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During races, forces and accelerations must be contrasted with the use of skiing’s techniques and muscles strength to ski faster and safely. Therefore, muscular injuries can negatively affect performances.

Muscular damage, consequent to strenuous activities, could exceed the recovery potential of muscles and determine renal failure. Whole body cryostimulation is a cold-based therapy used to improve recovery or overcome fatigue symptoms. This study aimed to evaluate the effects of repeated sessions of cryostimulation on muscle damage, renal function, and their relationship. Serum samples, from 27 elite rugby players, under training, before and after 2 sessions/day of cryotherapy over 7 days, were tested for markers of muscular (creatine kinase, lactate dehydrogenase, and aspartate aminotransferase) and renal (creatinine, cystatin C) functions. eGFR was calculated with two formulas based on either serum creatinine concentration (MDRD) or serum creatinine and cystatin C concentrations (creatinine/cystatin C CKD EPI). Pre- and posttreatment differences were determined by Wilcoxon’s test; correlations were evaluated with Spearman’s test. Cryostimulation helped muscular recovery (increased lactate dehydrogenase activity (P<0.001) and the stabile creatine kinase and aspartate aminotransferase activities). Creatinine was unaffected while cystatin C was increased (P=0.013). Creatinine-based eGFR was not affected by cryostimulation, while creatinine/cystatin C-based eGFR showed a slight decrease (P=0.015). eGFR and muscular biomarkers were not correlated, suggesting a real recovery effect of cryotherapy. Cystatin C seemed more sensible than creatinine in evaluating the kidney function.

The single-bundle ACL reconstruction ensures good outcomes and it is a well-established and widespread technique. Nevertheless, some patients still present residual pain and instability. Recent studies have showed that the double-bundle technique restores better natural ACL-fitting kinematics. Long-term clinical studies comparing the two surgical techniques are not frequent and there is no instrument to evaluate function and kinematics during the knee rotation in vivo. In this randomised prospective study performed on sportive people, we compare the BPTB single-bundle ACL reconstruction technique, which is the most common surgical technique performed on these patients' category, with the ACL double-bundle reconstruction technique (DB), in order to evaluate possible differences between the groups. Comparing the two groups, no statistically significant difference regarding the post-operative Lysholm score (p=0.368) the Tegner activity scale (p=0.519) and the arthrometric evaluation with KT-1000 (p=0.74) have been observed. On the contrary, the IKDC evaluation showed a statistically significant difference (p=0.004) better results of the DB group. Moreover, as assessed by the Tegner activity scale, only patients of the DB group were able to return to sports at a pre-injury level. Our data suggest that the double bundle ST/G ACL reconstruction technique results into slightly better outcome than the traditional technique of single-bundle BPTB. The verification and quantification of the advantages of this technique is anticipated with future studies focusing to the accurate measurement of knee rotation during different activities.

Cold therapy is commonly used as a procedure to relieve pain symptoms, particularly in inflammatory diseases, injuries and overuse symptoms. A peculiar form of cold therapy (or stimulation) was proposed 30 years ago for the treatment of rheumatic diseases. The therapy, called whole-body cryotherapy (WBC), consists of exposure to very cold air that is maintained at -110 degrees C to -140 degrees C in special temperature-controlled cryochambers, generally for 2 minutes. WBC is used to relieve pain and inflammatory symptoms caused by numerous disorders, particularly those associated with rheumatic conditions, and is recommended for the treatment of arthritis, fibromyalgia and ankylosing spondylitis. In sports medicine, WBC has gained wider acceptance as a method to improve recovery from muscle injury. Unfortunately, there are few papers concerning the application of the treatment on athletes. The study of possible enhancement of recovery from injuries and possible modification of physiological parameters, taking into consideration the limits imposed by antidoping rules, is crucial for athletes and sports physicians for judging the real benefits and/or limits of WBC. According to the available literature, WBC is not harmful or detrimental in healthy subjects. The treatment does not enhance bone marrow production and could reduce the sport-induced haemolysis. WBC induces oxidative stress, but at a low level. Repeated treatments are apparently not able to induce cumulative effects; on the contrary, adaptive changes on antioxidant status are elicited--the adaptation is evident where WBC precedes or accompanies intense training. WBC is not characterized by modifications of immunological markers and leukocytes, and it seems to not be harmful to the immunological system. The WBC effect is probably linked to the modifications of immunological molecules having paracrine effects, and not to systemic immunological functions. In fact, there is an increase in anti-inflammatory cytokine interleukin (IL)-10, and a decrease in proinflammatory cytokine IL-2 and chemokine IL-8. Moreover, the decrease in intercellular adhesion molecule-1 supported the anti-inflammatory response. Lysosomal membranes are stabilized by WBC, reducing potential negative effects on proteins of lysosomal enzymes. The cold stimulation shows positive effects on the muscular enzymes creatine kinase and lactate dehydrogenase, and it should be considered a procedure that facilitates athletes' recovery. Cardiac markers troponin I and high-sensitivity C-reactive protein, parameters linked to damage and necrosis of cardiac muscular tissue, but also to tissue repair, were unchanged, demonstrating that there was no damage, even minimal, in the heart during the treatment. N-Terminal pro B-type natriuretic peptide (NT-proBNP), a parameter linked to heart failure and ventricular power decrease, showed an increase, due to cold stress. However, the NT-proBNP concentrations observed after WBC were lower than those measured after a heavy training session, suggesting that the treatment limits the increase of the parameter that is typical of physical exercise. WBC did not stimulate the pituitary-adrenal cortex axis: the hormonal modifications are linked mainly to the body's adaptation to the stress, shown by an increase of noradrenaline (norepinephrine). We conclude that WBC is not harmful and does not induce general or specific negative effects in athletes. The treatment does not induce modifications of biochemical and haematological parameters, which could be suspected in athletes who may be cheating. The published data are generally not controversial, but further studies are necessary to confirm the present observations.

Objective: To compare the outcomes of arthroscopic reconstruction of the posterior cruciate ligament (PCL) by means of the double bundle technique with the ipsilateral semitendinosus and gracilis (St-Gr) and the single bundle technique with the ipsilateral patellar tendon (PT). Methods and measures : 14 patients had randomly been assigned to either PT ot St-Gr graft for PCL reconstruction. The IKDC Knee Ligament Evaluation Form, the Lysholm Knee Scoring Scale, the Cincinnati Knee Rating Scale and concentric isokinetic knee extensor-flexor test at 60 and 180 ◦ /s were used to compare the results. Results: there were no significant differences in the clinical scores. The isokinetic tests, however, disclosed a significant loss of strength at the harvest site. Conclusion: since biomechanical considerations underscore the importance of recovery of the quadriceps after PCL reconstruction, employment of the semitendinous and gracilis with a possible loss of flexor strength could be rationally more acceptable solution than reconstruction with the patellar tendon and weakening of the extensors.

Sports anemia is a common risk for athletes. Intravasclar hemolysis is the principal source of an accelerated turnover of erythrocytes in sportsmen. The hemolysis induces some biochemical and hematological modifications; in particular, high concentrations of total and indirect (unconjugated) bilirubin could be reported in professional athletes. We recruited 24 rugby players of the Italian National Team. In these athletes we measured hematological parameters, including mean sphered cell volume (MSCV) by means of Coulter LH 750 (Beckman Coulter, Brea, CA, USA), beside biochemical parameters, including bilirubin and haptoglobin. We observed differences in the athletes' indirect bilirubin between the blood drawing performed before the start of training and competitions and the one performed at the end of the competition season. The bilirubin was increased during competition season from 7% to 329% when compared with the baseline value measured before training and competitions. MSCV, in contrast, decreased from a mean of 88.4 fL to 86 fL. The MSCV decrease in association with an indirect bilirubin increase is a specific sign of erythrocyte destruction, and specific training and competitions schemes and diet or therapy modifications should be decided according to their values. The modifications of MSCV are correlated with those of haptoglobin and hemoglobin, but not with reticulocytosis.

We assessed haematological parameters and possible modifications in elite rugby players throughout a competitive season for increasing the knowledge of physiological characteristics of these sportsmen. Blood samples were collected from the members of the Italian National rugby team at four consecutive training camps during a whole competitive season. Forty-four athletes were recruited for the first camp, 36 for the second, 30 for the third and 32 for the fourth. Due to turnover of the subjects during the season only 13 athletes could be examined at all four camps, and another six in the first three camps. Therefore, we selected the data of these 19 athletes. Iron and transferrin saturation were stable, whilst ferritin increased at the end of the season. The modifications of the soluble transferrin receptor (sTFR) were linked to those of haematocrit: sTFR increased after training and during the competition period when haemoglobin and haematocrit decreased, and decreased at the end of the season. Haemoglobin and haematocrit showed slightly higher levels during the first part of the season and decreased in the second half, when physical demand was high, as demonstrated by biochemical additional tests. Leucocytes and platelets were stable throughout the season. Haematological and iron metabolism parameters in the elite rugby players examined during a whole season fall within physiological range of values. The variability of the parameters during the season is related to training and competition workload. Reticulocytes and sTFR are the most sensitive parameters for studying the iron metabolism of the athletes.

Objective: To describe and compare two ultrasonographic localization techniques for the treatment of lateral epicondylitis with extracorporeal shock wave therapy (ESWT). Design: Forty-one subjects selected through clinical examination were randomly assigned to two groups of treatment. Interventions: Each subject received a three-session ultrasound-guided ESWT (performed weekly). Lateral tangential focusing was used in group A, whereas back tangential focusing was used for group B. Main outcome measures: Total Elbow Scoring System (TESS) and a visual analogue scale (VAS) were used to evaluate each subject before the treatment and at six months follow-up. Results: TESS and VAS pretreatment scores were homogeneous between the groups (p/0.05). In both groups there was a significant (p B=0.05) increase in the TESS score and a decrease in the VAS score but there was no resolution of the pain. TESS and VAS follow-up scores were homogeneous between the two groups (p/0.05). Conclusions: There was no difference between the two techniques of using ESWT.

The incidence rate of muscle injuries and re-injuries in professional elite soccer players actually is very high and may interfere with the fate of a championship.To investigate the effect of a two-tiered injury prevention programme on first injury and re-injury incidence in top level male soccer players. Study design.Muscle injuries and re-injuries sustained by a group of 36 soccer player of an italian elite soccer team have been collected during 2010-2011 season. These data have been compared with those collected during the previous season in the same elite soccer team.A total of 64 injuries occurred, 36 (56%) of which during practice and 28 (44%) during matches. Muscle injuries accounted for 31.3% of the total (n=20), 70% (n=14) of which occurred during practice and 30% (n=6) during matches. Hamstring were the muscles most often injured (n=11) In all, 3 re-injuries occurred (15% of muscle injuries). No early re-injuries occurred. The incidence was 2.5 injuries/1000 hours and the burden was 37 days absence/1000 hours.Through the implementation of a group and personalized injury prevention program, we were able to reduce the total number of muscle injuries and days absent because of injury, in a team of elite soccer players, as compared to the previous season. Specifically, muscle injuries accounted for 31% of all injuries, as compared to 59% of all injuries sustained by the team during the previous season. The number of injuries/1000 hours of exposure was reduced by half (from 5.6 to 2.5) and the days absent/1000 hours fell from 106 to 37.

Whole body cryotherapy (WBC) consists of a brief exposure to extreme cold air (-110°C) in a controlled chamber and it is applied in sports medicine to improve recovery from musculoskeletal trauma. The aim of this study is to better define the beneficial effect of WCB on the musculoskeletal system of athletes, in particular on bone remodelling. Remodelling osteoimmunological biomarkers OPG, RANKL and RANK were measured after WBC treatment in 10 male rugby players randomly selected from the Italian National team. OPG levels were increased significantly, supporting the view that WBC induces an osteogenic effect. Further studies evaluating the effect of WBC on bone metabolism are desirable.

Cold-based therapies are commonly applied to alleviate pain symptoms secondary to inflammatory diseases, but also to treat injuries or overuse, as done in sports rehabilitation. Whole body cryotherapy, a relatively new form of cold therapy, consists of short whole-body exposure to extremely cold air (-110 degrees C to -140 degrees C). Cryostimulation is gaining wider acceptance as an effective part of physical therapy to accelerate muscle recovery in rugby players. The aim of this study was to evaluate the effect of repeated cryostimulation sessions on the hematological profile and martial status markers in professional rugby players. Twenty-seven professional rugby players received 2 daily cryostimulation treatments for 7 consecutive days. Blood samples were collected before and after administration of the cryotherapic protocol and hematological profiles were obtained. No changes in the leukocyte count or composition were seen. There was a decrease in the values for erythrocytes, hematocrit, hemoglobin and mean corpuscular hemoglobin content, and an increase in mean corpuscular volume and red cell distribution width. Platelet count and mean volume remained unchanged. Serum transferrin and ferritin decreased, while soluble transferrin receptor increased. Serum iron and transferrin saturation were unchanged, as was reticulocyte count, whereas the immature reticulocyte fraction decreased substantially. In conclusion, in this sample of professional rugby players, cryostimulation modified the hematological profile, with a reduction in erythrocyte count and hemoglobinization paralleled by a change in martial status markers.

The incidence rate of ACL rupture in young patients (15–40 years) has recently been reported to be 85 per 100,000 person-year, and it is estimated that approximately 250,000 ACL reconstructions are performed yearly in Europe and the United States. Although ACL reconstruction is a successful operation with satisfactory outcomes, an overall clinical failure rate of 10 % to 25 % has been reported. Therefore, an increasing number of patients are requiring revision ACL reconstruction. Indeed, the number of revision ACL reconstructions has almost doubled during the past 10 years according to national registries.

Objective: To generate data on optimal shoulder position comparing two ultrasound-guided extracorporeal shock wave therapy techniques for the treatment of calcifying tendinitis of the shoulder. Design: Random assignment to two groups of treatment with three months follow-up. Setting: The data were collected in outpatients. Subjects: Thirty-five subjects affected by calcifying tendinitis of the shoulder were examined. Interventions: Each subject received three sessions of ultrasound-guided extracorporeal shock wave therapy (performed weekly). Neutral position technique was used in group A (n = 17, mean age 53 ± 9.2 years) and the hyperextended internal rotation technique was used in group B (n = 18, mean age 52.2 ± 10.8 years). Main outcome measures: The Constant and Murley method and radiographs were used to evaluate each subject before the treatment and at three months follow-up. Results: There were no significant differences between changes in Constant total score and pain, activity of daily living and range of motion subscales of the two groups. Only the pain subscale showed a significant difference in favour of group B. Significant differences in the radiographic outcome were observed between the two groups: the percentage of total or subtotal resorption of the calcified deposits was 35.3% in group A (neutral position technique) versus 66.6% in group B (hyperextended internal rotation technique). The resorption of the calcific deposit positively influenced the clinical outcome. Conclusions: Positioning the shoulder in hyperextension and internal rotation during extracorporeal shock wave therapy seems to be a useful technique to achieve resorption of calcific deposits.

Equations to estimate the glomerular filtration rate (GFR) have recently been advocated over serum creatinine values as a means to more accurately assess kidney function. The Cockcroft-Gault (CG) equation requires a body weight parameter, whereas the Modification of Diet in Renal Disease (MDRD) Study and Mayo Clinic Quadratic Equation (MCQE) formulae do not. We measured the serum creatinine and cystatin C concentrations in male athletes belonging to the Italian National Rugby team. Blood was obtained before the start of training and during competitive season. The serum creatinine level was measured by Jaffe and enzymatic reactions, cystatin C by nefelometry. The same parameters were measured in a control group of male, sedentary and overweight subjects. The concentrations of cystatin C were always into the reference ranges. The concentrations of creatinine were often higher than reference interval. The use of enzymatic method did not improve the specificity. The equations based on cystatin C and creatinine were not correlated. The two equations based on cystatin C were correlated. Two equations based on creatinine values were correlated (MDRD and MCQE); they were not correlated with CG. 29 level athletes, characterized from a high release of creatinine. The use of equations should be accurately evaluated: the CG equation can overestimate the eGFR, the MDRD and MCQE formulae systematically underestimates it. The use of equations to estimate GFR in the general population needs examination of their behaviour in subjects having atypical anthropomorphic characteristics.

Muscle strains are one of the most common sports-induced injuries. Depending on the severity and location of the muscle strain, different treatment approaches can be taken. This review highlights recent trends in conservative, pharmacologic, and surgical approaches to the management of sports-induced muscle injuries as presented at a symposium held during the 93rd Annual Congress of the Italian Society of Orthopedics and Traumatology (SIOT) in Rome, Italy in November 2008. Conservative approaches now include growth factor therapy and administration of autologous platelet-rich plasma during the early postinjury period; however, its use is currently considered a doping violation under the World Anti-Doping Agency code, therefore restricting its use to nonelite sports people only. Topical anti-inflammatory therapy is a promising therapeutic strategy, since it allows local analgesic and anti-inflammatory effects while minimizing systemic adverse events. As the drug delivery system is critical to clinical effectiveness, the advent of a new delivery system for ketoprofen via a new-generation plaster with a marked increase in tissue penetration and a clinical efficacy comparable with that of oral administration, provides a viable option in the treatment of single sport lesions. Surgical treatment of muscle lesions is less common than conservative and topical therapies and indications are limited to more serious injuries. Presentations from SIOT 2008 show that advances in our understanding of the healing process and in conservative, pharmacologic, and surgical treatment approaches to the management of sports-induced muscle strains contribute to better clinical outcomes, faster healing, and a swifter return to normal training and activity levels.

Whole-body cryotherapy (WBC) covers a wide range of therapeutic applications and consists of briefly exposing the body to extremely cold air. In sports medicine, WBC is used to improve recovery from muscle injury; however, empirical studies on its application to this area are lacking. To fill this gap, we compared changes in immunological parameters (C3, IgA, IgM, IgG, C-reactive protein, PGE2), cytokines (IL-2, IL-8, IL-10), adhesion molecules (sICAM-1), and muscle enzymes (creatine kinase [CK], lactate dehydrogenase [LAD]) before and after WBC in 10 top-level Italian National team rugby players. The subjects underwent five sessions on alternate days once daily for 1 week. During the study period, the training workload was the same as that of the previous weeks. Compared to baseline values, immunological parameters remained unchanged, while CK and LAD levels significantly decreased after treatment. No alterations in immunological function were observed but there is a decrease in pro-inflammatory cytokine/chemokine and an increase in anti-inflammatory cytokine. As measured by changes in serum CK and LAD concentrations, and cytokines pathway, short-term cold air exposure was found to improve recovery from exercise-induced muscle injury and/or damage associated with intense physical training.

Background. Sport's anemia is a common risk for athletes. The principal source of an accelerated turnover of the erythrocytes in sportsmen is the intravascular hemolysis. This phenomenon is induced by mechanical breakage for impact of feet and muscular contractions, but also by osmotic changes causing membrane fragility, typically evident after exercise, when free radicals are increased. Whole-body cryotherapy (WBC) covers a wide range of therapeutic applications and consists of briefly exposing the body to extremely cold air. In sports medicine, WBC is used to improve recovery from muscle injury; however, empirical studies on its application to this area are lacking. Design and Methods. We recruited ten rugby players of the Italian National Team. In these athletes we measured hematological parameters, before including mean sphered cell volume (MSCV) by means of Coulter LH750, besides of haptoglobin, and after WBC. The subjects underwent five sessions on alternate days once daily for one week. During the study period, the training workload was the same as that of the previous weeks. Results. We observed in the athletes increase of haptoglobin and an increase of MSCV after the treament period. Conclusions. WBC reduces sports haemolysis, as judged from MSCV and haptoglobin data, supported from other haematological values, as well as the absence of mean corpuscolar volume and reticulocytes increase. The treatment is useful to prevent the physiological impairments derived from sport haemolysis.

Dear Sir, Serum creatinine concentrations in professional athletes are higher than those found in the general population, as demonstrated in a large series of top-level sportsmen competing in eight different sports disciplines. Cystatin C has been proposed as an alternative to creatinine for assessing glomerular filtration rate (GFR). We measured serum creatinine concentration in 25 men (age range 22–30 years; mean body mass index [BMI] 27.4 (SD 1.3) kg/m) belonging to the Italian national rugby team; blood was drawn in January, in the middle of the competitive season, when the psychophysical stress for athletes is at highest level. Serum creatinine was measured by the Jaffe reaction (Aeroset c8000, Abbott, Chicago, IL, USA; upper limit of normal 110 mmol/L) and by an enzymatic method (Johnson and Johnson Vitros 950, Johnson and Johnson, Raritan, NJ, USA). Cystatin C was measured nephelometrically (Dade Behring, Marburg, Germany; upper limit of normal 0.95 mg/L). The mean Jaffe serum creatinine concentration was 115 mmol/L (SD: 13.3), while the mean value using the enzymatic method was 119 mmol/L (SD: 13.3). Twelve/fifteen players had serum creatinine concentrations exceeding 110 mmol/L using the Jaffe/enzymatic assays respectively. The mean cystatin C concentration was 0.85 mg/L (SD: 0.08); no player had a cystatin C concentration exceeding 0.95 mg/L. Body mass and in particular muscle mass are known to influence serum creatinine concentration. Our data suggest that serum cystatin C concentration may be a more accurate reflection of GFR in these professional athletes.

Objective: To describe and compare two extracorporeal shock wave therapy techniques for the treatment of painful subcalcaneal spur.Design: Random assignment to two groups of treatment with two and eight months follow-up.Setting: The data were collected in outpatients.Subjects: Forty-five subjects with a history of at least six months of heel pain were studied.Interventions: Each subject received a three-session ultrasound-guided extracorporeal shock wave therapy (performed weekly). Perpendicular technique was used in group A (n=22, mean age 59.3 ± 12 years) and tangential technique was used in group B (n= 23, mean age 58.8 ± 12.3 years).Main outcome measures: Mayo Clinical Scoring System was used to evaluate each subject before the treatment and at two and eight months follow-up.Results: Mayo Clinical Scoring System pretreatment scores were homogeneous between the groups (group A 55.2 ±18.7; group B 53.5 ± 20; P>0.05). In both groups there was a significant (PConclusions: There was no difference between the two techniques of using extracorporeal shock wave therapy. The tangential technique was found to be better tolerated as regards treatment-induced pain, allowing higher energy dosages to be used.

BackgroundRevision of an anterior cruciate ligament reconstruction is a complicated and delicate clinical procedure whose results, theoretically, are less satisfactory than those of the first operation.HypothesisThe outcome of a revised anterior cruciate ligament surgery is comparable to primary anterior cruciate ligament reconstruction, with a rate of success around 70% to 80%.Study DesignCase series; Level of evidence, 4.MethodsA total of 66 revisions of anterior cruciate ligament reconstructions were carried out from September 2000 to September 2004. Patients with concomitant instability and those with alterations in the weightbearing axis of the lower limbs were not included. Sixty patients were followed from 24 to 72 months: 50 clinically and 10 by a phone interview. Six patients were lost to follow-up due to changes of address.ResultsLysholm scores were 57% excellent (95–100 points), 13% good (84–94 points), 22% fair (63–83 points), and 8% poor (ConclusionThe results of these anterior cruciate ligament reconstruction revision surgeries are close to those achieved by other series of primary reconstructions with a little less satisfactory results. We attribute the high success rate to the strict application of the same technique and the confinement of revision to motivated patients. It should be noted, however, that follow-up is only at the midterm stage (mean, 41.9 months).

The principal source of increased turnover of erythrocytes in athletes is sport hemolysis, the intravascular hemolysis that characteristically occurs with athletic performance in sport. The use of the parameter mean sphered cell volume (MSCV), automatically measured by means of the Coulter LH750, could be useful for diagnosing the presence of sport hemolysis. We studied the behavior of MSCV and mean corpuscular volume (MCV) in 30 top-level rugby players who underwent a heavy training session followed by 3 different recovery methods, administered to 3 subgroups of 10 athletes. We tested the use of active recovery consisting of cold water (5 degrees C) immersion of legs for 10 minutes either before (n = 10) or after (n = 10) cycling at 180 W for 10 minutes. In the whole group of athletes, measurements performed at rest and after training session and recovery showed no differences in MCV and MSCV values. The difference between MCV and MSCV was significant in the whole group and in the subgroup performing passive recovery, whereas the difference was not significant in the subgroups performing active recovery. This finding indicates that the use of active recovery in the top-level rugby players prevented the modifications of erythrocyte volume and shape. We outline that the values of the difference between MCV and MSCV was significantly modified in the whole group but the variations were not significant in the active recovery subgroups. The use of an index of erythrocyte shape modification (MCV - MSCV) can be very useful for evaluating sport hemolysis.

The use of methods other than passive recovery for improving recovery after intense training and competitions in sports is growing. In particular, in rugby, the use of cold water, possibly associated with active recovery (cycling), and the use of cold and hot water immersion are quite popular. In our experience, the perception of muscle soreness after heavy exercise in top-level rugby players decreases when cold-water immersion of legs is performed during recovery period, as also quantified by a semiquantitative scale.1 Gill and coworkers described the effectiveness of contrast water therapy (CWT) for improving the post-match recovery in elite rugby players.2 CWT was performed by immersion of the body to …

Objective: To evaluate the effectiveness of extracorporeal shock wave therapy (ESWT) for the treatment of painful subcalcaneal spurs and evaluate whether local steroid injections, body weight and the length of symptoms can affect the clinical results. Design: Subjects were selected through clinical examination and heel radiograms according to diagnosis of painful subcalcaneal spurs. Subjects: Sixty-four subjects were divided into two groups of treatment depending on their past history of previous local steroid injections. Interventions: Each subject received a three-session ESWT (performed weekly). A rehabilitative programme was instituted, consisting of self-assisted plantar fascia and plantar ‘exors stretching exercises. Main outcome measures: The Mayo Clinical Scoring System (MCSS) was utilized to evaluate each subject before the treatment and at two- and ten- month follow-ups. In addition, standard radiograms were done both before the treatment and at the ten-month follow-up. Results: Patients with no past treatment using steroids did not show any statistically significant improvement of the MCSS at the two-month follow-up. The statistical significance was obtained at the ten-month follow-up. Patients with past treatment using steroids did not show any statistically significant improvement of the MCSS at either follow-up. At the radiogram check, none of the subjects showed any modification of the heel spurs. Conclusions: According to the results of the present study ESWT should be considered as an effective treatment for painful subcalcaneal spurs. Previous local steroid injections may negatively affect the result of ESWT.

To evaluate the effects of a rehabilitation brace locked in extension for the first week on the recovery of full extension after ACL reconstruction we compared two groups of subjects who underwent ACL bone-patellar tendon-bone reconstruction. The brace was unlocked twice a day for assisted physiotherapy. In Group A, 18 male subjects wore a post-operative brace locked from 0 degrees to 90 degrees. In Group B, 18 male subjects wore the same post-op brace locked in full extension for the first week. In both groups the brace was unlocked (0 degrees -120 degrees ) at the beginning of the second postoperative week, and then removed at the beginning of the third week. All the subjects followed the same rigorous, accelerated rehabilitation protocol. Each subject was evaluated pre and post-operatively (at second, fourth and eighth week) with bubble-level heel height difference (HHD) measurements and KT 1000 arthrometric assessment at the fourth postoperative month. Preoperative bubble-level HHD measurements of the two groups were statistically similar (Group A 0.6 cm, Group B 1 cm; not significant, n.s.). At the fourth week (Group A 2.2 cm, Group B 0.6 cm) and eighth week (Group A 1.6 cm, Group B 0.1 cm) follow-ups, bubble-level HHD measurements showed that the extension of the operated knees of Group B was significantly greater than in Group A. KT 1000 arthrometric scores showed no difference between the two groups (Group A 1.8 mm, Group B 1.5; n.s.).

Whole-body cryotherapy refers to brief exposure to very cold air for treating symptoms of various illnesses. In sports medicine, whole-body cryotherapy is administered to improve recovery from muscular trauma. As specific Studies are lacking we Measured cardiac markers in 10 top-level rugby players of the Italian National team before and after a I-week course of daily sessions of whole-body cryotherapy. All Subjects continued with the same training workload as that of the previous weeks. N-terminal pro B-type natriuretic peptide (NTproBNP) levels increased but remained within the normal range. whilst troponin I (TnI) and high sensitivity C-reactive protein (hsCRP) Were Unchanged. Whole-body cryotherapy did not impair cardiac function in this sample of elite athletes. (C) 2008 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

The publishers would like to add an erratum, as suggested by the authors Angelo De Carli, et al., to remove any ambiguity that may have been caused by the use of the term “relative risk” in Table 1 (shown below). As such, the authors would like to replace the term with “relative benefit.” The original table header is: “Relative risk (fixed) and number needed to treat (NNT) from a metaanalysis of various topically applied nonsteroidal anti-inflammatory drugs (NSAIDs) compared with placebo for the treatment of acute musculoskeletal pain conditions.” The rephrased table header should read: “Relative benefit (fixed) and number needed to treat (NNT) from a meta-analysis of various topically applied nonsteroidal anti-inflammatory drugs (NSAIDs) compared with placebo for the treatment of acute musculoskeletal pain conditions.” Here, relative benefit is defined as the relative risk of experiencing a 50% reduction in pain in the active drug group versus placebo. The revised table with header is shown below, for clarity. 0068-8

Whole-body cryotherapy is a treatment used for various conditions, especially rheumatological disease.1 In sports medicine, whole-body cryotherapy is known to encourage recovery from muscular traumas, although well-controlled studies have not been published. The treatment is not dangerous for lung function2 and does not decrease antioxidant capacity.3 In whole-body cryotherapy, the subjects, wearing minimal clothing, are exposed to very cold air: a period of 30 seconds at –60°C and, later, a period of 2 minutes at –110°C. Despite the high cold …