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Oh, My Achin’ Ligament

Doctors and surgeons now have many ways to treat ligament injuries, with or without surgery. But there are still many questions about the way ligaments heal. To summarize what is known about ligament healing, the authors focused on two different knee ligaments, the medial collateral ligament (MCL) and anterior cruciate ligament (ACL).

Athletes commonly injure both these knee ligaments. Treatments for these ligaments can range from simple remedies like rest and ice to surgery. However, no matter what kind of treatment is used, injured ligaments may never become as good as new. Two years after an injury, electron microscope studies show that the cells in the injured area are smaller in size and shape. This verifies that the ligament still hasn’t returned to normal.

Ligament healing is affected by many factors. Most MCL injuries, for example, tend to heal better without surgery. Not so with ACL injuries. Doctors are not exactly sure why this is true. It may have to do with factors like blood flow to the ligament and the ligament’s structure. New scientific discoveries are guiding the ways doctors and other health professionals treat injured ligaments.

The authors listed several new advances that may someday be used to speed the healing process.

Growth factors are small polypeptides that bind to cells and promote cell growth.

Gene transfer technology involves transplanting genetically altered tissues into the ligaments to improve healing.

Cell therapy uses genetically altered cells to enhance ligament repair.

The authors are optimistic that new insights on ligament healing in the knee will prove useful in other parts of the body as well.

Risk Factors for Knee Pain in Distance Runners

Knee pain is the most common problem facing people who run more than 10 miles per week. Most of these problems happen in the anterior(front) part of the knee, around and under the kneecap. Each year, up to 65% of all distance runners will have to stop running or seek medical care due to anterior knee pain. Since there are about 32 million regular distance runners in North America, that translates to roughly 21 million people.

Knowing which runners are at risk for knee pain is the first step toward prevention. To help with this, the authors recruited runners at local races and in running magazines. Two groups were formed. Seventy non-injured runners were selected for the control group, and 99 injured runners were selected for the injury group. All the runners completed detailed questionnaires about their running experience, training routines, running terrain, shoes, and injury history. Researchers used medical and video technology to measure each runner’s legs, feet, strength, stride, and running style.

The authors found several differences between the groups. Runners were more likely to have problems with anterior knee pain if:

They had high arches in their feet.

Their feet didn’t begin to pronate as soon as they hit the ground.

They had weakness in the muscles that straighten the knee.

The authors also found that runners with knee pain replaced their shoes more often. According to the authors, this probably did not actually cause the pain. It could be that having high arches caused their shoes to wear out faster, because high-arched feet generally don’t absorb shock very well.

Professionals who work with runners may be able to use this new information to help their clients avoid problems with anterior knee pain.

Knee Injuries Can Be Catching

Believe it or not, catching a ball can actually make you more likely to suffer a knee injury. Injuries to the anterior cruciate ligament (ACL) of the knee are more common in sports like basketball, which involve sudden stops and ball handling. Researchers in Australia tested why that may happen.

They tested seven male and 11 female recreational athletes with an average age of about 23. The subjects ran three steps and then jumped onto a force platform, where they landed on one leg. Sometimes, without advance warning, they had to catch a ball as they landed.

The subjects were filmed and their muscle activity measured as they did the jumping tests. Researchers found that catching a ball didn’t change the movements or angle of the legs, hips, or body as the subjects landed on the platform. However, catching a ball made major changes in the timing of muscle contractions. Something about catching a ball made the quadriceps contract earlier and the hamstring contract later than during the other landings.

Normally, the hamstring muscle keeps the tibia bone in the lower leg centered. This keeps it from sliding forward under the femur bone of the thigh. If the quadriceps muscle on the front of the thigh tightens without the opposing action of the hamstrings, the tibia gets pulled forward. This causes the ACL to become taut to the point where it can stretch out. It may even tear.

Proper muscle coordination when landing on one leg helps protect the ACL and the rest of the knee from heavy force. This study shows that catching a ball can alter muscle coordination between the quadriceps and hamstring muscles, making the ACL more vulnerable to injury. But why this happens is still a mystery that demands more research.

The “Eyes” Have It

We don’t realize it, but our eyes have a great deal to do with how we stand and move. The eyes feed the brain information about where the body is in relationship to the ground and objects all around us. Different eye positions in the eye socket inform sensors in the brain so the body can adjust its posture.

It is not surprising, then, that a link has been found between visual problems and spine problems. Scientists in France wanted to see if there was a relationship between scoliosis and vision problems.

A healthy spine normally curves in a couple different directions from front to back, with little or no curvature side-to-side. Scoliosis involves a side-to-side curvature, usually of the upper half of the spine. Often, an “S” shape develops as the spine compensates for the curve. Scoliosis can be a progressive problem or, as with most children in this study, it can be fairly stable.

The authors compared 75 children who were blind or severely visually impaired with 728 children with normal vision. Both groups averaged between 10 and 11 years old. Researchers used several methods of scoliosis measurement, including specialized photography and the standard forward bend test. Children with visual problems and scoliosis also had X-rays of their back.

The results showed that children with visual impairment were twice as likely to have scoliosis as those in the control group. An additional finding was that 18 of the children with scoliosis also had a head tilt and turn. The authors thought that the head tilt was a way to compensate for visual problems, and that it led to scoliosis of the neck vertebrae.

For example, nystagmus, a condition that causes constant circular eye movement, can be stopped by holding the head in a tilted position. Strabismus (crossed eyes) is caused by a weak or paralyzed eye muscle that keeps the eyes from looking in the same direction. Children with strabismus tilted their heads so they could avoid using their weak eye muscles. Over time, the head tilts resulted in scoliosis of the neck vertebrae.

Scoliosis caused by tilting the head didn’t seem to be a progressive problem in these children. That led the authors to conclude that this type of scoliosis should not be treated, unless the curve is severe.

Back Pain Can Be a Real Pain in the Backside

Back pain sometimes hurts just in the low back. But it can also be a pain in the rear–and a pain in the leg. Pain from the back that shoots into the buttock or leg is called radicular pain.

Foraminal stenosis and herniated discs are two common causes of radicular back pain. In foraminal stenosis, the spine narrows and may pinch nerves as they leave the spinal cord. A herniated or bulging disc can push on the nerves leaving the spinal cord. Pressure on nerves can cause a lot of pain and weakness in the back and down the legs along the path of the nerve. Radicular back pain can be so disabling that patients may need surgery to stop the pain.

Doctors often treat radicular back pain with epidural injections of steroids, although the effectiveness of this treatment is controversial. Another method for getting steroids to the inflamed nerve is called a selective nerve-root injection. Doctors use a special kind of X-ray called a fluoroscope to guide a needle directly to the painful spinal nerve. This procedure gets more medication to the painful spot.

These researchers wanted to compare whether nerve-root injections using numbing medicine alone or in combination with steroids actually lessened radicular back pain. They were also interested to see whether patients got enough relief that they no longer wanted or needed back surgery.

Researchers selected 55 patients who had requested back surgery to relieve their pain. They were divided into two groups. Twenty-seven patients received bupivacaine, a long-acting numbing medicine. The other 28 patients received bupivicaine plus a steroid. The researchers considered the treatment a failure if the patient went ahead with surgery. From the group who received bupivicaine alone, 18 patients ended up going through with surgery. But only eight who’d gotten bupivicaine in addition to the steroid needed surgery.

The math is pretty straightforward. Out of the 55 total patients, 29 avoided surgery after being treated with nerve-root injections. And even though bupivicaine alone was helpful, the number of people helped by getting the additional steroid was significant.

This study showed no difference in pain control between the patients with spinal stenosis and patients with a herniated disc. However, the researchers questioned whether this would be the case over time. It’s been shown that herniated discs can fully recover without any treatment, while foraminal stenosis typically worsens with time. This study followed patients from 15 to 28 months. If patients with a herniated disc avoided back pain in this time frame, it is unlikely that they would need surgery in the long run. The authors conclude that treatments like nerve-root injection could be just what the doctor ordered in helping more people avoid back surgery.

Surgery or No Surgery? That Is the Question

Lumbar spinal stenosis is a term commonly used to describe narrowing of the spinal canal that causes pressure against the spinal cord. The problem is fairly common in people with back pain, especially in older people. There are several different types of conservative (nonsurgical) and surgical treatments for lumbar spinal stenosis. But so far it is unclear whether people get better results with surgery or conservative treatment.

Previously, these authors published the results of a one-year study comparing patients who underwent surgery and those who got conservative treatments for lumbar stenosis. It suggested that patients treated surgically got better faster, had less pain, and were more satisfied with their back condition than patients who got conservative treatments.

But did the results of surgery stand up to the test of time? The authors checked in with the same patients four years later. They found that both groups were doing about the same. However, the group who had surgery was still better off than the nonsurgical group. This held true even when the authors compared patients by their condition when they first saw a doctor for treatment. Significantly, 79% of the patients who had surgery reported that if they could go back in time, they would still have the surgery.

The authors note that poor outcomes are common with lumbar spinal stenosis, no matter how it is treated. Up to 40% of patients who have surgery, and up to 60% who get conservative treatment, are not doing too well after four years. So even though this study sheds some light on its possible benefits, surgery is not necessarily the automatic choice for all patients with lumbar spinal stenosis.

Crying Wolf about Low Back Pain

Accurately measuring physical impairment is easier said than done. So far, most of the strategies identified by researchers don’t work. One of the factors that makes such measurement difficult is that patients sometimes exaggerate their symptoms when they bend and twist in the doctor’s office. Patients may exaggerate their impairments on purpose–to get treatment, medication, or disability status. But many patients exaggerate their symptoms without even knowing it. They may be afraid of causing themselves pain, or they may simply be nervous about being in the doctor’s office.

These authors used exaggeration to gauge the usefulness of one method of measuring low back impairment. They tested two groups of 100 people each. One group had low back problems, and the other group didn’t. Both groups underwent a physical examination while wearing a device to monitor their body movements. The participants bent forward, bent side to side, and twisted their trunk back and forth. They did their best with each motion on the first try. The second time they were told to move as if their back was more painful than it actually was.

The results showed that the monitor was fairly accurate in determining which motions were real and which ones were exaggerated. This suggests that the device might be a useful way to more accurately measure low back impairment.

It also supports the theory that we tend to move our bodies in set patterns–unless, of course, we’re faking it. The monitor showed erratic patterns of movement when people tried to exaggerate their motion. They simply couldn’t fake it the same way twice.

Too Old for ACL Surgery? Not Likely

A mere few years ago, most surgeons probably wouldn’t have considered doing surgery to reconstruct the anterior cruciate ligament (ACL) in patients over 40. However, with the steady rise of more technically advanced ways to do this surgery, the boundaries of age are being stretched.

But how do “older” patients fare after ACL surgery? Surely they don’t do as well as their younger counterparts. Or do they?

Fresh evidence indicates that patients over 40 have results after ACL surgery that are comparable to patients in their early 20s. Two groups of ACL patients were compared before and after surgery. One group included people over the age of 40. The other represented the typical age group for this type of surgery, ages 20 to 24.

Patients had a recheck within 38 weeks after surgery. The final results showed that the older group did nearly as well as the younger group. Researchers measured the patients’ knee motion, ability to hop on one leg, and side-to-side slackness in the affected knee. In each instance, the differences were minimal between groups.

Researchers also asked questions about daily activities and knee function. The questions showed only one major difference between the groups. Younger patients tended to return to higher activity levels after the surgery.

When asked about their opinion of the surgery, the people in the middle-aged group reported being more pleased with their results than those in the younger group.

The authors conclude that being over 40 shouldn’t be an obstacle to good results from ACL surgery. Hmmm. Too old to have an ACL surgery? That’s almost like saying you’re too old to rock ‘n roll.

Extra Oxygen Not the Answer for Injured Muscles–Yet

Part of the body’s healing response is to flood injured tissues with blood. The blood flushes away toxins that build up, and it brings in a fresh supply of nutrients and oxygen to help the tissues heal. Tissues that don’t have good blood supply tend not to heal as well. For this reason, doctors treat certain types of injuries by giving patients extra oxygen. The idea is that maximizing the amount of oxygen in the blood will help get more oxygen to the injured tissues. Recently, high-level athletes have begun to use specialized oxygen therapy for injured muscles.

This technique for giving extra oxygen is called hyperbaric oxygen therapy (HBO). HBO treatments are given in special chambers that also increase the atmospheric pressure. The patient wears a mask over the face that delivers 100% oxygen, rather than the 21% oxygen in the air you’re breathing right now.

In this study, researchers tested the benefits of giving HBO therapy for injured muscles. They divided 21 college-aged men into three groups. Each person did six sets of 10 bicep curls using a preset weight that would produce a strain in the muscles.

After lifting weights, the three groups got different treatments. One group received HBO treatment two hours after lifting weights and then once a day over the following three days. The second group got a fake HBO treatment two hours after exercising and then real HBO treatments once a day for the following three days. The control group got four fake HBO treatments.

The men went through a series of tests before, during, and for two weeks after the study. Their arm strength was checked, MRI scans were compared to look for changes in the muscles, and blood was tested for a chemical that builds up in injured tissues. As expected, all the measurements showed that the men had injured their muscles. However, over the course of the study there was very little difference in the test results between the three groups. The muscles of all participants seemed to heal at about the same rate, no matter what kind of HBO treatments they received.

Research has shown that HBO is effective for injured tendons or other connective tissues in the body. But the authors conclude that HBO didn’t help injured muscles heal faster in this study. However, this study didn’t test whether HBO therapy was effective if it is started immediately after injury or if it is useful in more extreme muscle injuries. Accordingly, the authors stress that more research is needed.

Strength Training Is OK for Junior–But Don’t Expect Bulging Muscles

Almost 30 million kids–50% of boys and 25% of girls–in the United States take part in organized sports programs. As the number of kids involved in organized sports activities has grown, there’s been a drive to get kids involved in strength training. But are kids safe to train this way, and does the training make a difference?

The conclusions of this article are that strength programs can be an effective and safe way for kids to become stronger. But kids will probably not get honed and bulging muscles like Hulk Hogan or Marion Jones–at least not right away.

Past research clearly shows that carefully designed and supervised programs of strength training, done two to three times a week, can increase muscle strength in children and adolescents. Research also shows that kids don’t usually “bulk up” when they get stronger, because their bodies don’t produce the necessary chemicals until after they reach puberty. Increased coordination, neurological activity, and muscle adaptations seem to account for the increase in strength.

Many doctors and coaches believe that strength training causes injuries to kids. Yet in all the studies, children had very few or no injuries during strength training. Emergency rooms do see about 17,000 adolescents with weightlifting injuries each year. But the authors note that most of these injuries were from power lifting, not from doing the strength training that was done in the studies. Power lifting involves trying to lift the heaviest weight possible. And most of the injuries happened to kids who were unsupervised and weren’t taking part in organized sports.

There are reasons to be cautious, however. Adults should:

Make sure children get a physical examination before starting a strength training program.

Always supervise strength training programs.

Educate kids about the dangers of using steroids.

Avoid putting too much pressure on child athletes to perform.

And, for budding Mr. and Ms. Universe contestants, adults should make sure kids understand that they can’t develop big muscles at this time of their life, no matter how much weight they lift.

Just Not Doing It

Most of us know that exercise is good for us, and that we should exercise at least five days a week. We know that exercise is good for our physical and mental well-being. There are organizations that publish guidelines about how much we should exercise. But how many of us turn that knowledge into action?

This study was designed to get a better idea of just how active we are–or aren’t–and how this relates to people’s beliefs about exercise benefits. Phone surveys were conducted in the United States of 2002 randomly adults. They were asked questions about the amount, duration, and intensity of their weekly exercise habits. They were also asked questions about their opinion of the risks of inactivity to their health, along with other questions about their age, gender, education level, ethnicity, and income level.

When the results were tallied, researchers found that 52 percent of the respondents said that physical inactivity was a very important risk factor for good health, 37 percent felt it was important, and 8 percent believed it was somewhat important. Only 3 percent of the respondents said being inactive wasn’t an important risk factor.

Despite the widespread perception that exercise was important to good health, only 32 percent of respondents met the minimum level of physical activity for health benefits. Those that did were more likely to be male and to believe that physical activity was very important to health. Exercise levels didn’t seem to be affected significantly by a person’s age, income, or ethnicity. This is differerent than the results of other research where these factors did matter.

The researchers conclude that a strong belief in the benefits of exercise does lead to better exercise habits. Respondents with a strong belief in the benefits of exercise were 40 percent more likely to meet exercise guidelines. Males were 45 percent more likely to get the recommended amount of exercise.

The authors suggest that people might exercise more if they had more reasons to help convince them of the benefits of exercise. For example, people who join a gym to lose weight might get more motivation by learning about the positive effects on their mental health or blood pressure. People who start exercising for a specific health condition might be more likely to stick with it if they believe that improving muscle strength and stamina will help them in other ways, too.

Do You Need an X-ray for Low Back Pain?

Patients who suffer from low back pain often feel frustrated when the cause of the pain is unclear, as is often the case. Sometimes people think that the more tests they have, the closer they will get to understanding the problem. However, X-rays for low back pain–a commonly prescribed diagnostic test–have a poor record of helping doctors figure out what’s wrong. If that’s the case, why are X-rays so commonly prescribed for this condition?

A recent study conducted in Norway suggests that patients who are given adequate information and support may be less likely to want unnecessary tests. In the study, 99 patients who received X-rays for low back pain were interviewed afterward. They ranged in age from 14 to 91 years old. They were asked to rate the importance of having an X-ray for their back pain. They were also asked about their views on the usefulness of and reasons for the X-rays. Other information was collected on the patients’ condition.

Seventy-two percent of patients in the study said X-rays were very important for their condition. Men were more likely to think that X-rays were important than women. Those with worsening symptoms were more likely to think that, too. Interestingly, those who had the least real need for X-rays according to medical criteria were also more likely to think the X-rays important. This led researchers to believe that some patients may need more information or support from their doctors.

The researchers suggest that doctors should carefully explain why X-rays may not be helpful. Doctors should also try to understand the patients’ specific concerns, frustrations, and fears. They suggest that sometimes patients may ask for X-rays out of anxiety or dissatisfaction with the doctor’s explanation of their pain.

Overall, the researchers suggest that the real key is greater understanding between doctors and patients. If patients and doctors talked more about their concerns and beliefs about low back pain, fewer of these unnecessary tests might be done.

Ultrasound Gaining Acceptance in Diagnosing Shoulder Problems

A wide variety of tools are available to a physician to determine the extent of a serious shoulder injury. This is especially true for injuries to the rotator cuff muscles of the shoulder. The rotator cuff muscles consist of a small group of four muscles surrounding the shoulder. These muscles aren’t responsible for forceful movements. Instead, they guide the movements of the shoulder.

High-resolution ultrasound has recently become popular as a tool to help diagnose the extent of tears to the rotator cuff following shoulder injury. This recent study determined that ultrasound is a very effective way to help diagnose the extent of rotator cuff tears. In fact, with complete tears to the rotator cuff, ultrasound accurately diagnosed the problem 100% of the time. Ultrasound also helped correctly identify tears to the biceps tendon approximately 60% of the time and shoulder dislocations over 90% of the time.

Doctors may still try conservative measures such as medication, physical therapy, and time to help heal a shoulder injury. But ultrasound has been proven a very effective tool to help doctors diagnose the nature and extent of shoulder injuries, especially rotator cuff tears.

Triathletes May Have Thick Skin–But Not Thicker Cartilage

Most of the tissues in the human body respond to the demands placed on them. For example, the weightlessness of space travel weakens soft tissues. Lifting weights improves muscle tone. Walking and other weight-bearing exercise can improve bone strength. But cartilage in the knees of triathletes doesn’t seem to get thicker from their heavy schedules of training and competition.

This was an unexpected finding in a recent study that compared the knee joint cartilage of nine triathletes and nine inactive volunteers. To be included in the study, the triathletes had to have been active throughout life and training for at least 10 hours per week over the past three years. The inactive group included people who had never done more than one hour per week of any type of sport or heavy work at any time in life.

Using magnetic resonance imaging (MRI) and three-dimensional imaging technology, the authors calculated cartilage thickness of the right knee joint of each participant. In general, the results showed wide differences in the cartilage thickness between participants. Although there were parts of the knee that tended to have slightly more cartilage in triathletes, there were some areas that had less. The conclusion drawn by the authors is that the cartilage was generally not thicker in the knee joints of triathletes. “These results are unexpected,” say the authors, “in view of the functional adaptation observed in other musculoskeletal tissues.”

Past animal studies that measured the effect of activity on cartilage have shown varied results. No other studies have been done measuring the effect of physical activity on cartilage thickness in the human knee. Even though the cartilage didn’t look thicker on MRI, the authors caution that these types of images don’t show whether the chemical makeup is different, since MRI can’t detect these kinds of changes.

Too Far, Too Much, and Too Often: Knowing Safe Limits for the Low Back

Past studies have shown that some low back postures and heavy lifting at work can put the spine at risk. But how can you know when you’re bending or twisting too far, or if that box you’re about to lift weighs too much? Scientists haven’t carved that answer in stone–yet.

So how far is too far, and how much is too much? Researchers in the Netherlands have started to put some numbers to these questions. They recorded workers on videotape to see how far and how often they had to bend or twist. They also tallied how much weight the workers lifted over the course of the workday. They followed up with the workers yearly for three years. Here’s what they found.

The more people have to bend, twist, or lift at work, the higher the risk. Bending forward more than 60 degrees and twisting more than 30 degrees appeared to be the angles that mattered the most. The chance of back pain was higher for bending, especially when people did it more than 5% of the day. Lifting less than 55 pounds didn’t seem to be a problem. But when workers lifted at least 50 pounds more than 15 times a day, the incidence of back injuries gradually went up. These values are summarized below:

bending forward at least 60 degrees for more than 5% of the day

rotating at least 30 degrees for more than 10% of the day

lifting more than 55 pounds more than 15 times a day.

In their concluding remarks, the authors say the risk for low back pain is “moderate” for people who flex, twist, and lift at work, especially when they move too far and lift too much–too often.

Safe Choices for Sport Participants with Total Knee Replacement

Which sport and recreational activities are safe for someone who has had total knee replacement surgery? At best, past answers were educated guesses. At worst, a poor guess might end up causing a person to participate in activities that put too much strain on the implant, leading to extra wear or possibly even destruction of the replacement parts.

Now doctors have fresh scientific information to help them guide their patients after knee replacement surgery. Scientists experimented with three different types of knee joint replacements. After securing each joint in a special holder, they measured the amount and location of the pressure on the joint during simulated activities of cycling, power walking, downhill walking, and jogging.

They found that stress levels from cycling and power walking were evenly spread over the surfaces of the joint. Downhill walking and jogging built up too much pressure over the joint surface. As a result, the authors determined that power walking and cycling can be permitted after total knee replacement surgery, but activities like jogging, hiking, and downhill walking place the joint at risk.

Their study showed how the pressure on the joint builds up the further the knee bends. This led the authors to recommend that people who cycle after total knee replacement surgery should raise their bicycle seat as high as comfortably possible. They also recommend doing a combination of activities, like walking and cycling, so the joint isn’t loaded the same way all the time.

“Cycling and power walking seem to be the least demanding endurance activities for the knee joint,” say the authors. “Regular jogging, or sports involving running,” they conclude, “should be discouraged after total knee replacement.”

Doctor, Can I Play Tennis after My Hip Replacement Surgery?

Most doctors agree that patients who have had a total hip replacement should avoid playing high-impact sports such as tennis. In this recent study, over half of the doctors told their patients not to play tennis. A third recommended only doubles tennis. Only 14% said it would be okay for their patients to play singles tennis after the surgery.

The danger of overdoing it after hip replacement surgery is that the new implant could loosen up, requiring another surgery to revise the hip joint. Also, there are concerns that the surfaces of the new joint might wear out sooner because of the heavy and repeated strains placed on it.

The authors polled members of the United States Tennis Association from three states. Fifty men and eight women who had total hip replacement filled out and returned the questionnaire. On average, these players returned to the court about seven months after their surgery. Even though they weren’t as quick on their feet, they all reported better performance on the court than when they were feeling symptoms before surgery. By eight years after surgery, only 16% reported pain or stiffness on the court. The authors reported a 4% failure rate, meaning that three hips eventually had to be revised.

Readers must keep in mind, however, that this study compared highly competitive tennis players who were members of the United States Tennis Association. The authors acknowledge that this can lead to “selection bias,” since patients who had stopped playing or who were unable to play after hip replacement surgery would likely have discontinued their membership. As a result, these patients would not have been part of the study.

Therefore, the conclusions of this study must be viewed cautiously and should not be used to say that anyone who has had a total hip replacement would be safe to play tennis, that their game would improve, and that they probably wouldn’t end up needing a revision.

The authors insist that doctors not use this research as a basis to advise people on continuing to play tennis after having a total hip replacement. They also say that doctors should “advise caution in tennis activities.” Further, the authors recommend that doctors who allow their patients to play tennis should follow these patients on a yearly basis to make sure the joint and surrounding bone are holding steady.

Telemark Skiing: What Are the Risks of Injury?

People heading to the slopes and the backcountry to telemark ski may want to know about their risk of injury. The recent surge in popularity of this sport, along with recent design changes in boots and bindings, led researchers to evaluate the risks.

The authors gathered information by polling members of two different ski clubs between 1996 and 1999. By tallying the total number of days skied by the 677 respondents, they calculated a rate of 9.8 injuries per 1000 skier days, nearly the same as the injury rate for alpine skiing.

The types of injuries reported varied by the skiers’ gender, age, experience, terrain, and equipment choices. Men had more shoulder and ankle injuries than women. Women had a higher percentage of knee injuries involving the ligaments and cartilage. Although the knee was the most common area injured, telemark skiers tended to have less severe knee injuries than alpine skiers.

Telemark skiers between the ages of 30 to 49 had significantly more injuries than skiers aged 13 to 29. Less experienced skiers were injured more often than experienced skiers. And more injuries happened on easier slopes than on advanced runs. However, the authors caution that “no terrain is safer than another.” People using the newer plastic boots had fewer injuries than those using older, leather-style boots. And more injuries took place when people used three-pinned bindings rather than advanced styles of bindings.

In conclusion, the authors state that “the use of flexible plastic boots is the most significant factor affecting the telemark skier’s risk of injury, followed by level of skill, and use of releasable bindings.”

Stretching the Truth about Injury Prevention

Most athletes would never consider exercising without stretching first. However, stretching before intensive training does not appear to pay off in fewer injuries. Age and fitness levels seem to be more important factors in predicting whether a person ends up with a leg, hip, or foot injury.

These conclusions come from a recent study of 1538 army recruits. Before going through 11 weeks of intensive training, each of the recruits was randomly placed in either a stretching or a control group. Before each training session, members in the stretching group did six different stretches, holding each one for 20 seconds. The control group did regular warm-ups without doing any stretches. At the end of the 11 weeks, researchers tallied 333 total injuries to the lower limbs. The injuries were split nearly fifty-fifty between the two groups.

The authors calculated that it would take 3100 stretching sessions, each lasting five minutes, to prevent one injury. This means 260 hours of stretching. The authors conclude that stretching before exercise to prevent injury is “of dubious clinical significance.”

Age and fitness levels were better indicators of lower-limb injuries. The authors found that “the least fit subjects were 14 times more likely too sustain a lower-limb injury than the fittest subjects.” Older recruits also had significantly more injuries.

So what is the truth about stretching? It seems to be that improved overall fitness is the best way to reduce training-related injuries of the lower limbs.

Spines at Risk: Snowboarders Versus Skiers

When heading out to the slopes to snowboard or ski, it’s nice to know the risks that lie ahead. Both sports carry a high risk of injury. But according to this recent study, snowboarders have four times the risk of having a serious spine injury.

According to the authors, the goal of their study was to pull together information that could improve injury prevention programs for skiers and snowboarders. Specifically, they wanted to find out how often people doing these sports injure their spines, and they wanted to find out which types of spine injuries happen the most.

The authors tallied the number of skiers and snowboarders frequenting two ski areas in Canada between 1994 and 1996. The bar codes on the lift tickets ensured an accurate count of the number and ages of people using the lifts at these two resorts. Snowboarders accounted for 15% of the people on the slopes, indicating that its popularity is on the rise.

A total of 56 people had serious spine injuries during the study period. This included 34 skiers and 22 snowboarders. Ten of the skiers were women. All of the injured snowboarders were men. The average age of the skiers was 34.5 years. Snowboarders were generally younger, averaging 22.4 years old.

Skiers were most commonly injured from a fall. Jumping was the main culprit for snowboarders, accounting for 77% of the injuries in this group. Age and sex did not seem to have affect how people were injured. Whether girl or guy, young or old, skiing and, especially, snowboarding are high-risk sports when it comes to spinal injuries.

The authors realize that jumping is a big part of snowboarding and that telling people to avoid jumps isn’t the solution. They do feel, however, that instruction and training on the risks of jumping could be a step in that direction. “Until research defines effective injury-prevention strategies,” they conclude, “knowledge of the risk of snowboarding should be disseminated and techniques for safe jumping should be taught.”