stop in training or a loss of performance. Methods: We measured the VO2max and analyzed a Sportomic profile of four national elite cyclists and diagnosed a liver injury caused by pharmaceutical abuse in one athlete. We suggested that the injured athlete decrease both training intensity and volume by 30-40% while simultaneously increasing resting and sleeping time. We discontinued the use of APAP and started a high intake of dietary methionine and cysteine together with N-acetyl-cysteine  daily. Results: After two weeks of following our regimen and dietary recommendations, the athlete reported pain relief. This change was corroborated by biochemical analysis, which showed that the amounts of creatine kinase and gamma-glutamyltransferase in the blood were less than 20% and 70% of pre-treatment levels, respectively. As a referral of our treatment, the team won third place in an 800 km cycling competition. Conclusion: This study has shown that collecting and analyzing physiological data during training can give important information about an athlete’s clinical condition as well as the degrees of performance. In this particular case, we have shown that two weeks of reduced training combined with dietary changes can promote liver recovery. The importance of this report is that we were able to diagnose and treat a silent liver injury and maintain an athlete’s performance during both training and competition. 07/20/2020 11:19:27 am The risk factors for rupture of the anterior cruciate ligament of the knee: The neuromuscular state. http://www.oapublishinglondon.com/article/687 Multiple factors act conjointly to influence the risk of injury of the anterior cruciate ligament (ACL) of the knee. An understanding of neuromuscular factors remains necessary although this does not guarantee a complete analysis of the risks of ACL injury.Women have a greater risk of ACL injury in comparison to men. This can be explained by an increase in the internal rotation of the hip coupled with an increase in the external rotation of the tibia and increased muscular activation of the quadriceps (with a concomitant decrease in hamstring activity) during landing or pivotal movements. In addition, muscular fatigue of the hamstrings and a weak hamstring/quadriceps ratio could contribute to the risk of ACL injury. Finally, a lack of relative joint laxity can also constitute a risk factor of ACL injury in women. Other potential neuromuscular risk factors could also be highlighted. Screening for these risk factors, for example by means of a functional jump-landing test together with an isokinetic test could help to recommend new prevention protocols. 07/20/2020 11:19:27 am Increased anterior translation of the knee in professional rugby players following one-hour game-related training: An etiological factor for anterior cruciate ligament ruptures? http://www.oapublishinglondon.com/article/688 Brooks et al. (2005) described that most of the injuries to the cruciate ligaments in professional rugby players were most likely to occur during the third quarter of a game. It has been proposed that a short-term increase in ACL laxity would have the potential to predispose an athlete to such injury. The purpose of this investigation was to assess whether a one hour rugby training session would increase anterior tibial translation as evaluated with a KT-1000 arthrometer. 29 professional players( age range 18- 32 SD ; +/- 3.66)  were tested immediately before and immediately after a routine 60 minute rugby training session; 15 minutes warm-up consisting of agility ladders, mini hurdles, jogging, heel flicks, cariocas, side stepping and dynamic flexibility drills, followed by rugby specific sequence moves for 40 minutes and a five minute cool down. Instrumented knee laxity testing was undertaken on both legs using a KT-1000 knee ligament arthrometer. The mean anterior excursion pre-exercise with a 20 pound displacement force was 3.67mm in the left pre exercise group and 3.46mm in the right knee. The mean excursion post-exercise was 4.46mm in the left knee and 4.97mm in the right knee. This equates to a 23% increase for the left knee and a 30% increase for the right knee. In conclusion, the study showed that a one hour rugby session significantly increased anterior tibial translation of the knee in 26 professional players. Further studies are prompted to validate this finding versus a potentially increased risk of ACL rupture. 07/20/2020 11:19:27 am The effectiveness of different exercises protocols to prevent the incidence of hamstring injury in athletes. http://www.oapublishinglondon.com/article/701 Introduction: Hamstring strains are the most prevalent non-contact injury associated with sports participation. In addition to the anatomical and functional characteristics of the hamstrings such as the biarticular organization or the dual innervations of biceps femoris, a number of alterable and non-alterable factors have been associated with the risk of hamstring injuries in athletes. Each of these variables would impact upon hamstring injury risk within an integrated approach by which the possibilityof sustaining an injury can vary depending on the particular circumstances of each athlete. Aims To examine the effects of current preventative exercise protocols and to provide basic guidelines for hamstring injury prevention in athletes. Discussion Hamstring injuries occur during high-speed actions or extreme stretching, therefore, in order to prevent the incidence of these types of injuries, specific active lengthening, stretching exercises or sports specific drills have been integrated into regular training programmes. The response to these intervention programmes has showed mixed results. A conceptual framework is presented proposing that an effective injury prevention programme should include a combination of different specific and non-specific exercises. In addition, special consideration should be given to those eccentric exercises performed over a large muscle lengths and also emphasise the knee stabilising co-contraction actions of the hamstring. Conclusions The protective effects elicited by a well designed preventive programme could be obtained in 4 weeks with only two sessions per week involving 3 sets of 6 to 8 repetitions of three open and closed kinetic chain exercises. Future research should analyse the specific structural and functional modifications elicited by the regular application of different types of exercises and protocols aimed to reduce the risk of hamstring injury. 07/20/2020 11:19:27 am Sodium supplementation during prolonged exercise: effects on plasma sodium and performance. http://www.oapublishinglondon.com/article/715 Introduction: The reported incidence of Exercise Associated Hyponatremia (EAH) (plasma sodium concentration < 135mmol/L) in endurance sport has increased notably in recent decades. Sodium supplements have been suggested to attenuate the decline in plasma sodium concentration and hence prevent the effects of EAH on performance. Methods: This article reviews intervention studies that have assessed the impact of sodium supplements on plasma sodium concentrations and/or performance during endurance exercise. Results: Despite significant results in some laboratory studies showing benefits of sodium supplementation, more recent field studies suggest sodium supplementation has little impact on plasma sodium concentration during a racing situation and no effect on performance. These discrepancies are likely due to design differences between the studies. However, a well-controlled crossover field trial in a hot environment is still needed in order to develop practical recommendations. 07/20/2020 11:19:27 am Single bundle anatomic anterior cruciate ligament reconstruction: Indications, technique and results. http://www.oapublishinglondon.com/article/770 Anterior Cruciate Ligament (ACL) is a common injury and more than 100,000 ACL reconstruction procedures are performed in the United States every year. Although widely accepted and investigated, ACL reconstruction still continues to evolve and many technical issues are under debate. These mainly include: 1) graft selection;  2) surgical technique (double versus single bundle); and 3) femoral tunnel drilling in single bundle ACL reconstruction. In this review, the authors describe the indications, surgical technique and results of anatomic ACL reconstruction. The above mentioned controversies are also discussed, through a recent literature review. 07/20/2020 11:19:27 am Injuries in karate: A review. http://www.oapublishinglondon.com/article/771 Introduction.Sport injuries usually limit training effects and often ruin athletes' careers. The goal of the present study was to review the results obtained in the studies on injuries in karate athletes. Material and Methods.A comprehensive search in the international databases of MEDLINE, Web of Science, SPORTdiscuss, Academic Search Premiere, Google Scholar was conducted. The study was based on 20 papers from reviewed journals. The particular focus was on the data concerning injury rates. Relative injury risk was computed according to the following formula: injury rate in group 1 / injury rate in group 2, where the 1st and 2nd groups represented two different levels in terms of gender, age, competitive level or changes in competitive rules. Types, location and injury patterns in different groups of karate athletes, investigated in both retrospective and prospective studies, were also analysed. Results. The retrospective studies have documented serious injuries (chiefly fractures), whereas in the prospective studies, conducted exclusively during tournaments, minor injuries were usually recorded, among which contusions were predominant. The results of the majority of the prospective studies have demonstrated higher injury risk in men compared to women. Sports skill level and tournament rank were correlated with elevated risk of injury. Regardless of the study design, injuries were mostly recorded in the area of head, face and neck.  Modifications of the fighting regulations reduced injury risk during championships. However, the risk decline was observed only for minor injuries. Conclusion. It is important to investigate the factors that reduce injury risk in sport. In karate, injuries are impossible to be entirely eliminated as the impact that exceeds tissue mechanical strength has not been excluded as the main cause of severe injuries. Among children, formal exercise (kata) and pre-arranged sparring might represent a safe alternative for karate fights. 07/20/2020 11:19:27 am Suprascapular neuropathy related to rotator cuff tears: A short review. http://www.oapublishinglondon.com/article/772 Suprascapular nerve (SSN) neuropathy related to rotator cuff tears has become a topic of discussion. However, there are few studies to support SSN neuropathy in cases of (massive) rotator cuff tears. There are also few studies showing the indication for concomitant SSN release; however, several clinical and basic studies provide some evidence that SSN injury may be a part of the disease spectrum of rotator cuff pathology. In this short review article, suprascapular neuropathy related to rotator cuff tears is discussed. 07/20/2020 11:19:27 am Achievement of peak bone mass in women is critically dependent on adolescent calcium intake. http://www.oapublishinglondon.com/article/908 Prevalence of osteoporosis is dramatically increasing.  While adequate calcium and vitamin D intake combined with weight bearing exercise is recommended throughout life to prevent osteoporosis, the adolescent growth period is increasingly recognized as a critical time period when future osteoporosis risk is established.  The review focuses on adolescent patterns of calcium consumption in relationship to future osteoporosis risk.   Dietary changes in adolescents promoting soda consumption at the expense of dairy products may underlie the increase in osteoporosis prevalence.  Prevention efforts among female adolescents need to focus on reducing soda and increasing dairy consumption, promoting wider usage of calcium and vitamin D supplementation, and expanding calcium fortification of foods that are frequently consumed by adolescents. 07/20/2020 11:19:27 am What do we know about recovery interventions used in the management of delayed-onset muscle soreness? http://www.oapublishinglondon.com/article/909 No abstract available for this type of article. 07/20/2020 11:19:27 am Differences in swimming speed on short course and long course for female and male breaststroke swimmers: A comparison of swimmers at national and international level. http://www.oapublishinglondon.com/article/910 Background:The aims were to examine (i) the difference in swimming speed in breaststroke swimmers between short (SC) and long course (LC) and (ii) the change in swimming speed across years for elite female and male swimmers competing at national and international level. Methods: Swimming speed ofbreaststroke swimmers at national level (i.e. athletes listed in Swiss swimming high score list between 2000 and 2011) and at international level (i.e. finalists of World Championships between 2001 and 2012) were analyzed for three course distances (i.e. 50m, 100m and 200m) using linear regression analyses and analysis of variance. Results:Swimming speed was faster in SC than in LC in 50m (1.8-2.6%), 100m (2.2-3.6%) and 200m (2.6-4.2 %), respectively.Swimming speed increased between 1.2% and 5.2% both for SC and LC across years, independently of the sex and the distance. For all distances, thesex difference was greater in LC than in SC. Mean values for the sex difference in swimming speed at national level were 12.1% in SC versus11.9% in LC for 50 m, 11.9% in SC versus 11.3% in LC for 100mand 11.0% in SC versus 10.7% in LC for 200m, with significant difference only for 200m LC (p=0.03). Mean values for sex difference in swimming speed at international level were 13.3% in SC versus12.7% in LC for 50m, 12.6% in SC versus 11.9% in LC for 100mand 12.1% in SC versus 11.2% in LC for 200m, only with significance for 100m SC (p=0.01). Conclusion:Elite breaststroke swimmers were ~3% faster on SC compared to LC. The sex difference in breaststroke swimming speed from 50m to 200m events was ~11% (with significance at national level on 200m LC and on international level on 100m SC) but appeared slightly greater in LC compared to SC. 07/20/2020 11:19:27 am Comparison of age of peak swimming speed in elite backstroke swimmers at national and international level. http://www.oapublishinglondon.com/article/911 Background:Previous studies suggested that the age of peak performance in freestyle swimming was ~17 years for women and ~19 years for men. Data on the age of peak swimming performance in other swim strokes such as backstroke are lacking. The present study investigated the changes in (i) swimming speed and (ii) age of peak swimming speed across years for elite female and male backstroke swimmers competing at both national and international level. Methods:The changes in age and swimming speed in 50m, 100m and 200m were analyzed for elite backstroke and freestyle swimmers at national level (i.e. Switzerland) and international level (i.e.finalists of World Championships) on 50m long coursefrom 1994 to 2011. Results: For all distances and disciplines, women reached the age of peak swimming speed at a younger age (~18-23 years) than men (~21-26 years). The age of peak swimming speed in backstroke and freestyle swimmers at national level was ~1-2 years younger than in swimmers at international level. The age of peak swimming speed increased significantly (p<0.01) between 1994 and 2011 in 50m backstroke for women from 16 to 22 years and in 50m freestyle for men from 22 to 23 years in swimmers at national level. No changes in the age of peak swimming speed were observed in swimmers at international level for both swim styles across time for both sexes (p>0.05). Swimming speed increased across years in all distances and disciplines except for 50m backstroke in women at international level (p>0.05). Conclusion: Women reached in all disciplines the age of peak swimming speed at a younger age than men. Swimmers at national level were younger than swimmers at international level. Swimming speed increased in all distances and disciplines across years in swimmers competing at both national and international level. 07/20/2020 11:19:27 am Rotator cuff tears, evaluation and treatment: a critical review. http://www.oapublishinglondon.com/article/912 Rotator cuff tears are a common cause for shoulder pain in the older population. The etiology and pathophysiology are not fully understood. Theories for tear evolvement are divided into intrinsic (e.g. recurrent microtrauma) and extrinsic (e.g. subacromial impingement). The subacromial bursa is probably the source of pain in symptomatic patients with rotator cuff tears. It is uncertain whether the tear itself can produce pain because of the high prevalence of asymptomatic tears. Typically there is a gradual increase in shoulder pain and weakness; however, it can present acutely due to an injury. Difficulties in overhead activities and night pain are common. Imaging such as ultrasound and magnetic resonance are required for accurate evaluation of rotator cuff tears in patients with ongoing pain and limitations. Primary treatment includes activities modifications, pain relief and physical therapy. Surgery is advised for acute tears in active patients or chronic symptomatic tears in patients that fail to improve. Most repairs are currently performed in an all arthroscopic minimally invasive technique with easier rehabilitation and less pain compared to the traditional open surgery. 07/20/2020 11:19:27 am Epidemiology of knee osteoarthritis. http://www.oapublishinglondon.com/article/1116 This is a review of population-based studies for knee osteoarthritis (OA). The prevalence of knee OA is much higher in Caucasians than in Asians or in black people. Few population-based studies regarding the incidence of knee OA were found, with the incidence of knee OA being higher in Japanese than in Caucasians. However, strict comparisons among these studies are limited, because the definition of the incidence of knee OA is not the same for each study. A few risk factors for knee OA were established, such as female gender and obesity. Several cross-sectional studies found that presence of a previous knee injury is significantly associated with the incidence of knee OA, but longitudinal studies did not find this significant correlation. However, the same longitudinal studies found significant associations between previous knee injuries and incident knee pain. One of the limitations in previous studies is the definition of knee OA. The most popular grading system for knee OA is the Kellgren-Lawrence (KL) Classification. However, joint space narrowing and osteophytosis cannot be separately assessed in this grading system. Recent studies suggest distinct causes for both joint space narrowing and osteophytosis. These studies also found an independent association between joint space narrowing and osteophytosis with the quality of life (QOL) of the person. To further assess new risk factors or markers, joint space narrowing and osteophytosis should be assessed separately using a fully automatic system that measures joint space width and osteophyte area. 07/20/2020 11:19:27 am Intratendinous surgery and injection treatment for midportion Achilles tendinopathy: a critical review. http://www.oapublishinglondon.com/article/1117 Treatment of chronic painful midportion Achilles tendinopathyis known to be difficult. Multiple non tendon-invasive and tendon-invasive methods are used. When traditional non invasive treatments fail, it has become increasingly popular to try injections of PRP and autologous blood, and finally intra-tendinous open surgery is instituted. There is little, if any, scientific evidence from human studies backing up intra-tendinous injection treatment, and intra-tendinous surgical treatment can also be questioned. Based on recent research using immune-histochemical analyses of tissue biopsies from patients with midportion Achilles tendinopathy, new non tendon-invasive treatment methods combined with short rehabilitation periods have been invented. These methods have shown good clinical results, few complications, and decreased tendon thickness together with improved tendon structure, over time. The new knowledge about innervations patterns, tendon cells, and the potentials in the soft tissue on the ventral (deep) side of the Achilles tendon midportion, together with the good results using treatment methods focusing on the outside of the tendon, questions the use of tendon invasive treatment methods for midportion Achilles tendinopathy. 07/20/2020 11:19:27 am Physical activity and cancer. http://www.oapublishinglondon.com/article/1210 Significance of Physical activity (PA) in all phases of cancer disease is delineated in this review. Literature indicates that PA has significant primary-preventive effects concerning various cancer entities. An entity-specific approach is needed to study the mechanisms for these effects. Numerous studies showed that PA during tumor therapy can result in a reduction of fatigue, increase of quality of life and exercise capacity and a reduction of treatment-associated disorders like fatigue, nausea, insomnia and pain. Therefore, PA during ongoing cancer treatment is considered to be an effective support therapy without any negative effects if relevant contraindications are considered. Prognosis of some malignant diseases may be modulated by PA during follow up care. Furthermore, due to its other multi-dimensional effects, PA plays an increasing role in follow-up care even independent of the influence on prognosis. Summarized, PA can be recommended during all stages of cancer disease if contraindications are followed. 07/20/2020 11:19:27 am Patellar tendinopathy: a critical review of current therapeutic options. http://www.oapublishinglondon.com/article/1211 The treatment of patellar tendinopathy remains a subject of ongoing debate in the field of and sports medicine. It was initially thought that the tendon injury produced was characterized as an inflammatory process, but this thinking has evolved to reasoning it as a cellular degenerative process so as to explain the poor evolution that tendon injuries generally show. Traditionally, conservative treatment by means of eccentric exercise was advocated, going on to surgery when good results were not obtained. The use of minimally invasive techniques has grown in popularity over recent years. Currently, there is a significant therapeutic arsenal at our disposal in clinical practice that ranges from the use of shock waves, growth factors, sclerosis of neovessels using polidocanol or techniques such as Intratissue percutaneous electrolysis (EPI®). Despite the abundance of literature on the treatment of tendinopathy, there are few studies of high scientific evidence. Thus, the choice of a therapeutic method as a gold standard remains a point of debate. This present critical review, focused on the treatment of patellar tendinopathy, aims to shine a light on the different studies of each of these treatment options by analyzing each ones level of scientific evidence. 07/20/2020 11:19:27 am Concepts of ankle instability: A review. http://www.oapublishinglondon.com/article/1344 The article has been forwarded to the production team. The processing may take few weeks. Then the proof will be forwarded to the corresponding author. The final PDF and HTML files will be uploaded when the corrections to the proof are returned by the corresponding author. 07/20/2020 11:19:27 am