Prevention of non-contact anterior cruciate ligament injuries in soccer players. Part 1: Mechanisms of injury and underlying risk factors

Knee Surg Sports Traumatol Arthrosc (2009) 17:705–729
Soccer is the most commonly played sport in the world, with an estimated 265 million active soccer players by 2006. Inherent to this sport is the higher risk of injury to the anterior cruciate ligament (ACL) relative to other sports. ACL injury causes the most time lost from competition in soccer which has influenced a strong research focus to determine the risk factors for injury. This research emphasis has afforded a rapid influx of literature defining potential modifiable and non-modifiable risk factors that increase the risk of injury. The purpose of the current review is to sequence the most recent literature that reports potential mechanisms and risk factors for non-contact ACL injury in soccer players. Most ACL tears in soccer players are non-contact in nature. Common playing situations precluding a non-contact ACL injury include: change of direction or cutting maneuvers combined with deceleration, landing from a jump in or near full extension, and pivoting with knee near full extension and a planted foot. The most common non-contact ACL injury mechanism include a deceleration task with high knee internal extension torque (with or without perturbation) combined with dynamic valgus rotation with the body weight shifted over the injured leg and the plantar surface of the foot fixed flat on the playing surface. Potential extrinsic non-contact ACL injury risk factors include: dry weather and surface, and artificial surface instead of natural grass. Commonly purported intrinsic risk factors include: generalized and specific knee joint laxity, small and narrow intercondylar notch width (ratio of notch width to the diameter and cross sectional area of the ACL), pre-ovulatory phase of menstrual cycle in females not using oral contraceptives, decreased relative (to quadriceps) hamstring strength and recruitment, muscular fatigue by altering neuromuscular control, decreased “core” strength and proprioception, low trunk, hip, and knee flexion angles, and high dorsiflexion of the ankle when performing sport tasks, lateral trunk displacement and hip adduction combined with increased knee abduction moments (dynamic knee valgus), and increased hip internal rotation and tibial external rotation with or without foot pronation. The identified mechanisms and risk factors for non-contact ACL injuries have been mainly studied in female soccer players; thus, further research in male players is warranted. Non-contact ACL injuries in soccer players likely has a multi-factorial etiology. The identification of those athletes at increased risk may be a salient first step before designing and implementing specific pre-season and in-season training programs aimed to modify the identified risk factors and to decrease ACL injury rates. Current evidence indicates that this crucial step to prevent ACL injury is the only option to effectively prevent the sequelae of osteoarthritis associated with this traumatic injury.

Platelet-Rich Plasma

The American Journal of Sports Medicine 37:2259-2272 (2009)
Platelet-rich plasma (PRP) has been utilized in surgery for 2 decades; there has been a recent interest in the use of PRP for the treatment of sports-related injuries. PRP contains growth factors and bioactive proteins that influence the healing of tendon, ligament, muscle, and bone. This article examines the basic science of PRP, and it describes the current clinical applications in sports medicine. This study reviews and evaluates the human studies that have been published in the orthopaedic surgery and sports medicine literature. The use of PRP in amateur and professional sports is reviewed, and the regulation of PRP by antidoping agencies is discussed.

Recreational soccer is an effective health-promoting activity for untrained men

British Journal of Sports Medicine 2009;43:825-831
To examine the effects of regular participation in recreational soccer on health profile, 36 healthy untrained Danish men aged 20–43 years were randomised into a soccer group, a running group and a control group. Training was performed for 1 h two or three times per week for 12 weeks.
In conclusion, participation in regular recreational soccer training, organised as small-sided drills, has significant beneficial effects on health profile and physical capacity for untrained men, and in some aspects it is superior to frequent moderate-intensity running.

Non-steroidal anti-inflammatory drugs in sports medicine: guidelines for practical but sensible use

British Journal of Sports Medicine 2009;43:863-865
The authors recommend an approach to NSAID use in sports medicine whereby simple analgesia is preferentially used when analgesia is the primary desired outcome. However, based both on the current pathophysiological understanding of most injury presentations and the frequency that inflammation may actually be a component of the injury complex, it is premature to suppose that NSAID are not useful to the physician managing sports injuries. The prescribing of NSAID should be cautious and both situation and pathology specific. Both dose and duration minimisation should be prioritised and combined with simple principles of protection, rest, ice, compression, elevation (PRICE), which should allow NSAID-sparing. NSAID use should always be coupled with appropriate physical rehabilitation.  NSAID are probably most useful for treating nerve and soft-tissue impingements, inflammatory arthropathies and tenosynovitis. They are not generally indicated for isolated chronic tendinopathy, or for fractures. The use of NSAID in treating muscle injury is controversial. Conditions in which NSAID use requires more careful assessment include ligament injury, joint injury, osteoarthritis, haematoma and postoperatively.

BJSM reviews: A–Z of nutritional supplements: dietary supplements, sports nutrition foods and Ergogenic aids for health and performance Part 3

British Journal of Sports Medicine 2009;43:890-892

Until recently we have considered free oxygen radical production in the body to be a solely "negative" occurrence that might be countered by supplementation with antioxidant nutrients. The supposed benefits included improved health and mortality, and for athletes, the extra advantages of enhanced performance through a reduction in exercise-induced damage. In fact, as discussed below, The Cochrane Review¹ found little or no difference in the normal population between antioxidant administration and those taking a placebo. Mortality was, in fact, slightly higher in the antioxidant group. The review focuses on antioxidant supplementation in athletes and includes the possibility that some oxidative species play a positive role in the adaptation to exercis

Setting Standards For The Prevention And Management Of Travellers’ Diarrhoea In Elite Athletes: An Audit Of One Team During The Youth Commonwealth Games In India

Br J Sports Med. Published Online First: 25 October 2009
Hygiene guidelines included only drinking bottled water, eating hot food and regular hand washing with alcohol gel. Ciprofloxacin was offered to non athlete team members as prophylaxis but not to athletes due to its possible association with tendon disease. Rifaximin may be an alternative for this group.

A–Z of supplements: dietary supplements, sports nutrition foods and ergogenic aids for health and performance Part 2

British Journal of Sports Medicine 2009;43:807-810
The subject of supplements is of crucial importance and there is a vital need for reliable, balanced and unbiased information for athletes and their support staff. The use and potential for abuse of supplements by athletes have been of concern to all those involved in supporting athletes for many years. Of primary concern is the health of the athlete. Performance issues are secondary and performance will only be helped if optimum health is  maintained. The ergogenic effects of many supplements are controversial and good evidence for efficacy is rare.
This 2. part covers:
AMINO ACIDS, ANDROSTENEDIONE, ARGININE,ASPARAGINE AND ASPARTATE

A–Z of supplements: dietary supplements, sports nutrition foods and ergogenic aids for health and performance Part 1

British Journal of Sports Medicine 2009;43:728-729

All the above terms (and more) have been used to entice the unwary (and wary!) athlete to spend money on dietary products that claim to enhance their health and sports performance.

The Oxford English Dictionary definition of suppplement is: "Something added to supply a deficiency". Yet many supplements, or their individual ingredients, are nutrients or food chemicals for which the body does not have an estimated or theoretical requirement. Thus there are clearly other factors that underpin their use by athletes.

There are many reviews on supplementation in athletes, some of which are very good. Our aim is not to replicate these, but to give a series of very brief overviews, some of which will be by experts in the field. Our main aim is simply to demystify some of the many supplements on the market in order to provide a useful
resource for athletes, sport and exercise enthusiasts, along with allied professionals such as nutritionists, coaches, physiotherapists and doctors.