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British Journal of Sports Medicine Aug 2016To systematically review the evidence base related to hamstring strength and flexibility in previously injured hamstrings. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To systematically review the evidence base related to hamstring strength and flexibility in previously injured hamstrings.
DESIGN
Systematic review and meta-analysis.
DATA SOURCES
A systematic literature search was conducted of PubMed, CINAHL, SPORTDiscus, Cochrane Library, Web of Science and EMBASE from inception to August 2015.
INCLUSION CRITERIA
Full-text English articles which included studies which assessed at least one measure of hamstring strength or flexibility in men and women with prior hamstring strain injury within 24 months of the testing date.
RESULTS
Twenty-eight studies were included in the review. Previously injured legs demonstrated deficits across several variables. Lower isometric strength was found <7 days postinjury (d=-1.72), but this did not persist beyond 7 days after injury. The passive straight leg raise was restricted at multiple time points after injury (<10 days, d=-1.12; 10-20 days, d=-0.74; 20-30 days, d=-0.40), but not after 40-50 days postinjury. Deficits remained after return to play in isokinetically measured concentric (60°/s, d=-0.33) and Nordic eccentric knee flexor strength (d=-0.39). The conventional hamstring to quadricep strength ratios were also reduced well after return to play (60:60°/s, d=-0.32; 240:240°/s, d=-0.43) and functional (30:240°/s, d=-0.88), but these effects were inconsistent across measurement methods.
CONCLUSIONS
After hamstring strain, acute isometric and passive straight leg raise deficits resolve within 20-50 days. Deficits in eccentric and concentric strength and strength ratios persist after return to play, but this effect was inconsistent across measurement methods. Flexibility and isometric strength should be monitored throughout rehabilitation, but dynamic strength should be assessed at and following return to play.
Topics: Adolescent; Adult; Exercise Test; Female; Hamstring Muscles; Humans; Isometric Contraction; Knee Joint; Male; Middle Aged; Muscle Strength; Return to Sport; Sprains and Strains; Torque; Young Adult
PubMed: 27075962
DOI: 10.1136/bjsports-2015-095311 -
The Cochrane Database of Systematic... Nov 2014Background Deep transverse friction massage, one of several physical therapy interventions suggested for the management of tendinitis pain, was first demonstrated in the... (Meta-Analysis)
Meta-Analysis Review
Background Deep transverse friction massage, one of several physical therapy interventions suggested for the management of tendinitis pain, was first demonstrated in the 1930s by Dr James Cyriax, a renowned orthopedic surgeon in England. Its goal is to prevent abnormal fibrous adhesions and abnormal scarring. This is an update of a Cochrane review first published in 2001.Objectives To assess the benefits and harms of deep transverse friction massage for treating lateral elbow or lateral knee tendinitis.Search methods We searched the following electronic databases: the specialized central registry of the Cochrane Field of Physical and Related Therapies,the Cochrane Central Register of Controlled Trials (CENTRAL),MEDLINE, EMBASE, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Clinicaltrials.gov, and the Physiotherapy Evidence Database (PEDro), up until July 2014. The reference lists of these trials were consulted for additional studies.Selection criteria All randomized controlled trials (RCTs) and controlled clinical trials (CCTs) comparing deep transverse friction massage with control or other active interventions for study participants with two eligible types of tendinitis (ie, extensor carpi radialis tendinitis (lateral elbow tendinitis, tennis elbow or lateral epicondylitis or lateralis epicondylitis humeri) and iliotibial band friction syndrome (lateral knee tendinitis)) were selected. Only studies published in English and French languages were included.Data collection and analysis Two review authors independently assessed the studies on the basis of inclusion and exclusion criteria. Results of individual trials were extracted from the included study using extraction forms prepared by two independent review authors before the review was begun.Data were cross-checked by a third review author. Risk of bias of the included studies was assessed using the "Risk of bias"tool of The Cochrane Collaboration. A pooled analysis was performed using mean difference (MD) for continuous outcomes and risk ratio (RR)for dichotomous outcomes with 95% confidence intervals (CIs).Main results Two RCTs (no new additional studies in this update) with 57 participants met the inclusion criteria. These studies demonstrated high risk of performance and detection bias, and the risk of selection, attrition, and reporting bias was unclear.The first study included 40 participants with lateral elbow tendinitis and compared (1) deep transverse friction massage combined with therapeutic ultrasound and placebo ointment (n = 11) versus therapeutic ultrasound and placebo ointment only (n = 9) and (2)deep transverse friction massage combined with phonophoresis (n = 10) versus phonophoresis only (n = 10). No statistically significant differences were reported within five weeks for mean change in pain on a 0 to 100 visual analog scale (VAS) (MD -6.60, 95%CI -28.60 to 15.40; 7% absolute improvement), grip strength measured in kilograms of force (MD 0.10, 95% CI -0.16 to 0.36) and function ona 0 to 100 VAS (MD -1.80, 95% CI -0.18.64 to 15.04; 2% improvement), pain-free function index measured as the number of painfree items (MD 1.10, 95% CI -1.00 to 3.20) and functional status (RR 3.3, 95% CI 0.4 to 24.3) for deep transverse friction massage,and therapeutic ultrasound and placebo ointment compared with therapeutic ultrasound and placebo ointment only. Likewise for deep transverse friction massage and phonophoresis compared with phonophoresis alone, no statistically significant differences were found for pain (MD -1.2, 95% CI -20.24 to 17.84; 1% improvement), grip strength (MD -0.20, 95% CI -0.46 to 0.06) and function (MD3.70, 95% CI -14.13 to 21.53; 4% improvement). In addition, the GRADE (Grades of Recommendation, Assessment, Development and Evaluation) approach was used to evaluate the quality of evidence for the pain outcome, which received a score of "very low".Pain relief of 30% or greater, quality of life, patient global assessment, adverse events, and withdrawals due to adverse events were not assessed or reported.The second study included 17 participants with iliotibial band friction syndrome (knee tendinitis) and compared deep transverse friction massage with physical therapy intervention versus physical therapy intervention alone, at two weeks. Deep transverse friction massage with physical therapy intervention showed no statistically significant differences in the three measures of pain relief on a 0 to 10 VAS when compared with physical therapy alone: daily pain (MD -0.40, 95% CI -0.80 to -0.00; absolute improvement 4%), pain while running (scale from 0 to 150) (MD -3.00, 95% CI -11.08 to 5.08), and percentage of maximum pain while running (MD -0.10, 95% CI -3.97 to 3.77). For the pain outcome, absolute improvement showed a 4% reduction in pain. However, the quality of the body of evidence received a grade of "very low."Pain relief of 30% or greater, function, quality of life, patient global assessment of success, adverse events, and withdrawals due to adverse events were not assessed or reported.Authors' conclusions We do not have sufficient evidence to determine the effects of deep transverse friction on pain, improvement in grip strength, and functional status for patients with lateral elbow tendinitis or knee tendinitis, as no evidence of clinically important benefits was found.The confidence intervals of the estimate of effects overlapped the null value for deep transverse friction massage in combination with physical therapy compared with physical therapy alone in the treatment of lateral elbow tendinitis and knee tendinitis. These conclusions are limited by the small sample size of the included randomized controlled trials. Future trials, utilizing specific methods and adequate sample sizes, are needed before conclusions can be drawn regarding the specific effects of deep transverse friction massage on lateral elbow tendinitis.
Topics: Combined Modality Therapy; Cryotherapy; Humans; Iliotibial Band Syndrome; Massage; Ointments; Phonophoresis; Randomized Controlled Trials as Topic; Rest; Tennis Elbow; Ultrasonic Therapy
PubMed: 25380079
DOI: 10.1002/14651858.CD003528.pub2 -
The Cochrane Database of Systematic... Feb 2023Carpal tunnel syndrome (CTS) is a compression neuropathy of the median nerve causing pain and numbness and tingling typically in the thumb, index and middle finger. It... (Review)
Review
BACKGROUND
Carpal tunnel syndrome (CTS) is a compression neuropathy of the median nerve causing pain and numbness and tingling typically in the thumb, index and middle finger. It sometimes results in muscle wasting, diminished sensitivity and loss of dexterity. Splinting the wrist (with or without the hand) using an orthosis is usually offered to people with mild-to-moderate findings, but its effectiveness remains unclear.
OBJECTIVES
To assess the effects (benefits and harms) of splinting for people with CTS.
SEARCH METHODS
On 12 December 2021, we searched the Cochrane Neuromuscular Specialised Register, CENTRAL, MEDLINE, Embase, AMED, CINAHL, ClinicalTrials.gov, and WHO ICTRP with no limitations. We checked the reference lists of included studies and relevant systematic reviews for studies.
SELECTION CRITERIA
Randomised trials were included if the effect of splinting could be isolated from other treatment modalities. The comparisons included splinting versus no active treatment (or placebo), splinting versus another disease-modifying non-surgical treatment, and comparisons of different splint-wearing regimens. We excluded studies comparing splinting with surgery or one splint design with another. We excluded participants if they had previously undergone surgical release.
DATA COLLECTION AND ANALYSIS
Review authors independently selected trials for inclusion, extracted data, assessed study risk of bias and the certainty in the body of evidence for primary outcomes using the GRADE approach, according to standard Cochrane methodology.
MAIN RESULTS
We included 29 trials randomising 1937 adults with CTS. The trials ranged from 21 to 234 participants, with mean ages between 42 and 60 years. The mean duration of CTS symptoms was seven weeks to five years. Eight studies with 523 hands compared splinting with no active intervention (no treatment, sham-kinesiology tape or sham-laser); 20 studies compared splinting (or splinting delivered along with another non-surgical intervention) with another non-surgical intervention; and three studies compared different splinting regimens (e.g. night-time only versus full time). Trials were generally at high risk of bias for one or more domains, including lack of blinding (all included studies) and lack of information about randomisation or allocation concealment in 23 studies. For the primary comparison, splinting compared to no active treatment, splinting may provide little or no benefits in symptoms in the short term (< 3 months). The mean Boston Carpal Tunnel Questionnaire (BCTQ) Symptom Severity Scale (SSS) (scale 1 to 5, higher is worse; minimal clinically important difference (MCID) 1 point) was 0.37 points better with splint (95% confidence interval (CI) 0.82 better to 0.08 worse; 6 studies, 306 participants; low-certainty evidence) compared with no active treatment. Removing studies with high or unclear risk of bias due to lack of randomisation or allocation concealment supported our conclusion of no important effect (mean difference (MD) 0.01 points worse with splint; 95% CI 0.20 better to 0.22 worse; 3 studies, 124 participants). In the long term (> 3 months), we are uncertain about the effect of splinting on symptoms (mean BCTQ SSS 0.64 better with splinting; 95% CI 1.2 better to 0.08 better; 2 studies, 144 participants; very low-certainty evidence). Splinting probably does not improve hand function in the short term and may not improve hand function in the long term. In the short term, the mean BCTQ Functional Status Scale (FSS) (1 to 5, higher is worse; MCID 0.7 points) was 0.24 points better (95% CI 0.44 better to 0.03 better; 6 studies, 306 participants; moderate-certainty evidence) with splinting compared with no active treatment. In the long term, the mean BCTQ FSS was 0.25 points better (95% CI 0.68 better to 0.18 worse; 1 study, 34 participants; low-certainty evidence) with splinting compared with no active treatment. Night-time splinting may result in a higher rate of overall improvement in the short term (risk ratio (RR) 3.86, 95% CI 2.29 to 6.51; 1 study, 80 participants; number needed to treat for an additional beneficial outcome (NNTB) 2, 95% CI 2 to 2; low-certainty evidence). We are uncertain if splinting decreases referral to surgery, RR 0.47 (95% CI 0.14 to 1.58; 3 studies, 243 participants; very low-certainty evidence). None of the trials reported health-related quality of life. Low-certainty evidence from one study suggests that splinting may have a higher rate of adverse events, which were transient, but the 95% CIs included no effect. Seven of 40 participants (18%) reported adverse effects in the splinting group and 0 of 40 participants (0%) in the no active treatment group (RR 15.0, 95% CI 0.89 to 254.13; 1 study, 80 participants). There was low- to moderate-certainty evidence for the other comparisons: splinting may not provide additional benefits in symptoms or hand function when given together with corticosteroid injection (moderate-certainty evidence) or with rehabilitation (low-certainty evidence); nor when compared with corticosteroid (injection or oral; low certainty), exercises (low certainty), kinesiology taping (low certainty), rigid taping (low certainty), platelet-rich plasma (moderate certainty), or extracorporeal shock wave treatment (moderate certainty). Splinting for 12 weeks may not be better than six weeks, but six months of splinting may be better than six weeks of splinting in improving symptoms and function (low-certainty evidence).
AUTHORS' CONCLUSIONS
There is insufficient evidence to conclude whether splinting benefits people with CTS. Limited evidence does not exclude small improvements in CTS symptoms and hand function, but they may not be clinically important, and the clinical relevance of small differences with splinting is unclear. Low-certainty evidence suggests that people may have a greater chance of experiencing overall improvement with night-time splints than no treatment. As splinting is a relatively inexpensive intervention with no plausible long-term harms, small effects could justify its use, particularly when patients are not interested in having surgery or injections. It is unclear if a splint is optimally worn full time or at night-time only and whether long-term use is better than short-term use, but low-certainty evidence suggests that the benefits may manifest in the long term.
Topics: Adult; Humans; Middle Aged; Carpal Tunnel Syndrome; Hand; Occupational Therapy; Quality of Life; Upper Extremity
PubMed: 36848651
DOI: 10.1002/14651858.CD010003.pub2 -
Neurologia 2018Carpal tunnel syndrome (CTS) is the most common peripheral neuropathy. It is characterised by the compression of the median nerve in the carpal tunnel. CTS presents a...
BACKGROUND
Carpal tunnel syndrome (CTS) is the most common peripheral neuropathy. It is characterised by the compression of the median nerve in the carpal tunnel. CTS presents a high prevalence and it is a disabling condition from the earliest stages. Severe cases are usually treated surgically, while conservative treatment is recommended in mild to moderate cases. The aim of this systematic review is to present the conservative treatments and determine their effectiveness in mild-to-moderate cases of CTS over the last 15 years.
METHODS
A systematic review was performed according to PRISMA criteria. We used the Medline, PEDro, and Cochrane databases to find and select randomised controlled clinical trials evaluating the effects of conservative treatment on the symptoms and functional ability of patients with mild to moderate CTS; 32 clinical trials were included. There is evidence supporting the effectiveness of oral drugs, although injections appear to be more effective. Splinting has been shown to be effective, and it is also associated with use of other non-pharmacological techniques. Assessments of the use of electrotherapy techniques alone have shown no conclusive results about their effectiveness. Other soft tissue techniques have also shown good results but evidence on this topic is limited. Various treatment combinations (drug and non-pharmacological treatments) have been proposed without conclusive results.
CONCLUSIONS
Several conservative treatments are able to relieve symptoms and improve functional ability of patients with mild-to-moderate CTS. These include splinting, oral drugs, injections, electrotherapy, specific manual techniques, and neural gliding exercises as well as different combinations of the above. We have been unable to describe the best technique or combination of techniques due to the limitations of the studies; therefore, further studies of better methodological quality are needed.
Topics: Carpal Tunnel Syndrome; Conservative Treatment; Humans; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 27461181
DOI: 10.1016/j.nrl.2016.05.018 -
International Journal of Environmental... Feb 2021(1) Background: Carpal tunnel syndrome (CTS) is the most common peripheral neuropathy in the upper extremity. Conservative treatment has been effective for mild and... (Review)
Review
(1) Background: Carpal tunnel syndrome (CTS) is the most common peripheral neuropathy in the upper extremity. Conservative treatment has been effective for mild and moderate idiopathic CTS. However, severe CTS and systemic conditions were an exclusion criterion from the studies. The aim of this study is to review the effectiveness of conservative treatment in patients with CTS regardless of the level of severity and the presence or not of systemic diseases in the last ten years. (2) Methods: Randomized controlled clinical trials that compared the effect of conservative treatment on the Boston questionnaire and pain were selected. PubMed, PEDro, Scopus, Cochrane, and Web of Science databases were used. PRISMA statement checklist was performed. (3) Results: 876 studies were recorded, 29 were selected. Pharmacology, Electrotherapy and Manual Therapy had benefits for CTS. Electrotherapy and manual therapy could be effective for severe CTS patients with a systemic condition in the short term, but there was a low percentage of these patients included in the studies. (4) Conclusion: Some pharmacological treatments, manual therapy and electrotherapy have shown benefits for handling CTS, although the most effective combination of techniques is unknown. It would be necessary to include patients with systemic conditions in the selection criteria for future studies.
Topics: Boston; Carpal Tunnel Syndrome; Conservative Treatment; Humans; Musculoskeletal Manipulations; Pain; Treatment Outcome
PubMed: 33671060
DOI: 10.3390/ijerph18052365 -
The Cochrane Database of Systematic... Nov 2016Ulnar neuropathy at the elbow (UNE) is the second most common entrapment neuropathy after carpal tunnel syndrome. Treatment may be conservative or surgical, but optimal... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Ulnar neuropathy at the elbow (UNE) is the second most common entrapment neuropathy after carpal tunnel syndrome. Treatment may be conservative or surgical, but optimal management remains controversial. This is an update of a review first published in 2010 and previously updated in 2012.
OBJECTIVES
To determine the effectiveness and safety of conservative and surgical treatment in ulnar neuropathy at the elbow (UNE). We intended to test whether:- surgical treatment is effective in reducing symptoms and signs and in increasing nerve function;- conservative treatment is effective in reducing symptoms and signs and in increasing nerve function;- it is possible to identify the best treatment on the basis of clinical, neurophysiological, or nerve imaging assessment.
SEARCH METHODS
On 31 May 2016 we searched the Cochrane Neuromuscular Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, AMED, CINAHL Plus, and LILACS. We also searched PEDro (14 October 2016), and the papers cited in relevant reviews. On 4 July 2016 we searched trials registries for ongoing or unpublished trials.
SELECTION CRITERIA
The review included only randomised controlled clinical trials (RCTs) or quasi-RCTs evaluating people with clinical symptoms suggesting the presence of UNE. We included trials evaluating all forms of surgical and conservative treatments. We considered studies regarding therapy of UNE with or without neurophysiological evidence of entrapment.
DATA COLLECTION AND ANALYSIS
Two review authors independently reviewed titles and abstracts of references retrieved from the searches and selected all potentially relevant studies. The review authors independently extracted data from included trials and assessed trial quality. We contacted trial investigators for any missing information.
MAIN RESULTS
We identified nine RCTs (587 participants) for inclusion in the review, of which three studies were found at this update. The sequence generation was inadequate in one study and not described in three studies. We performed two meta-analyses to evaluate the clinical (3 trials, 261 participants) and neurophysiological (2 trials, 101 participants) outcomes of simple decompression versus decompression with submuscular or subcutaneous transposition; four trials in total examined this comparison.We found no difference between simple decompression and transposition of the ulnar nerve for both clinical improvement (risk ratio (RR) 0.93, 95% confidence interval (CI) 0.80 to 1.08; moderate-quality evidence) and neurophysiological improvement (mean difference (in m/s) 1.47, 95% CI -0.94 to 3.87). The number of participants to clinically improve was 91 out of 131 in the simple decompression group and 97 out of 130 in the transposition group. Transposition showed a higher number of wound infections (RR 0.32, 95% CI 0.12 to 0.85; moderate-quality evidence).In one trial (47 participants), the authors compared medial epicondylectomy with anterior transposition and found no difference in clinical and neurophysiological outcomes.In one trial (48 participants), the investigators compared subcutaneous transposition with submuscular transposition and found no difference in clinical outcomes.In one trial (54 participants for 56 nerves treated), the authors found no difference between endoscopic and open decompression in improving clinical function.One trial (51 participants) assessed conservative treatment in clinically mild or moderate UNE. Based on low-quality evidence, the trial authors found that information on avoiding prolonged movements or positions was effective in improving subjective discomfort. Night splinting and nerve gliding exercises in addition to information provision did not result in further improvement.One trial (55 participants) assessed the effectiveness of corticosteroid injection and found no difference versus placebo in improving symptoms at three months' follow-up.
AUTHORS' CONCLUSIONS
We found only two studies of treatment of ulnar neuropathy using conservative treatment as the comparator. The available comparative treatment evidence is not sufficient to support a multiple treatment meta-analysis to identify the best treatment for idiopathic UNE on the basis of clinical, neurophysiological, and imaging characteristics. We do not know when to treat a person with this condition conservatively or surgically. Moderate-quality evidence indicates that simple decompression and decompression with transposition are equally effective in idiopathic UNE, including when the nerve impairment is severe. Decompression with transposition is associated with more deep and superficial wound infections than simple decompression, also based on moderate-quality evidence. People undergoing endoscopic surgery were more likely to have a haematoma. Evidence from one small RCT of conservative treatment showed that in mild cases, information on movements or positions to avoid may reduce subjective discomfort.
Topics: Decompression, Surgical; Elbow; Exercise Therapy; Humans; Nerve Transfer; Patient Education as Topic; Randomized Controlled Trials as Topic; Splints; Ulna; Ulnar Nerve; Ulnar Nerve Compression Syndromes
PubMed: 27845501
DOI: 10.1002/14651858.CD006839.pub4 -
British Journal of Sports Medicine May 2015To systematically review the scientific level of evidence for the 'Top 3' risk factors, screening tests and preventative exercises identified by a previously published... (Review)
Review
Injury risk factors, screening tests and preventative strategies: a systematic review of the evidence that underpins the perceptions and practices of 44 football (soccer) teams from various premier leagues.
PURPOSE
To systematically review the scientific level of evidence for the 'Top 3' risk factors, screening tests and preventative exercises identified by a previously published survey of 44 premier league football (soccer) teams. Also, to provide an overall scientific level of evidence and graded recommendation based on the current research literature.
METHODS
A systematic literature search (Pubmed [MEDLINE], SportDiscus, PEDRO and Cochrane databases). The quality of the articles was assessed and a level of evidence (1++ to 4) was assigned. Level 1++ corresponded to the highest level of evidence available and 4, the lowest. A graded recommendation (A: strong, B: moderate, C: weak, D: insufficient evidence to assign a specific recommendation) for use in the practical setting was given.
RESULTS
Fourteen studies were analysed. The overall level of evidence for the risk factors previous injury, fatigue and muscle imbalance were 2++, 4 and 'inconclusive', respectively. The graded recommendation for functional movement screen, psychological questionnaire and isokinetic muscle testing were all 'D'. Hamstring eccentric had a weak graded 'C' recommendation, and eccentric exercise for other body parts was 'D'. Balance/proprioception exercise to reduce ankle and knee sprain injury was assigned a graded recommendation 'D'.
CONCLUSIONS
The majority of perceptions and practices of premier league teams have a low level of evidence and low graded recommendation. This does not imply that these perceptions and practices are not important or not valid, as it may simply be that they are yet to be sufficiently validated or refuted by research.
Topics: Athletic Injuries; Early Diagnosis; Evidence-Based Medicine; Exercise Therapy; Fatigue; Health Knowledge, Attitudes, Practice; Humans; Muscle Strength; Muscle, Skeletal; Postural Balance; Proprioception; Risk Assessment; Risk Factors; Soccer; Surveys and Questionnaires
PubMed: 25576530
DOI: 10.1136/bjsports-2014-094104 -
Journal of Orthopaedic Surgery and... Apr 2023The combination of resistance training (RT) and aerobic training is believed to achieve the best effects. Several different aerobic training methods have emerged in...
BACKGROUND
The combination of resistance training (RT) and aerobic training is believed to achieve the best effects. Several different aerobic training methods have emerged in combination with or as a substitute for traditional RT. This study wished to verify which RT is safest in terms of injury prevalence and incidence. Also, it ascertained the characteristics of the injured subjects, the level of severity of the injuries and what definitions of injuries the available studies use.
METHODS
This systematic review followed the PRISMA recommendations and was registered in PROSPERO with the number CRD42021257010. The searches were performed in the PubMed, Cochrane and Web of Science, electronic databases using the Medical Subject Headings terms "Resistance training" or "Strength training" or "Crossfit" or "Weightlifting" or "Powerlifting" combined (AND) with "Injury" or "Injuries" or "Sprain" AND "Incidence" or "Prevalence" AND "Epidemiology" or "Epidemiological" in the title or abstract. The last search was performed on March 2023. To be included in the review, the studies had to be available as full text, be clinical trials focusing on epidemiological injuries of resistance training. There was no time limit for the selection of articles. To assess the quality of the studies, the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) was used.
RESULTS
The initial literature search resulted in 4982 studies. After reading the titles, abstracts and full text, 28 articles were selected for data extraction. Seventeen investigated the injuries in HIFT/CrossFit, three in powerlifting, three in strength training, three in weightlifting and one in strongman. In addition, one study examined the HIFT/CrossFit and weightlifting. The incidence of injuries presented in the studies ranged from 0.21/1000 h to 18.9/1000 h and the prevalence of injuries was 10% to 82%. In the quality assessment for STROBE, five studies were classified at level A, 21 at level B and two at level C.
CONCLUSION
This systematic review showed that traditional strength training is the safest RT method, and strongman is the least safe regarding injuries. Few studies have been rated highly according to STROBE. Furthermore, few studies have been published on some RT methods. These two factors make it difficult to generalize the results.
Topics: Humans; Sprains and Strains; Resistance Training; Sports; Exercise; Incidence
PubMed: 37046275
DOI: 10.1186/s13018-023-03781-x -
Sports Health 2023Soft tissue injuries are often treated with injectables such as corticosteroids and platelet-rich plasma (PRP) to reduce inflammation and promote healing. There is... (Meta-Analysis)
Meta-Analysis Review
CONTEXT
Soft tissue injuries are often treated with injectables such as corticosteroids and platelet-rich plasma (PRP) to reduce inflammation and promote healing. There is increasing evidence examining the use of hyaluronic acid (HA) for the management of soft tissue injuries.
OBJECTIVE
To evaluate the treatment effect and role of HA for available soft tissue indications.
DATA SOURCES
A search of PubMed, MEDLINE, EMBASE, and CENTRAL from the inception date of each database through February 24, 2021, was conducted for all randomized controlled trials (RCTs) involving the use of HA for soft tissue indications. Two reviewers independently screened articles for eligibility and extracted data from included studies for analysis. We assessed risk of bias for all included studies and pooled outcomes using a fixed-effects model. Outcomes (ie, function and pain relief) were categorized to short-term (<6 weeks, 6-12 weeks) and mid-term (>12 weeks) data. We present effect estimates as mean differences (MDs) and standardized mean differences (SMDs) and present the estimate of effect of HA for available indications in relation to available comparators.
STUDY DESIGN
Meta-analysis of RCTs.
LEVEL OF EVIDENCE
Level 1.
RESULTS
Of the 6930 articles screened, 19 RCTs (n = 1629 patients) were eligible and included in this review. HA was evaluated across a variety of soft tissue indications including rotator cuff disease, elbow pain, ankle sprains, Achilles tendinopathy, patellar tendinopathy, and trigger finger. Of the 19 RCTs, 11 were placebo-controlled and 9 used active comparators (PRP, cortisone, prolotherapy, or extracorporeal shockwave therapy). The pooled treatment effect of HA across most soft indications against placebo and active comparators demonstrated benefit in short-term pain <6 weeks (MD visual analogue scale [VAS] 2.48, 95% CI 2.31-2.65) and 6 to 12 weeks (MD VAS 2.03, 95% CI 1.86-2.20). Mid-term pain relief also favored HA over comparators across indications >12 weeks from administration (MD VAS 3.57, 95% CI 3.35-3.78). High heterogeneity was present with rotator cuff (10 trials, I = 94%), and elbow tendinopathy (2 trials, I = 99%). We identified uncertain benefit for trigger finger (2 trials, I = 67%). Heterogeneity for ankle sprains, patellar tendinopathy and Achilles tendinopathy could not be assessed as they only had 1 trial each.
CONCLUSION
This systematic review and meta-analysis support HA's efficacy in the treatment of a variety of soft tissue indications. Understanding the relative effects of HA to other injectable modalities requires additional, large trials.
Topics: Humans; Hyaluronic Acid; Trigger Finger Disorder; Pain; Tendinopathy; Soft Tissue Injuries; Ankle Injuries; Platelet-Rich Plasma; Treatment Outcome
PubMed: 35114853
DOI: 10.1177/19417381211073316 -
Gait & Posture Mar 2023Iliotibial band syndrome is a common overuse injury that is twice as likely to affect female runners compared to male runners. It is unclear if there is a consistent... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Iliotibial band syndrome is a common overuse injury that is twice as likely to affect female runners compared to male runners. It is unclear if there is a consistent running pattern and strength profile exhibited by female and male runners with iliotibial band syndrome.
RESEARCH QUESTION
The purpose of this systematic review and meta-analysis was to determine if any differences existed in lower-extremity kinematics and hip strength between runners who retrospectively, currently, or prospectively had iliotibial band syndrome.
METHODS
Papers included must have reported three-dimensional kinematic running data and/or hip strength data that were statistically analyzed between runners that never developed iliotibial band syndrome and runners with iliotibial band syndrome. Meta-analysis was performed for each kinematic or strength variable reported in at least three studies. Female and male runners were analyzed separately and grouped into three cohorts (retrospective, current, prospective).
RESULTS
Seventeen articles were included in this systematic review. Data from 10 cross-sectional studies were included for meta-analysis. Female runners with current iliotibial band syndrome exhibited smaller peak hip internal rotation angles and lower isometric hip abductor strength compared to controls.
SIGNIFICANCE
Although limited biomechanical evidence exists, risk factors for ITBS are different between female and male runners and may vary according to injury status. Specifically, transverse plane hip motion and hip abductor strength weakness may be biomechanical risk factors in female runners with current iliotibial band syndrome only.
Topics: Male; Female; Humans; Iliotibial Band Syndrome; Retrospective Studies; Biomechanical Phenomena; Cross-Sectional Studies; Prospective Studies; Hip Joint; Knee Joint; Lower Extremity; Joint Diseases; Running
PubMed: 36758425
DOI: 10.1016/j.gaitpost.2023.02.001