The asthmatic athlete: inhaled Beta-2 agonists, sport performance, and doping.

Clin J Sport Med. 2011 Jan;21(1):46-50.

McKenzie DC, Fitch KD.

Division of Sports Medicine, School of Human Kinetics, The University of British Columbia, 3055 Wesbrook Mall, Vancouver, BC, Canada. don.mckenzie@shaw.ca

Abstract

The asthmatic athlete has a long history in competitive sport in terms of success in performance and issues related to doping. Well documented are detailed objective tests used to evaluate the athlete with symptoms of asthma or airway hyperresponsiveness and the medical management. Initiated at the 2002 Salt Lake City Games, the International Olympic Committee's Independent Asthma Panel required testing to justify the use of inhaled beta-2 agonists (IBAs) in Olympic athletes and has provided valuable guidelines to the practicing physician. This program was educational and documented the variability in prevalence of asthma and/or airway hyperresponsiveness and IBA use between different sports and different countries. It provided a standard of care for the athlete with respiratory symptoms and led to the discovery that asthmatic Olympic athletes outperformed their peers at both Summer and Winter Olympic Games from 2002 to 2010. Changes to the World Anti-Doping Agency's Prohibited List in 2010 permitted the use of 2 IBA produced by the same pharmaceutical company. All others remain prohibited. However, there is no pharmacological difference between the permitted and prohibited IBAs. As a result of these changes, asthmatic athletes are being managed differently based on a World Anti-Doping Agency directive that has no foundation in pharmacological science or in clinical practice.

Hip pain referral patterns in patients with labral tears: analysis based on intra-articular anesthetic injections, hip arthroscopy, and a new pain "circle" diagram.

Phys Sportsmed. 2011 Feb;39(1):29-35.

Arnold DR, Keene JS, Blankenbaker DG, Desmet AA.

Division of Sports Medicine, Department of Orthopaedic Surgery, University of Wisconsin-Madison, Madison, WI.

Abstract

Background: Fluoroscopically guided intra-articular (FGIA) anesthetic hip joint injections have been used to determine whether the hip joint is the source of a patient's hip pain. However, there have been no reports documenting the efficacy of their use for defining the pain referral patterns (PRPs) of patients with labral tears. The aim of this study was to determine the PRPs of patients with labral tears and evaluate a new pain "circle" diagram (PCD) developed for this analysis. Methods: Fifty-two patients were evaluated at our institution who had: 1) a preoperative FGIA anesthetic hip joint injection; 2) completed our PCD and a visual analog pain scale pre- and postinjection; 3) significant (≥ 80%) pain reduction after their FGIA injection; and 4) a labral tear and minimal (≤ grade II) degenerative joint disease, as documented by hip arthroscopy. The PCD had circles in which patients put an "X" in to indicate pain in the following locations: anterior superior spine, lateral peritrochanteric area, central groin, symphysis pubis, proximal inner thigh, anterior thigh, posterior iliac crest, sacroiliac joint, sciatic notch, and ischial tuberosity. Results: Based on the percentage of patients with significant (≥ 80%) pain reduction after administration of FGIA, 2 areas demonstrated substantially more and consistent presence of pain, which improved after injection. These were the central groin (P < 0.001) and the lateral peritrochanteric area (P = 0.02). Conclusion: The most common locations of pain were the central groin and the lateral peritrochanteric area. The least common were the ischial tuberosity and the anterior thigh, which are 2 areas often associated with osteoarthritis of the hip. The use of the PCD combined with an FGIA anesthetic injection may help physicians reconcile the expectations of those patients with labral tears who believe that hip arthroscopy will treat their multiple areas of "hip" pain.

A return-to-sport algorithm for acute hamstring injuries

Phys Ther Sport. 2011 Feb;12(1):2-14. Epub 2010 Aug 21.

Mendiguchia J, Brughelli M.

Head of Rehabilitation Department at Athletic Club de Bilbao, Garaioltza 147 CP:48196, Lezama (Bizkaia), Spain. jurdan24@hotmail.com

Abstract

Acute hamstring injuries are the most prevalent muscle injuries reported in sport. Despite a thorough and concentrated effort to prevent and rehabilitate hamstring injuries, injury occurrence and re-injury rates have not improved over the past 28 years. This failure is most likely due to the following: 1) an over-reliance on treating the symptoms of injury, such as subjective measures of "pain", with drugs and interventions; 2) the risk factors investigated for hamstring injuries have not been related to the actual movements that cause hamstring injuries i.e. not functional; and, 3) a multi-factorial approach to assessment and treatment has not been utilized. The purpose of this clinical commentary is to introduce a model for progression through a return-to-sport rehabilitation following an acute hamstring injury. This model is developed from objective and quantifiable tests (i.e. clinical and functional tests) that are structured into a step-by-step algorithm. In addition, each step in the algorithm includes a treatment protocol. These protocols are meant to help the athlete to improve through each phase safely so that they can achieve the desired goals and progress through the algorithm and back to their chosen sport. We hope that this algorithm can serve as a foundation for future evidence based research and aid in the development of new objective and quantifiable testing methods.

Skin-Derived Tenocyte-like Cells for the Treatment of Patellar Tendinopathy

1. Andrew W. Clarke, FRANZCR*†,
2. Faisal Alyas, FRCR†,
3. Tim Morris‡,
4. Claire J. Robertson, MSc, PGCE, MCSP§,
5. Jonathan Bell, FRCS(Orth)‖ and
6. David A. Connell, FRANZCR†

+ Author Affiliations

1. ^†Department of Radiology, Royal National Orthopaedic Hospital NHS Trust, London, United Kingdom
2. ^‡MRC Clinical Trials Unit, London, United Kingdom
3. ^§University of London, London, United Kingdom
4. ^‖Kingston Hospital NHS Trust, Surrey, United Kingdom
5. Investigation performed at Royal National Orthopaedic Hospital, Stanmore, United Kingdom

1. *Andrew W. Clarke, Department of Radiology, Royal National Orthopaedic Hospital NHS Trust, Brockley Hill, Stanmore, Middlesex, London HA7 4LP United Kingdom (e-mail: david.connell@googlemail.com).

Abstract

Background: Recent research of lateral elbow tendinopathy has led to the use of laboratory-amplified tenocyte-like cells.

Hypothesis: Ultrasound-guided injection of autologous skin-derived tendon-like cells are effective compared with other injectable therapies for the treatment of refractory patellar tendinosis.

Study Design: Randomized controlled trial; Level of evidence, 1.

Methods: From 60 patellar tendons in 46 patients with refractory patellar tendinopathy, a 4-mm skin biopsy was sampled to grow tenocyte-like collagen-producing cells. Patients were allocated into 2 groups: (1) injection with laboratory-prepared, amplified collagen-producing cells derived from dermal fibroblasts and suspended in autologous plasma from centrifuged autologous whole blood or (2) injection with autologous plasma alone. Injections were made into the sites of hypoechogenicity, intrasubstance tears, and fibrillar discontinuity within the patellar tendon. The Victorian Institute of Sport Assessment (VISA) score was used to assess pain, severity, and functional disability. Ultrasound was performed to assess structural and blood flow changes, evaluating 4 criteria: tendon thickness, hypoechogenicity, intrasubstance tears, and neovascularity.

Results: In the cell group, mean VISA scores improved from 44 ± 15 before treatment to 75 ± 17 at 6 months; in the plasma group, from 50 ± 18 to 70 ± 14. Estimated average difference between groups was 8.1, a significantly higher score in the cell group. Patients treated with collagen-producing cells also had significantly faster improvement and a highly significant effect of treatment, with the difference between groups estimated as 2.5 per unit increase in . One patient treated with cell therapy had a late rupture and progressed to surgery; histopathology showed normal tendon structure.

Conclusion: Ultrasound-guided injection of autologous skin-derived tendon-like cells can be safely used in the short term to treat patellar tendinopathy, with faster response of treatment and significantly greater improvement in pain and function than with plasma alone.