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Plain radiography is useful when positive, but generally has low sensitivity. Radionuclide bone scanning is highly sensitive, but lacks specificity and the ability to directly visualize fracture lines. In this article, we focus on magnetic resonance imaging, which provides highly sensitive and specific evaluation for bone marrow edema, periosteal reaction as well as detection of subtle fracture lines.

To evaluate whether playing ball sports during childhood and adolescence is associated with the risk of stress fractures in runners later in life. Retrospective cohort study. National track and field championships, held at Stanford University. One hundred fifty-six elite female and elite male distance runners, age 18 to 44 years. A 1-page questionnaire was used to collect data regarding ages during which athletes played basketball and soccer, as well as other important covariates and outcomes.

Athletes reported the ages when stress fractures occurred. Time to event was defined as the number of years from beginning competitive running to the first stress fracture or to current age, if no fracture had occurred. In both men and women, playing ball sports in youth correlated with reduced stress fracture incidence later in life by almost half, controlling for possible confounders. Among women with regular menses, the HR for each additional year of playing ball sports was similar: 0.

In men, younger ages of playing ball sports conferred more protection against stress fractures HR for each 1-year-older age at first exposure, 1. Runners who participate during childhood and adolescence in ball sports may develop bone with greater and more symmetrically distributed bone mass, and with enhanced protection from future stress fractures. High hamstring tendinopathy is an uncommon overuse injury seen in running athletes. Patients typically report deep buttock or thigh pain. A detailed physical examination and, occasionally, imaging studies are necessary to confirm the diagnosis.

Rehabilitation involves soft-tissue mobilization, frequent stretching, and progressive eccentric hamstring strengthening and core stabilization exercises. In recalcitrant cases, an ultrasound-guided corticosteroid injection into the tendon sheath can be helpful, and, occasionally, surgery may be necessary to release the scar tissue around the proximal hamstring muscles and the sciatic nerve. Iliotibial band syndrome ITBS is the most common cause of lateral knee pain in runners.

It is an overuse injury that results from repetitive friction of the iliotibial band ITB over the lateral femoral epicondyle, with biomechanical studies demonstrating a maximal zone of impingement at approximately 30 degrees of knee flexion. Training factors related to this injury include excessive running in the same direction on a track, greater-than-normal weekly mileage and downhill running.

Studies have also demonstrated that weakness or inhibition of the lateral gluteal muscles is a causative factor in this injury. When these muscles do not fire properly throughout the support phase of the running cycle, there is a decreased ability to stabilise the pelvis and eccentrically control femoral abduction. As a result, other muscles must compensate, often leading to excessive soft tissue tightness and myofascial restrictions.

Initial treatment should focus on activity modification, therapeutic modalities to decrease local inflammation, nonsteroidal anti-inflammatory medication, and in severe cases, a corticosteroid injection. Stretching exercises can be started once acute inflammation is under control. Identifying and eliminating myofascial restrictions complement the therapy programme and should precede strengthening and muscle re-education. Strengthening exercises should emphasise eccentric muscle contractions, triplanar motions and integrated movement patterns.

With this comprehensive treatment approach, most patients will fully recover by 6 weeks. Interestingly, biomechanical studies have shown that faster-paced running is less likely to aggravate ITBS and faster strides are initially recommended over a slower jogging pace. Over time, gradual increases in distance and frequency are permitted. In the rare refractory case, surgery may be required. The most common procedure is releasing or lengthening the posterior aspect of the ITB at the location of peak tension over the lateral femoral condyle.

To examine hip abductor strength in long-distance runners with iliotibial band syndrome ITBS , comparing their injured-limb strength to their nonaffected limb and to the limbs of a control group of healthy long-distance runners; and to determine whether correction of strength deficits in the hip abductors of the affected runners through a rehabilitation program correlates with a successful return to running.

Case series. Stanford University Sports Medicine Clinics. The control group of 30 distance runners 14 females, 16 males were randomly selected from the Stanford University Cross-Country and Track teams. Group differences in hip abductor strength, as measured by torque generated, were analyzed using separate two-tailed t-tests between the injured limb, non-injured limb, and the noninjured limbs of the control group. Prerehabilitation hip abductor torque for the injured runners was then compared with postrehabilitation torque after a 6-week rehabilitation program.

Average prerehabilitation hip abductor torque of the injured females was 7. Average prerehabilitation hip abductor torque of the injured males was 6. All prerehabilitation group differences were statistically significant at the p View details for Web of Science ID Patellofemoral pain syndrome PFPS is a multifactorial disorder with a variety of treatment options.

The assortment of components that contribute to its pathophysiology can be categorized into local joint impairments, altered lower extremity biomechanics, and overuse. A detailed physical examination permits identification of the unique contributors for a given individual and permits the formation of a precise, customized treatment plan. This review aims to describe the latest evidence and recommendations regarding rehabilitation of PFPS. We address the utility of quadriceps strengthening, soft tissue flexibility, patellar taping, patellar bracing, hip strengthening, foot orthoses, gait reeducation, and training modification in the treatment of PFPS.

We used provocative computed tomography angiography CTA in these patients to guide partial debulking of the anterolateral quadrant of the medial head of the gastrocnemius muscle for FPAES and reviewed the outcomes of this technique in this highly specialized cohort. All patients underwent posterior approach operative exposure of the popliteal artery, adhesiolysis, side branch ligation, and partial excision of the gastrocnemius muscle with or without fasciotomies.

Preoperative imaging, operative findings, and midterm follow-up, including return to baseline function and return to competitive function, as well as symptom recurrence, were retrospectively reviewed. The average patient age was Thirty-one percent of patients were referred after already having undergone prior fasciotomies. The mean amount of gastrocnemius muscle removed was 7. Nine percent of limbs underwent a bypass along with debulking owing to arterial occlusion at presentation. All patients were able to resume their athletic endeavor at a recreational level. Provocative CTA protocols can help to guide the location of muscle debulking to alleviate the functional entrapment that occurs in these athletes with exercise.

The health benefits of regular recreational physical activity are well known in reducing secondary health consequences of a sedentary lifestyle in the general population. However, individuals with physical disabilities participate less frequently in recreational activity compared with those without disabilities. Although evidence on the impact of recreational physical activity on quality of life in this population is in its infancy, regular recreational and sports activity participation has shown to have a positive association with improvements in quality of life, life satisfaction, community reintegration, mood, and employment in those with disabilities.

Facilitators of participating in adaptive sports include a desire to improve social support, physical fitness, health, and fun. Unfortunately, those with disabilities face numerous barriers to participate in adaptive sports including accessibility, transportation, awareness, finances, and physical and cognitive impairments. Further studies are needed to investigate facilitators and barriers to participating in adaptive sports to capitalize on the physical and psychosocial benefits of regular recreational activity.

The aim of this article is to review the available literature on the effects of adaptive sports participation on quality of life. Running is a popular sport for children in the United States. However, review of available literature on health effects and safety recommendations for youth running has not been previously conducted. Unique factors for injury include periods of growth during puberty and potential for growth plate injury. Youth runners may benefit from activities that incorporate high-impact loading and multidirectional movement for optimal bone maturation, exercises to strengthen tendons and muscles, and strategies aimed at improving running biomechanics to reduce risk of injury.

In addition, addressing lifestyle factors, including nutrition and sleep is essential for a runner's general health. Similar to other sports, sports specialization should not be encouraged in youth runners. Reducing running-related injury in growing children and assessing readiness for running should be based on a combination of physical, emotional, psychological, social, and cognitive factors. Youth runners require individualized training and competition to safely participate in the sport. The purpose of this study was to evaluate the effects of variations in quadriceps muscle forces on patellofemoral stress.

We created subject-specific finite element models for 21 individuals with chronic patellofemoral pain and 16 pain-free control subjects. We applied the quadriceps muscle forces to our finite element models and evaluated patellofemoral cartilage stress. We quantified cartilage stress using an energy-based effective stress, a scalar quantity representing the local stress intensity in the tissue. We used probabilistic methods to evaluate the effects of variations in quadriceps muscle forces from five trials of the stair climb task for each subject.

Patellofemoral effective stress was most sensitive to variations in forces in the two branches of the vastus medialis muscle. This study provides new evidence of the importance of the vastus medialis muscle in the treatment of patellofemoral pain. METHODS: male runners at two collegiate programmes were studied using mixed retrospective and prospective design for a total of 7years.

The outcome was subsequent development of BSI. Only one earlier review has strictly focused on this treatment method. The aims of this study are to evaluate the evidence on the effectiveness of hydrodilatation in treatment of adhesive capsulitis and, if appropriate, to assess the correlation between the effects of this procedure and the amount of fluid injected.

Of the records identified through search, 12 studies were included in qualitative and quantitative analysis and seven were included in a meta-analysis. The pooled effect of hydrodilatation on disability level was insignificant 0. The amount of injected solution did not have a substantial effect on pain severity or range of shoulder motion. According to current evidence, hydrodilatation has only a small, clinically insignificant effect when treating adhesive capsulitis.

Iliotibial band syndrome has been associated with altered hip and knee kinematics in runners. Previous studies have recommended further research on neuromuscular factors at the hip. The frontal plane hip muscles have been a strong focus in strength comparison but not for electromyography investigation. To compare hip surface electromyography, and frontal plane hip and knee kinematics, in runners with and without iliotibial band syndrome.

Observational cross-sectional study.

Introduction

Biomechanics research laboratory within a university. Thirty subjects were recruited consisting of 15 injured runners with iliotibial band syndrome and 15 gender-, age-, and body mass index-matched controls. In each group, 8 were male runners and 7 were female runners. Inclusion criteria for the injured group were pain within 2 months related to iliotibial band syndrome and a positive Noble compression test. Participants were excluded if they reported other lower extremity diagnoses within the last year or active lower extremity or low back pain not related to iliotibial band syndrome.

Michael Fredericson, MD | Stanford Health Care

Controls were excluded if they reported a history of iliotibial band syndrome. Convenience sampling was used based on referrals from local running clinics and orthopedic clinics. Three-dimensional motion capture was performed with 10 high-speed cameras synchronized with wireless surface electromyography during a minute run. The first data point was at 3 minutes, using a constant speed of 2. A second data point was at 30 minutes, using a self-selected pace by the participant to allow for a challenging run until completion at 30 minutes. Motion capture was reported as peak kinematic values from heel strike to peak knee flexion for hip adduction and knee adduction.

Surface electromyography was reported as a percentage of maximal voluntary contraction for the gluteus maximus, gluteus medius and tensor fascia latae muscles. The results of this study suggest that lateral knee pain in runners localized to the distal iliotibial band is associated with increased knee adduction at 30 minutes. Increased tensor fasciae latae muscle activation at 3 minutes is noted, but more investigation is needed to better understand the clinical meaning.

These findings are consistent with but not conclusive evidence supporting the theory that neuromuscular factors of the hip muscles may contribute to increased knee adduction in runners with iliotibial band syndrome. Additional research is needed to confirm whether the degree of knee adduction changes earlier versus later in a run and whether fatigue is a clinically relevant factor.

The purpose of this study is to understand the influence of sports participation and Triad on BMD. We hypothesize that athletes in high-impact and multi-directional loading sports will have highest BMD, whereas non-impact and low-impact sports will have lowest BMD. Triad risk factors are expected to reduce BMD values independent of sports participation. Height and weight were measured to calculate body mass index BMI. Triad risk assessment variables were obtained from preparticipation examination.

Mean BMD Z-scores were compared between sports and by sport category high-impact, multi-directional, low-impact, and non-impact. Highest values were in gymnastics LS Tibial stress fractures are a common and debilitating injury that occur in distance runners. Runners may be able to decrease tibial stress fracture risk by adopting a running pattern that reduces biomechanical parameters associated with a history of tibial stress fracture. The purpose of this study was to test the hypothesis that converting to a forefoot striking pattern or increasing cadence without focusing on changing foot strike type would reduce injury risk parameters in recreational runners.

Running kinematics, ground reaction forces and tibial accelerations were recorded from seventeen healthy, habitual rearfoot striking runners while running in their natural running pattern and after two acute retraining conditions: 1 converting to forefoot striking without focusing on cadence and 2 increasing cadence without focusing on foot strike.

We found that converting to forefoot striking decreased two risk factors for tibial stress fracture: average and peak loading rates. Increasing cadence decreased one risk factor: peak hip adduction angle. Our results demonstrate that acute adaptation to forefoot striking reduces different injury risk parameters than acute adaptation to increased cadence and suggest that both modifications may reduce the risk of tibial stress fractures. To evaluate the evidence regarding the effectiveness of conservative treatment in reducing patellofemoral pain.

Adults with patellofemoral pain, randomized controlled trials only, any conservative treatment compared with placebo, sham, other conservative treatment, or no treatment. Two independent reviewers. Data were extracted from the full-text of the articles, based on Cochrane Collaboration recommendations. The outcome of interest was the difference between groups regarding change in pain severity.

The majority of studies were underpowered. Clinically significant effects of different sizes were found for 7 trials 6 studies out of 7 had short follow-ups. These effects were found for: i pulsed electromagnetic fields combined with home exercise There is no evidence that a single treat-ment modality works for all patients with patellofemoral pain.

There is limited evidence that some treatment modalities may be beneficial for some subgroups of patients with patellofemoral pain. Plantar fascial disorder is comprised of plantar fasciitis and plantar fibromatosis. Plantar fasciitis is the most common cause of heel pain, especially for athletes involved in running and jumping sports. Plantar fibromatosis is a rare fibrous hyperproliferation of the deep connective tissue of the foot.

To identify genetic loci associated with plantar fascial disorders, a genome-wide association screen was performed using publically available data from the Research Program in Genes, Environment and Health including 21, cases of plantar fascial disorders and 80, controls. One indel chrD and one SNP rs showed an association with plantar fascial disorders at genome-wide significance p View details for PubMedID Rotator cuff tears are common, especially in the fifth and sixth decades of life, but can also occur in the competitive athlete.

Genetic differences may contribute to overall injury risk. Identifying genetic loci associated with rotator cuff injury could shed light on the etiology of this injury. We performed a genome-wide association screen using publically available data from the Research Program in Genes, Environment and Health including 8, cases of rotator cuff injury and 94, controls.

This SNP is located next to cadherin8, which encodes a protein involved in cell adhesion. We also attempted to validate previous gene association studies that had reported a total of 18 SNPs showing a significant association with rotator cuff injury. However, none of the 18 SNPs were validated in our dataset. Ankle injuries, including sprains, strains and other joint derangements and instability, are common, especially for athletes involved in indoor court or jumping sports. Identifying genetic loci associated with these ankle injuries could shed light on their etiologies.

A genome-wide association screen was performed using publicly available data from the Research Program in Genes, Environment and Health RPGEH including 1, cases of ankle injury and 97, controls. The ACTN3 RX mutation was previously reported to show an association with acute ankle sprains, but did not show an association in this cohort. This study is the first genome-wide screen for ankle injury that yields insights regarding the genetic etiology of ankle injuries and provides DNA markers with the potential to inform athletes about their genetic risk for ankle injury. Shoulder dislocations are common shoulder injuries associated with athletic activity in contact sports, such as football, rugby, wrestling, and hockey.

Identifying genetic loci associated with shoulder dislocation could shed light on underlying mechanisms for injury and identify predictive genetic markers. This genetic marker may one day be used to identify athletes with a higher genetic risk for shoulder dislocation. It will be important to replicate this finding in future studies. Medial collateral ligament MCL injuries are a common knee injury, especially in competitive athletes. Identifying genetic loci associated with MCL injury could shed light on its etiology. Achilles tendinopathy or rupture and anterior cruciate ligament ACL rupture are substantial injuries affecting athletes, associated with delayed recovery or inability to return to competition.

To identify genetic markers that might be used to predict risk for these injuries, we performed genome-wide association screens for these injuries using data from the Genetic Epidemiology Research on Adult Health and Aging GERA cohort consisting of , individuals. We did not find any single nucleotide polymorphisms SNPs associated with either of these injuries with a p-value that was genome-wide significant p View details for DOI The female athlete triad referred to as the triad contributes to adverse health outcomes, including bone stress injuries BSIs , in female athletes.

Guidelines were published in for clinical management of athletes affected by the triad. This study aimed to 1 classify athletes from a collegiate population of 16 sports into low-, moderate-, and high-risk categories using the Female Athlete Triad Cumulative Risk Assessment score and 2 evaluate the predictive value of the risk categories for subsequent BSIs. Cohort study; Level of evidence, 3. A total of athletes completed both electronic preparticipation physical examination and dual-energy x-ray absorptiometry scans. Chart review was used to identify athletes who sustained a subsequent BSI during collegiate sports participation; the injury required a physician diagnosis and imaging confirmation.

Of athletes, 61 Sports with the highest proportion of athletes assigned to the moderate- and high-risk categories included gymnastics Twenty-five athletes After adjusting for age and participation in cross-country, we found that moderate-risk athletes were twice as likely as low-risk athletes to sustain a BSI risk ratio [RR], 2. Moderate- and high-risk athletes were more likely to subsequently sustain a BSI; most BSIs were sustained by cross-country runners.

Stanford Medical School has created a class in lifestyle medicine that any student in the university can attend for credit. It is based on the foundational principles of lifestyle medicine and also informs students about topics such as Chinese medicine, naturopathic medicine, and wearable devices. The popularity of the course at Stanford speaks to the growing interest in the field of lifestyle medicine for medical students, undergraduate students, business students, and even engineers. Limited research has evaluated risk factors for low bone mineral density BMD in male adolescent athletes.

This study assessed the association between hyaluronic acid HA injections and time-to-total knee replacement TKR surgery for patients with knee osteoarthritis OA. Patients 18 to 64 years of age who had TKR surgery between January 1, and December 31, were identified from the MarketScan Commercial claims database. All patients had 6 years or more of continuous enrollment prior to TKR surgery. Time-to-TKR was defined as the total days from the date of diagnosis of knee OA on the patient's first visit to an orthopedic surgeon to the date of TKR surgery. Those receiving HA injections had a median 1.

These results have both clinical and economic implications. Numerous musculoskeletal disorders are caused by thickened ligament, tendon stiffness, or fibrosis of joint capsule. Relaxin, a peptide hormone, can exert collagenolytic effect on ligamentous and fibrotic tissues. We hypothesized that local injection of relaxin could be used to treat entrapment neuropathy and adhesive capsulitis. Because hormonal effect depends on the receptor of the hormone on the target cell, it is important to confirm the presence of such hormonal receptor at the target tissue before the hormone therapy is initiated.

The aim of this study was to determine whether there were relaxin receptors in the ligament, tendon, and joint capsular tissues of rats and to identify the distribution of relaxin receptors in these tissues. Transverse carpal ligaments TCLs , inguinal ligaments, anterior cruciate ligaments ACLs , Achilles tendons, and shoulder joint capsules were obtained from male Wistar rats. The distribution of relaxin receptors was determined by immunohistochemical staining. The RXFP1 isoform was found in all tissues examined.

Its expression in ACLs tissues was relatively weak compared to that in other tissues. Our results revealed that RXFP1 and RXFP2 were distributed in distinctly different patterns according to the type of tissue vascular endothelial cells, fibroblast-like cells they were identified. A year-old male long distance runner presented with low back and left buttock pain, which eventually progressed to severe and debilitating pain, intermittently radiating to the posterior thigh and foot.

A comprehensive workup ruled out possible spine or hip causes of his symptoms. A pelvic magnetic resonance imaging neurogram with complex oblique planes through the piriformis demonstrated variant anatomy of the left sciatic nerve consistent with the clinical diagnosis of piriformis syndrome. The patient ultimately underwent neurolysis with release of the sciatic nerve and partial resection of the piriformis muscle.

After surgery the patient reported significant pain reduction and resumed running 3 months later. Piriformis syndrome is uncommon but should be considered in the differential diagnosis for buttock pain. Advanced imaging was essential to guide management.


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Participation in sports offers many health benefits to athletes of both sexes. However, subsets of both female and male athletes are at increased risk of impaired bone health and bone stress injuries. The Female Athlete Triad Triad is defined as the interrelationship of low energy availability with or without disordered eating , menstrual dysfunction, and low bone mineral density.

The Triad may result in health consequences, including bone stress injuries. Our review presents evidence that an analogous process may occur in male athletes. Our review of the available literature indicates that a subset of male athletes may experience adverse health issues that parallel those associated with the Triad, including low energy availability with or without disordered eating , hypogonadotropic hypogonadism, and low bone mineral density. Consequently, male athletes may be predisposed to developing bone stress injuries, and these injuries can be the first presenting feature of associated Triad conditions.

We discuss the evidence for impaired nutrition, hormonal dysfunction, and low bone mineral density in a subset of male athletes, and how these health issues may parallel those of the Triad. With further research into the mechanisms and outcomes of these health concerns in active and athletic men, evidence-based guidelines can be developed that result in best practice. The purpose of this pilot study is to use surface electromyography to determine an individual athlete's typical muscle onset activation sequence when performing a golf or tennis forward swing and to use the method to assess to what degree the sequence is reproduced with common conditioning exercises and a machine designed for this purpose.

Data for 18 healthy male subjects were collected for 15 muscles of the trunk and lower extremities. Data were filtered and processed to determine the average onset of muscle activation for each motion. A Spearman correlation estimated congruence of activation order between the swing and each exercise. The averaged sequences differed among each athlete tested, but pooled correlations demonstrated a positive association between each exercise and the participants' natural muscle onset activation sequence.

The results support consideration of a larger, adequately powered study using this method to quantify to what degree each of the selected exercises is appropriate for use in both golf and tennis. Patellofemoral pain is characterized by insidious onset anterior knee pain that is exaggerated under conditions of increased patellofemoral joint stress. A variety of risk factors may contribute to the development of patellofemoral pain.

It is critical that the history and physical examination elucidate those risk factors specific to an individual in order to prescribe an appropriate and customized treatment plan. This article aims to review the epidemiology, risk factors, diagnosis, and management of patellofemoral pain.

Elevated cartilage stress has been identified as a potential mechanism for retropatellar pain; however, there are limited data in the literature to support this mechanism. Females are more likely to develop patellofemoral pain than males, yet the causes of this dimorphism are unclear. We used experimental data and computational modeling to determine whether patients with patellofemoral pain had elevated cartilage stress compared with pain-free controls and test the hypothesis that females exhibit greater cartilage stress than males.

We created finite element models of 24 patients with patellofemoral pain 11 males and 13 females and 16 pain-free controls 8 males and 8 females to estimate peak patellar cartilage stress strain energy density during a stair climb activity. Simulations took into account cartilage morphology from magnetic resonance imaging, joint posture from weight-bearing magnetic resonance imaging, and muscle forces from an EMG-driven model.

We found no difference in peak patellar strain energy density between those with patellofemoral pain 1. Females exhibited greater cartilage stress compared with males 2. Patients with patellofemoral pain did not display significantly greater patellar cartilage stress compared with pain-free controls; however, there was a great deal of subject variation. Females exhibited greater peak cartilage stress compared with males, which might explain the greater prevalence of patellofemoral pain in females compared with that in males, but other mechanical and biological factors are clearly involved in this complex pathway to pain.

Retrospective case series. Tertiary care, institutional setting. For assessment of risk factors, plain radiographs and magnetic resonance imaging studies were reviewed for features of cam or pincer FAI. Medical records were reviewed to determine whether patients required operative intervention. Twenty-one female and 3 male participants mean age 27 years, range years were identified with magnetic resonance imaging evidence of femoral neck stress injury.

The results of the current study suggest that patients in the general population with femoral neck stress injuries have a higher incidence of bony abnormalities associated with pincer impingement, including coxa profunda and acetabular retroversion, although it is unclear whether pincer FAI is a true risk factor in the development of FNSF.

Adolescent runners may be at risk for low bone mineral density BMD associated with sports participation. Few prior investigations have evaluated bone health in young runners, particularly males. To characterize sex-specific risk factors for low BMD in adolescent runners. Cross-sectional study; Level of evidence, 3. Training characteristics, fracture history, eating behaviors and attitudes, and menstrual history were measured using online questionnaires.

A food frequency questionnaire was used to identify dietary patterns and measure calcium intake. In multivariable analyses, risk factors for lower LS BMD Z-scores in girls included lower A:G ratio, being shorter, and the combination of interaction between current menstrual irregularity and a history of fracture all P View details for DOI Running is a popular sport that may be performed safely during pregnancy.

Few studies have characterized running behavior of competitive female runners during pregnancy and breastfeeding. Women modify their running behavior during pregnancy and breastfeeding. Observational, cross-sectional study. Level 2. One hundred ten female long-distance runners who ran competitively prior to pregnancy completed an online survey characterizing training attitudes and behaviors during pregnancy and postpartum. On average, women reduced training during pregnancy, including cutting their intensity to about half of their nonpregnant running effort.

Only 3. Fewer than one third Of the women who breastfed, Most felt that running had no effect on their ability to breastfeed. Women who ran during breastfeeding were less likely to report postpartum depression than those who did not run 6. Patellofemoral pain is characterized by insidious onset anterior knee pain that is exaggerated under conditions of increased patellofemoral joint stress. A variety of risk factors may contribute to the development of patellofemoral pain.

It is critical that the history and physical examination elucidate those risk factors specific to an individual in order to prescribe an appropriate and customized treatment plan. This article aims to review the epidemiology, risk factors, diagnosis, and management of patellofemoral pain. Elevated cartilage stress has been identified as a potential mechanism for retropatellar pain; however, there are limited data in the literature to support this mechanism. Females are more likely to develop patellofemoral pain than males, yet the causes of this dimorphism are unclear.

We used experimental data and computational modeling to determine whether patients with patellofemoral pain had elevated cartilage stress compared with pain-free controls and test the hypothesis that females exhibit greater cartilage stress than males. We created finite element models of 24 patients with patellofemoral pain 11 males and 13 females and 16 pain-free controls 8 males and 8 females to estimate peak patellar cartilage stress strain energy density during a stair climb activity.

Simulations took into account cartilage morphology from magnetic resonance imaging, joint posture from weight-bearing magnetic resonance imaging, and muscle forces from an EMG-driven model. We found no difference in peak patellar strain energy density between those with patellofemoral pain 1. Females exhibited greater cartilage stress compared with males 2.

Patients with patellofemoral pain did not display significantly greater patellar cartilage stress compared with pain-free controls; however, there was a great deal of subject variation. Females exhibited greater peak cartilage stress compared with males, which might explain the greater prevalence of patellofemoral pain in females compared with that in males, but other mechanical and biological factors are clearly involved in this complex pathway to pain. Retrospective case series. Tertiary care, institutional setting.

For assessment of risk factors, plain radiographs and magnetic resonance imaging studies were reviewed for features of cam or pincer FAI. Medical records were reviewed to determine whether patients required operative intervention. Twenty-one female and 3 male participants mean age 27 years, range years were identified with magnetic resonance imaging evidence of femoral neck stress injury.

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The results of the current study suggest that patients in the general population with femoral neck stress injuries have a higher incidence of bony abnormalities associated with pincer impingement, including coxa profunda and acetabular retroversion, although it is unclear whether pincer FAI is a true risk factor in the development of FNSF. Adolescent runners may be at risk for low bone mineral density BMD associated with sports participation.

Few prior investigations have evaluated bone health in young runners, particularly males. To characterize sex-specific risk factors for low BMD in adolescent runners. Cross-sectional study; Level of evidence, 3. Training characteristics, fracture history, eating behaviors and attitudes, and menstrual history were measured using online questionnaires. A food frequency questionnaire was used to identify dietary patterns and measure calcium intake. In multivariable analyses, risk factors for lower LS BMD Z-scores in girls included lower A:G ratio, being shorter, and the combination of interaction between current menstrual irregularity and a history of fracture all P View details for DOI Running is a popular sport that may be performed safely during pregnancy.

Few studies have characterized running behavior of competitive female runners during pregnancy and breastfeeding. Women modify their running behavior during pregnancy and breastfeeding. Observational, cross-sectional study. Level 2. One hundred ten female long-distance runners who ran competitively prior to pregnancy completed an online survey characterizing training attitudes and behaviors during pregnancy and postpartum. On average, women reduced training during pregnancy, including cutting their intensity to about half of their nonpregnant running effort.

Only 3. Fewer than one third Of the women who breastfed, Most felt that running had no effect on their ability to breastfeed. Women who ran during breastfeeding were less likely to report postpartum depression than those who did not run 6. Women runners reported a reduction in total training while pregnant, and few sustained running injuries during pregnancy. The effect of running on postpartum depression was not clear from our findings. We characterized running behaviors during pregnancy and breastfeeding in competitive runners.

Most continue to run during pregnancy but reduce total training effort. Top reasons for running during pregnancy were fitness, health, and maintaining routine; the most common reason for not running was not feeling well.

Most competitive runners run during breastfeeding with little perceived impact. To examine whether the frequency of bracing, geographic region, clinical specialty, or percentage of practice devoted to knee pain influences the criteria used by sports medicine professionals to determine whether a brace should be prescribed for treating patients with nontraumatic patellofemoral pain syndrome.

Cross-sectional study. Sports medicine practices in the United States. Not applicable. Thirty-seven potential patellofemoral bracing criteria encompassing history and function, alignment, physical examination, previous treatments, and radiographic evidence. A total of of providers replied response rate, Mean bracing frequencies were The mean number of total bracing criteria used was No statistically significant trends were noted with regard to experience or percentage of practice devoted to knee pain.

Plantar fasciopathy, a common, painful condition of the foot, is often diagnosed by a musculoskeletal physiatrist in an outpatient practice setting. This focused review examines the most recent recommendations for the management of plantar fasciopathy in acute, subacute, and chronic phases. The evidence for treatment with various interventions is discussed, and suggestions for clinical care along with the respective rationales for those therapies are provided.

The purpose of this review is to enable clinicians to make informed evidence-based decisions about the best available treatments for patients with any phase of plantar fasciopathy. Emerging technologies for the treatment of the condition are also addressed. Few investigators have evaluated risk factors for prospective stress fracture in this population. METHODS: To better characterize risk factors for and incidence of stress fractures in this population, we collected baseline risk factor data on competitive high school runners girls and boys using an online survey.

We then followed them prospectively for the development of stress fractures for an average of 2. Tibial stress fractures were most common in girls, and the metatarsus was most frequently fractured in boys. Multivariate regression identified four independent risk factors for stress fractures in girls: prior fracture, BMI View details for DOI Stress fractures are a common type of overuse injury in athletes.

Females have unique risk factors such as the female athlete triad that contribute to stress fracture injuries. We review the current literature on risk factors for stress fractures, including the role of sports participation and nutrition factors. Discussion of the management of stress fractures is focused on radiographic criteria and anatomic location and how these contribute to return to play guidelines.

We outline the current recommendations for evaluating and treatment of female athlete triad. Technologies that may aid in recovery from a stress fracture including use of anti-gravity treadmills are discussed. Prevention strategies may include early screening of female athlete triad, promoting early participation in activities that improve bone health, nutritional strategies, gait modification, and orthotics. The purpose of this study is to determine if patellar maltracking is more prevalent among patellofemoral PF pain subjects with patella alta compared to subjects with normal patella height.

We imaged 37 PF pain and 15 pain free subjects in an open-configuration magnetic resonance imaging scanner while they stood in a weightbearing posture. We measured patella height using the Caton-Deschamps, Blackburne-Peel, Insall-Salvati, Modified Insall-Salvati, and Patellotrochlear indices, and classified the subjects into patella alta and normal patella height groups.

We measured patella tilt and bisect offset from oblique-axial plane images, and classified the subjects into maltracking and normal tracking groups. Patellar maltracking was more prevalent among PF pain subjects with patella alta compared to PF pain subjects with normal patella height two-tailed Fisher's exact test, p View details for DOI To determine whether bone metabolic activity corresponds to bone and cartilage damage in patients with patellofemoral pain. Pelvic stress injuries are a relatively uncommon form of injury that require high index of clinician suspicion and usually MRI for definitive diagnosis.

We present a case report of a year-old female elite runner who was diagnosed with pelvic stress injury and used an antigravity treadmill during rehabilitation. Ten weeks from time of diagnosis, she competed at her conference championships and advanced to the NCAA Championships in the 10,meters. She competed in both races without residual pain. To our knowledge, this is the first published case report on use of an antigravity treadmill in rehabilitation of bone-related injuries.

Our findings suggest that use of an antigravity treadmill for rehabilitation of a pelvic stress injury may result in appropriate bone loading and healing during progression to ground running and faster return to competition. Future research may identify appropriate protocols for recovery from overuse lower extremity injuries and other uses for this technology, including neuromuscular recovery and injury prevention.

Patellofemoral PF pain is a common ailment of the lower extremity. A theorized cause for pain is patellar maltracking due to vasti muscle activation imbalance, represented as large vastus lateralis:vastus medialis VL:VM activation ratios. However, evidence relating vasti muscle activation imbalance to patellar maltracking is limited.

The purpose of this study was to investigate the relationship between VL:VM activation ratio and patellar tracking measures, patellar tilt and bisect offset, in PF pain subjects and pain-free controls. We classified the PF pain subjects into normal tracking and maltracking groups based on patellar tilt and bisect offset measured from weight-bearing magnetic resonance imaging.

This suggests that a clinical intervention targeting vasti muscle activation imbalance may be effective only in PF pain subjects classified as maltrackers. Post-traumatic osteoarthritis PTOA is a process resulting from direct forces applied to a joint that cause injury and degenerative changes. Neuromuscular prehabilitation is the process of improving neuromuscular function to prevent development of PTOA after an initial traumatic joint injury. Prehabilitation strategies include restoration of normative movement patterns that have been altered as the result of traumatic injury, along with neuromuscular exercises and gait retraining to prevent the development of OA after an injury occurs.

A review of the current literature shows that no studies have been performed to evaluate methods of neuromuscular prehabilitation to prevent PTOA after a joint injury. Instead, current research has focused on management strategies after knee injuries, the value of exercise in the management of OA, and neuromuscular exercises after total knee arthroplasty.

Recent work in gait retraining that alters knee joint loading holds promise for preventing the development of PTOA after joint trauma. Future research should evaluate methods of neuromuscular prehabilitation strategies in relationship to the outcome of PTOA after joint injury. Patellofemoral pain is characterized by pain behind the kneecap and is often thought to be due to high stress at the patellofemoral joint.

We examined 20 subjects diagnosed with patellofemoral pain. Uptake of 18 F NaF in the patella and trochlea was quantified by computing the standardized uptake value and normalizing by the background tracer uptake in bone. The implication of these results is that patellofemoral pain may be related to bone metabolic activity at the patellofemoral joint.

Buttock gluteal pain is commonly experienced by athletes of all ages and activity levels. Evaluation of buttock pain can be challenging because the differential diagnoses are extensive. Symptoms may originate from the pelvis or hip or be referred from the lumbosacral spine or neurovascular structures. Few articles in the literature are dedicated to the primary complaint of buttock pain.

The purpose of this article is to provide a clinical algorithm to assist the sports clinician in reaching an accurate diagnosis and initiating the appropriate treatment. Muscle performance factors and altered loading mechanics have been linked to a variety of lower extremity musculoskeletal disorders. In this article, biomechanical risk factors associated with iliotibial band syndrome ITBS are described, and a strategy for incorporating these factors into the clinical evaluation of and treatment for that disorder is presented.

Abnormal movement patterns in runners and cyclists with ITBS are discussed, and the pathophysiological characteristics of this syndrome are considered in light of prior and current studies in anatomy. Differential diagnoses and the use of imaging, medications, and injections in the treatment of ITBS are reviewed. The roles of hip muscle strength, kinematics, and kinetics are detailed, and the assessment and treatment of muscle performance factors are discussed, with emphasis on identifying and treating movement dysfunction.

Various stages of rehabilitation, including strengthening progressions to reduce soft-tissue injury, are described in detail. ITBS is an extremely common orthopedic condition that presents with consistent dysfunctional patterns in muscle performance and movement deviation. Through careful assessment of lower quarter function, the clinician can properly identify individuals and initiate treatment.

To develop and test a method to measure core ability in healthy athletes with 2-dimensional video analysis software SiliconCOACH. Specific objectives were to: 1 develop a standardized exercise battery with progressions of increasing difficulty to evaluate areas of core ability in elite athletes; 2 develop an objective and quantitative grading rubric with the use of video analysis software; 3 assess the test-retest reliability of the exercise battery; 4 assess the interrater and intrarater reliability of the video analysis system; and 5 assess the accuracy of the assessment.

Test-retest repeatability and accuracy. Nine female gymnasts currently training with the Stanford Varsity Women's Gymnastics Team participated in testing. Participants completed a test battery composed of planks, side planks, and leg bridges of increasing difficulty. Subjects completed two minute testing sessions within a 4- to day period. Two-dimensional sagittal-plane video was captured simultaneously with 3-dimensional motion capture. The main outcome measures were pelvic displacement and time that elapsed until failure occurred, as measured with SiliconCOACH video analysis software.

Test-retest and interrater and intrarater reliability of the video analysis measures was assessed. Accuracy as compared with 3-dimensional motion capture also was assessed. Core ability test battery with SiliconCOACH grading method is an accurate and reliable way to assess core ability exercise performance. Patellar maltracking is thought to be one source of patellofemoral pain.

Measurements of patellar tracking are frequently obtained during non-weight-bearing knee extension; however, pain typically arises during highly loaded activities, such as squatting, stair climbing, and running. It is unclear whether patellofemoral joint kinematics during lightly loaded tasks replicate patellofemoral joint motion during weight-bearing activities.

The purpose of this study was to: evaluate differences between upright, weight-bearing and supine, non-weight-bearing joint kinematics in patients with patellofemoral pain; and evaluate whether the kinematics in subjects with maltracking respond differently to weight-bearing than those in nonmaltrackers. We compared patellofemoral kinematics measured from the images. The kinematics of the maltrackers responded differently to joint loading than those of the non-maltrackers.

These results suggest that patellofemoral kinematics measured during supine, unloaded tasks do not accurately represent the joint motion during weight-bearing activities. Delayed onset of vastus medialis VM activity compared with vastus lateralis activity is a reported cause for patellofemoral pain. The delayed onset of VM activity in patellofemoral pain patients likely causes an imbalance in muscle forces and lateral maltracking of the patella; however, evidence relating VM activation delay to patellar maltracking is sparse.

The aim of this study was to investigate the relationship between VM activation delay and patellar maltracking measures in pain-free controls and patellofemoral pain patients. Patellar tilt and bisect offset, measures of patellar tracking, correlate with VM activation delay in patellofemoral pain patients classified as maltrackers. Case control study; Level of evidence, 3. All participants were scanned in an open-configuration magnetic resonance scanner in an upright weightbearing position to acquire the position of the patella with respect to the femur. Patellar tilt and bisect offset were measured, and patellofemoral pain participants were classified into normal tracking and maltracking groups.

To compare the reliability of quadriceps-angle Q-angle measurements performed using a short-arm goniometer and a long-arm goniometer and to assess the accuracy of goniometer-based Q-angle measurements compared with anatomic Q angles derived from magnetic resonance imaging MRI. An intra- and interobserver reliability study.

University hospital. Eighteen healthy subjects with no history of knee pain, trauma, or prior surgery were examined. Two physicians, blinded to subject identity, measured Q angles on both knees of all subjects using 2 goniometers: 1 a short-arm goniometer and 2 a long-arm goniometer. Q angles were derived from axial MRIs of the subjects' hip and knees. The intra- and interobserver reliabilities of each goniometer were assessed using the intraclass correlation coefficient ICC.

Intra- and interobserver reliabilities of the long-arm goniometer intraobserver ICC, 0.

To evaluate lifetime prevalence and risk factors for overuse injuries in high school athletes currently participating in long-distance running and provide recommendations for injury prevention strategies. Retrospective study design. Twenty-eight high schools in the San Francisco Bay Area. A total of female and male athletes, ages years, who are on cross-country and track and field teams. Online survey with questions that detailed previous injuries sustained and risk factors for injury. Previous overuse injuries and association of risk factors to injury including training variables, dietary patterns, and, in girls, menstrual irregularities.

More injury types were seen in girls 1. Calcium and vitamin D are recognized as 2 components of nutrition needed to achieve and maintain bone health. Calcium and vitamin D have been clearly shown to improve bone density and prevent fractures at all ages. However, the literature is conflicting as to the role of these nutrients in young athletes ages 18 to 35 years, both for bone development and for the prevention of bone overuse injuries. Differences in findings may relate to study design.

Although retrospective and cross-sectional studies have had mixed results, the authors of prospective studies have consistently demonstrated a relationship of increased calcium intake with an improvement in bone density and a decrease in fracture risk. A prospective study in young female runners demonstrated reduced incidence of stress fractures and increased bone mineral density with increased dietary calcium intake. Findings from both studies suggest female athletes and military recruits who consumed greater than mg of calcium daily exhibited the largest reduction in stress fracture injuries.

To date, no prospective studies have been conducted in male athletes or in adolescent athletes. In most studies, males and nonwhite participants were poorly represented. Evidence regarding the relationship of vitamin D intake with the prevention of fractures in athletes is also limited. More prospective studies are needed to evaluate the role of calcium and vitamin D intake in prevention of stress fracture injuries in both male and female adolescent athletes, particularly those participating in sports with greater incidences of stress fracture injury.

The goals of this study were to review the MRI and sonographic findings in patients diagnosed clinically with high hamstring tendinopathy and to evaluate the efficacy of ultrasound-guided corticosteroid injections in providing symptomatic relief. MRI is more sensitive than ultrasound in detecting peritendinous edema and tendinopathy at the proximal hamstring origin.

The role of ultrasound in musculoskeletal imaging is expanding as technology advances and clinicians become better educated about its clinical applications. The main use of musculoskeletal ultrasound to physiatrists is to examine the soft tissues of the body and to diagnose pathologic changes. Ultrasound can be used to assist clinicians in performing interventional procedures. However, to successfully integrate this technology into their clinical practices, physicians must be familiar with the normal and abnormal appearance of tissues.

They also must recognize the clinically relevant limitations and pitfalls associated with the use of ultrasound. Controlled laboratory study using a cross-sectional design. To compare patellofemoral joint kinematics, femoral rotation, and patella rotation between females with patellofemoral pain PFP and pain-free controls using weight-bearing kinematic magnetic resonance imaging.

Recently, it has been recognized that patellofemoral malalignment may be the result of femoral motion as opposed to patella motion. Fifteen females with PFP and 15 pain-free females between the ages of 18 and 45 years participated in this study. Kinematic imaging of the patellofemoral joint was performed using a vertically open magnetic resonance imaging system. Axial-oblique images were obtained using a fast gradient-echo pulse sequence.

Images were acquired at a rate of 1 image per second while subjects performed a single-limb squat. Measures of femur and patella rotation relative to the image field of view , lateral patella tilt, and lateral patella displacement were made from images obtained at 45 degrees , 30 degrees , 15 degrees , and 0 degrees of knee flexion.

Group differences were assessed using a mixed-model analysis of variance with repeated measures. When compared to the control group, females with PFP demonstrated significantly greater lateral patella displacement at all angles evaluated and significantly greater lateral patella tilt at 30 degrees , 15 degrees , and 0 degrees of knee flexion. Similarly, greater medial femoral rotation was observed in the PFP group at 45 degrees , 15 degrees , and 0 degrees of knee flexion when compared to the control group.

No group differences in patella rotation were found. Altered patellofemoral joint kinematics in females with PFP appears to be related to excessive medial femoral rotation, as opposed to lateral patella rotation. Our results suggest that the control of femur rotation may be important in restoring normal patellofemoral joint kinematics. Magnetic resonance MR imaging can be a very useful tool in the evaluation of instability in the athlete's shoulder.

Technical options of MR imaging, such as arthrography, higher power magnets, and shoulder positioning, have enhanced MR evaluation of the shoulder. This update discusses the application of new MR techniques to a variety of shoulder instability patterns, including anterior instability, posterior instability, and atraumatic multidirectional instability. Specific applications of MR imaging in the postoperative patient is discussed.

Finally, we describe the future directions of MR imaging in the setting of shoulder instability. To determine whether posterior lumbar disk contour dimensions differ in the flexed seated, upright seated, and extended seated positions. Academic medical center. Eight subjects with a central disk bulge and 9 subjects with a dark nucleus pulposus on magnetic resonance imaging. Quantitative comparisons of posterior disk contour between neutral, flexed, and extended sitting positions.

Of 8 subjects with central disk bulge, spinal flexion from the neutral position produced a decreased disk contour in all subjects, whereas spinal extension from the neutral position produced an increased disk contour in 6 subjects, a decreased disk contour in 1 subject, and no measurable change in 1 subject.

Changes in posterior disk contour in subjects with a dark nucleus pulposus were variable. Approximately half increased and half decreased, but no relation to position was determined. The results of this pilot study suggest a consistent pattern of decreased posterior disk contour with spinal flexion and increased posterior disk contour with spinal extension in subjects with central disk bulge, but not in those with a dark nucleus pulposus. One proposed mechanism of patellofemoral pain, increased stress in the joint, is dependent on forces generated by the quadriceps muscles.

Describing causal relationships between muscle forces, tissue stresses, and pain is difficult due to the inability to directly measure these variables in vivo. Subjects walked and ran at self-selected speeds in a gait laboratory. Lower limb kinematics and electromyography EMG data were input to an EMG-driven musculoskeletal model of the knee, which was scaled and calibrated to each individual to estimate forces in 10 muscles surrounding the joint.

Muscle forces during running were similar between groups, but the net knee extension moment was less in the patellofemoral pain group compared to controls. Abnormal patellofemoral joint motion is a possible cause of patellofemoral pain, and patellar braces are thought to alleviate pain by restoring normal joint kinematics. We evaluated whether females with patellofemoral pain exhibit abnormal patellofemoral joint kinematics during dynamic, weight-bearing knee extension and assessed the effects of knee braces on patellofemoral motion.

Real-time magnetic resonance MR images of the patellofemoral joints of 36 female volunteers 13 pain-free controls, 23 patellofemoral pain were acquired during weight-bearing knee extension. Pain subjects were also imaged while wearing a patellar-stabilizing brace and a patellar sleeve. We measured axial-plane kinematics from the images. Our results indicate that some subjects with patellofemoral pain exhibit abnormal weight-bearing joint kinematics and that braces may be effective in reducing patellar maltracking in these subjects.

To characterize abnormalities on magnetic resonance images MRI in the shoulder and wrist joints of asymptomatic elite athletes to better define the range of "normal" findings in this population. Cohort study. Grade of severity of MRI changes of the shoulder and wrist joints. A 3- to 4-year follow-up questionnaire was administered to determine the clinical significance of the asymptomatic findings. All athletes demonstrated at least mild imaging abnormalities in the joints evaluated.

Swimmers had no wrist abnormalities. At follow-up interview, only 1 swimmer and 1 volleyball player reported shoulder problems during the study. Additionally, only 1 gymnast reported a wrist injury during their career. Asymptomatic elite athletes demonstrate MRI changes of the shoulder swimmers and volleyball players and wrist gymnasts similar to those associated with abnormalities for which medical treatment and sometimes surgery are advised.

Given the somewhat high frequency of these asymptomatic findings, care must be taken to correlate clinical history and physical examination with MRI findings in these patients with symptoms. Internal and external rotation of the femur plays an important role in defining the orientation of the patellofemoral joint, influencing contact areas, pressures, and cartilage stress distributions. The purpose of this study was to determine the influence of femoral internal and external rotation on stresses in the patellofemoral cartilage.

We constructed finite element models of the patellofemoral joint using magnetic resonance MR images from 16 volunteers 8 male and 8 female. Subjects performed an upright weight-bearing squat with the knee at 60 degrees of flexion inside an open-MR scanner and in a gait laboratory. Quadriceps muscle forces were estimated for each subject using an electromyographic-driven model and input to a finite element analysis.

Cartilage stresses were more sensitive to external rotation of the femur, compared with internal rotation, with large variation across subjects. Shear stresses were higher in the patellar cartilage compared to the femoral cartilage and patellar cartilage stresses were more sensitive to femoral rotation compared with femoral cartilage stress.

Large variation in the cartilage stress response between individuals reflects the complex nature of the extensor mechanism and has clinical relevance when considering treatment strategies designed to reduce cartilage stresses by altering femoral internal and external rotation. To test the feasibility and accuracy of measuring joint motion with real-time MRI in a 1.

We developed an MRI-compatible motion phantom to evaluate the accuracy of tracking bone positions with real-time MRI for varying movement speeds. The measurement error was determined by comparing phantom positions estimated from real-time MRI to those measured using optical motion capture techniques. To assess the feasibility of measuring in vivo joint motion, we calculated 2D knee joint kinematics during knee extension in six subjects and compared them to previously reported measurements.

Measurement accuracy decreased as the phantom's movement speed increased. We measured knee joint kinematics with small intraobserver variation variance of 0. Our results suggest that real-time MRI can be used to measure joint kinematics when 2 mm accuracy is sufficient. They can also be used to prescribe the speed of joint motion necessary to achieve certain measurement accuracy. This is the second of two articles focusing on ultrasound examination of musculoskeletal components of the upper and lower limbs. Treatment of musculoskeletal injuries is based on establishing an accurate diagnosis.

No one would dispute that a good history and physical examination by a competent clinician can help achieve that in the majority of cases. However, musculoskeletal imaging is also an essential adjunct in the work-up of many musculoskeletal disorders. This article describes the ultrasound examination of the lower limb in terms of anatomic structure.

Normal and pathologic ultrasound features of these structures, including muscles, tendons, ligaments, bursae, and other soft tissues of the lower limb, will be described by reviewing several representative pathologies commonly seen in musculoskeletal medicine. Most individuals seeking consultation at sports medicine clinics are young, healthy athletes with injuries related to a specific activity. However, these athletes may have other systemic pathologies, such as rheumatic diseases, that may initially mimic sports-related injuries.

As rheumatic diseases often affect the musculoskeletal system, they may masquerade as traumatic or mechanical conditions. A systematic review of the literature found numerous case reports of athletes who presented with apparent mechanical low back pain, sciatica pain, hip pain, meniscal tear, ankle sprain, rotator cuff syndrome and stress fractures and who, on further investigation, were found to have manifestations of rheumatic diseases. Common systemic, inflammatory causes of these musculoskeletal complaints include ankylosing spondylitis AS , gout, chondrocalcinosis, psoriatic enthesopathy and early rheumatoid arthritis RA.

Low back pain is often mechanical among athletes, but cases have been described where spondyloarthritis, especially AS, has been diagnosed. Neck pain, another common mechanical symptom in athletes, can be an atypical presentation of AS or early RA.

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