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  • 1.
    Aasa, Ulrika
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. Umeå University, Faculty of Social Sciences, Umeå Sport Sciences Center.
    Svartholm, Ivar
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Andersson, Fredrik
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Berglund, Lars
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. Umeå University, Faculty of Social Sciences, Umeå Sport Sciences Center.
    Injuries among weightlifters and powerlifters: a systematic review2017In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 51, no 4, p. 211-219Article in journal (Refereed)
    Abstract [en]

    Background Olympic weightlifting and powerlifting are two sports that expose the body to great forces. Injury characteristics have not been systematically reviewed for these two growing sports.

    Objective The purpose of this study was to systematically review the literature regarding various definitions of injuries used, injury localisation, the prevalence and incidence of injuries and the associated risk factors for injuries in weightlifting and powerlifting.

    Design Systematic review.

    Data sources Five databases, PubMed, MEDLINE, SPORTDiscus, Scopus and Web of Science, were searched between 9 March and 6 April 2015.

    Eligibility criteria for selecting studies Studies assessing injury incidence and prevalence in Olympic weightlifting and powerlifting were included. The Quality assessment tool for observational cohort and cross-sectional studies was used to assess methodological quality.

    Results 9 studies were included in the review. Injury was defined fairly consistently across studies. Most studies were of low methodological quality. The spine, shoulder and the knee were the most common injury localisations in both sports. The injury incidence in weightlifting was 2.4–3.3 injuries/1000 hours of training and 1.0–4.4 injuries/1000 hours of training in powerlifting. Only one retrospective study had analysed possible risk factors.

    Summary/conclusions The risk of injury in both sports were similar to other non-contact sports also requiring strength/power, but low compared to contact sports. The severity of injuries differed in the included studies. Since little has been studied regarding possible risk factors to injuries, further research is therefore warranted to explain why athletes get injured and how to prevent injuries.

    Trial registration number PROSPERO CRD42015014805.

  • 2.
    Alfredson, Hakan
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB). ISEH, UCLH, London, UK.
    Persistent pain in the Achilles midportion?: Consider the plantaris tendon as a possible culprit!2017In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 51, no 10, p. 833-834Article, review/survey (Refereed)
  • 3.
    Alfredson, Håkan
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Can specific treatment prevent progressive tendon degeneration?2011In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 45, no 4, p. 334-Article in journal (Refereed)
    Abstract [en]

    Background Tendon degeneration is generally believed to be irreversible.

    Objective To use ultrasound to study the Achilles midportion tendon structure and thickness before and after treatment of chronic painful tendinosis.

    Design Prospective study.

    Patients and interventions Middle aged patients on varying activity levels, having midportion chronic Achilles tendinosis, were followed with ultrasound examinations before and after treatment with eccentric training, sclerosing polidocanol injections and surgical scraping.

    Outcome measurements Tendon thickness and structure.

    Results 89 patients successfully treated (pain-free during tendon loading) with eccentric training (n=22), sclerosing polidocanol injections (n=38) and surgical scraping (n=29), had a significantly thinner Achilles midportion and a more normal tendon structure, after compared to before, treatment.

    Conclusion For the Achilles midportion, tendon degeneration might not be irreversible. The findings indicate a possible regeneration potential.

  • 4.
    Alfredson, Håkan
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Midportion Achilles tendinosis and the plantaris tendon2011In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 45, no 13, p. 1023-1025Article in journal (Refereed)
    Abstract [en]

    Objectives: When re-operating patients with midportion Achilles tendinosis, having had a poor effect of ultrasound (US) and Doppler-guided scraping, the author found the involvement of the plantaris tendon to be a likely reason for the poor result. The aim of this study was to investigate the occurrence of a plantaris tendon in close relation to the Achilles tendon in consecutive patients with midportion Achilles tendinosis undergoing treatment with US and Doppler-guided scraping.

    Material and methods: This study includes 73 consecutive tendons with chronic painful midportion Achilles tendinosis, where US+Doppler examination showed thickening, irregular tendon structure, hypo-echoic regions, and localised high blood flow outside and inside the ventral Achilles midportion. The tendons were treated with US+Doppler-guided scraping, via a medial incision. If there was a plantaris tendon located in close relation to the medial Achilles, it was extirpated.

    Results: An invaginated, or ‘close by located’, enlarged plantaris tendon was found in 58 of 73 (80%) tendons. Preliminary clinical results of the combined procedure, US + Doppler-guided surgical scraping and extirpation of the plantaris tendon, are very promising.

    Conclusions: A thickened plantaris tendon located in close relation to the medial Achilles seems common in patients with chronic painful midportion tendinosis. The role of the plantaris tendon in midportion Achilles tendinosis needs to be further evaluated and should be kept in mind when treating this condition.

  • 5.
    Alfredson, Håkan
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Ultrasound and Doppler-guided mini-surgery to treat midportion Achilles tendinosis: results of a large material and a randomised study comparing two scraping techniques.2011In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 45, no 5, p. 407-410Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Treatment based on ultrasound (US) and colour Doppler (CD) findings in midportion Achilles tendinosis has shown promising results. In a randomised study on a small patient material, similar short-term clinical results were demonstrated with surgery outside the tendon and sclerosing polidocanol injections, but surgical treatment led to a faster return to activity.

    OBJECTIVE: To evaluate the clinical results of US and CD-guided mini-surgery (scraping) outside the ventral tendon in a larger patient material and, in a randomised study, compare two different techniques for surgical scraping.

    MATERIAL AND METHODS: 103 patients (66 men, 37 women), mean age 43 years (range 24-77), with midportion tendinosis in 125 Achilles tendons were included. Patients from a large group (88 tendons), and a randomised study (37 tendons), were in local anaesthesia treated with a US and CD-guided new surgical approach outside the ventral tendon. All patients in the large group, and one arm of the randomised study, were treated open with a scalpel, while the other arm of the randomised study were treated percutaneously. Pain during Achilles tendon loading activity (Visual Analogue Scale (VAS)), and satisfaction with treatment, were evaluated.

    RESULTS: Before surgery, the mean VAS was 73. After surgery (follow-up mean 18 months, range 6-33), the mean VAS was 3 in 111 tendons (89%) from satisfied patients back in full Achilles tendon loading activity. In the randomised study, there were no significant differences in the results between open treatment with a scalpel and percutaneous treatment with a needle.

    CONCLUSIONS: US and CD-guided scraping show good short-term results in midportion Achilles tendinosis.

  • 6.
    Alfredson, Håkan
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Where to now with Achilles tendon treatment?2011In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 45, no 5, p. 386-386Article in journal (Refereed)
  • 7.
    Alfredson, Håkan
    et al.
    Umeå University, Faculty of Medicine, Surgical and Perioperative Sciences, Sports Medicine.
    Cook, J
    A treatment algorithm for managing Achilles tendinopathy: new treatment options.2007In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 41, no 4, p. 211-216Article, review/survey (Refereed)
    Abstract [en]

    Achilles tendinopathy affects athletes, recreational exercisers and even inactive people. The pathology is not inflammatory; it is a failed healing response. The source of pain in tendinopathy could be related to the neurovascular ingrowth seen in the tendon's response to injury. The treatment of Achilles tendinopathy is primarily conservative with an array of effective treatment options now available to the primary care practitioner. If conservative treatment is not successful, then surgery relieves pain in the majority of cases. Directing a patient through the algorithm presented here will maximise positive treatment outcomes.

  • 8.
    Alfredson, Håkan
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Masci, Lorenzo
    Öhberg, Lars
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Diagnostic Radiology.
    Partial midportion Achilles tendon ruptures: new sonographic findings helpful for diagnosis.2011In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 45, no 5, p. 429-432Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Partial Achilles tendon ruptures are not always easy to diagnose. A history including a sudden onset of pain, and/or relative weakness in plantar flexion force, are indicators. The most loaded side of the Achilles tendon is the dorsal side (skin side). OBJECTIVE: To evaluate the ultrasound (US) and Doppler (CD) findings in patients with a suspected partial rupture in the Achilles tendon. Material and METHODS: Seventeen patients (16 men and 1 woman) with a mean age of 36 years (range 23-71) were examined clinically and by US+CD because of midportion Achilles tendon pain. There was an acute onset in 14/17 patients, and all had painful weakness during tendon loading activity. RESULTS: In all patients the US examination showed a partial Achilles tendon rupture, presented as a disrupted dorsal (skin side) tendon line and an irregular tendon structure mainly located in the dorsal and mid-tendon. The size of the rupture varied from 1/3 to 2/3 of the tendon thickness. In the dorsal part of the tendon, corresponding to the region with disrupted tendon line and irregular structure, CD examination showed high blood flow-most often of a longitudinal character. Six of the patients were surgically treated, and macroscopical examination verified the ultrasound findings, showing disruption on the dorsal side, and a partial rupture in the dorsal and mid- tendon. CONCLUSIONS: Ultrasound and Doppler examination can be helpful tools to diagnose partial midportion Achilles tendon ruptures. The characteristic findings of a disrupted dorsal tendon line, and high blood flow in the structurally abnormal dorsal tendon, indicate a partial rupture.

  • 9.
    Alfredson, Håkan
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Spang, Christoph
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB), Anatomy.
    Forsgren, Sture
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB), Anatomy.
    Unilateral surgical treatment for patients with midportion Achilles tendinopathy may result in bilateral recovery2014In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 48, no 19, p. 1421-1424Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Bilateral midportion Achilles tendinopathy/tendinosis is not unusual, and treatment of both sides is often carried out. Experiments in animals suggest of the potential involvement of central neuronal mechanisms in Achilles tendinosis. OBJECTIVES: To evaluate the outcome of surgery for Achilles tendinopathy. METHODS: This observational study included 13 patients (7 men and 6 women, mean age 53 years) with a long duration (6-120 months) of chronic painful bilateral midportion Achilles tendinopathy. The most painful side at the time for investigation was selected to be operated on first. Treatment was ultrasound-guided and Doppler-guided scraping procedure outside the ventral part of the tendon under local anaesthetic. The patients started walking on the first day after surgery. Follow-ups were conducted and the primary outcome was pain by visual analogue scale. In an additional part of the study, specimens from Achilles and plantaris tendons in three patients with bilateral Achilles tendinosis were examined. RESULTS: Short-term follow-ups showed postoperative improvement on the non-operated side as well as the operated side in 11 of 13 patients. Final follow-up after 37 (mean) months showed significant pain relief and patient satisfaction on both sides for these 11 patients. In 2 of 13 patients operation on the other, initially non-operated side, was instituted due to persisting pain. Morphologically, it was found that there were similar morphological effects, and immunohistochemical patterns of enzyme involved in signal substance production, bilaterally. CONCLUSION: Unilateral treatment with a scraping operation can have benefits contralaterally; the clinical implication is that unilateral surgery may be a logical first treatment in cases of bilateral Achilles tendinopathy.

  • 10.
    Andersson, Gustav
    et al.
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB), Anatomy.
    Backman, Ludvig
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB), Anatomy.
    Scott, Alexander
    Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada; Centre for Hip Health and Mobility, Vancouver Coastal Health and Research Institute, Vancouver, British Columbia, Canada.
    Lorentzon, Ronny
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Forsgren, Sture
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB), Anatomy.
    Danielson, Patrik
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB), Anatomy.
    Substance P accelerates hypercellularity and angiogenesis in tendon tissue and enhances paratendinitis in response to Achilles tendon overuse in a tendinopathy model2011In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 45, no 13, p. 1017-1022Article in journal (Refereed)
    Abstract [en]

    Background Tenocytes produce substance P (SP) and its receptor (neurokinin-1 receptor (NK-1R) is expressed throughout the tendon tissue, expecially in patients with tendinopathy and tissue changes (tendinosis) including hypercellularity and vascular proliferation. Considering the known effects of SP, one might ask whether SP contributes to these canges.

    Objectives To test whether development of tendinosislike changes (hypercellularity and angiogenesis) is accelerated during a 1-week course of ecercise with local administration of SP in an establish Achilles tendinopathy model.

    Methods Rabbits were subjected to a protocol of Achilles tendon overuse for 1 week, in conjunction with SP injections in the paratenon. Exercised control animals received NaCl injections or no injections, and unexercised, uninjected controls were also used. Tenocyte number and vascular density, as well as paratendinous inflammation, were evaluated. Immunohistochemistry and in sity hybridisation to detect NK-1R were conducted.

    Results There was a significant increase in tenocyte number in the SP-injected and NaCl-injected groups compared with both unexercised and exercised, uninjected controls. Tendon blood vessels increased in number in the SP-injected group compared with unexercised controls, a finding not seen in NaCl-injected controls or in uninjected, exercised animals. Paratendinous inflammation was more pronounced in the SP-injected group than in the NaCl controls. NK-1R was detected in blood vessel walls, nerves, inflammatory cells and tenocytes.

    Conclusions SP accelerated the development of tendinosis-like changes in the rabbit. Achilles tendon, which supports theories of a potential role of SP in tendinosis development; a fact of clinical interest since SP effects can be effectively blocked. The angiogenic response to SP injections seems related to parateninitis.

  • 11.
    Andersson, Gustav
    et al.
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB), Anatomy.
    Forsgren, Sture
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB), Anatomy.
    Scott, Alexander
    University of British Columbia, Vancouver, Vancouver Coastal Health and Research Institute.
    Gaida, James Edmund
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB), Anatomy.
    Stjernfeldt, Johanna Elgestad
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB), Anatomy.
    Lorentzon, Ronny
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Alfredson, Håkan
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Backman, Clas
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Hand Surgery.
    Danielson, Patrik
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB), Anatomy.
    Tenocyte hypercellularity and vascular proliferation in a rabbit model of tendinopathy: contralateral effects suggest the involvement of central neuronal mechanisms2011In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 45, no 5, p. 399-406Article in journal (Refereed)
    Abstract [en]

    Objective To determine whether there are objective findings of tendinosis in a rabbit tendinopathy model on exercised and contralateral (non-exercised) Achilles tendons. Design Four groups of six New Zealand white rabbits per group were used. The animals of one (control) group were not subjected to exercise/stimulation. Interventions Animals were subjected to a protocol of electrical stimulation and passive flexion-extension of the right triceps surae muscle every second day for 1, 3 or 6 weeks. Main Outcome Measures Tenocyte number and vascular density were calculated. Morphological evaluations were also performed as well as in-situ hybridisation for vascular endothelial growth factor (VEGF) messenger RNA. Results There was a significant increase in the tenocyte number after 3 and 6 weeks of exercise, but not after 1 week, in comparison with the control group. This was seen in the Achilles tendons of both legs in experimental animals, including the unexercised limb. The pattern of vascularity showed an increase in the number of tendon blood vessels in rabbits that had exercised for 3 weeks or more, compared with those who had exercised for 1 week or not at all. VEGF-mRNA was detected in the investigated tissue, with the reactions being more clearly detected in the tendon tissue with tendinosis-like changes (6-week rabbits) than in the normal tendon tissue (control rabbits). Conclusions There were bilateral tendinosis-like changes in the Achilles tendons of rabbits in the current model after 3 weeks of training, suggesting that central neuronal mechanisms may be involved and that the contralateral side is not appropriate as a control.

  • 12.
    Backman, Ludvig J.
    et al.
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB), Anatomy. Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Eriksson, Daniella E.
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB), Anatomy.
    Danielson, Patrik
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB), Anatomy.
    Substance P reduces TNF-α-induced apoptosis in human tenocytes through NK-1 receptor stimulation2014In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 48, no 19, p. 1414-1420Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: It has been hypothesised that an upregulation of the neuropeptide substance P (SP) and its preferred receptor, the neurokinin-1 receptor (NK-1 R), is a causative factor in inducing tenocyte hypercellularity, a characteristic of tendinosis, through both proliferative and antiapoptotic stimuli. We have demonstrated earlier that SP stimulates proliferation of human tenocytes in culture.

    AIM: The aim of this study was to investigate whether SP can mediate an antiapoptotic effect in tumour necrosis factor-α (TNF-α)-induced apoptosis of human tenocytes in vitro.

    RESULTS: A majority (approximately 75%) of tenocytes in culture were immunopositive for TNF Receptor-1 and TNF Receptor-2. Exposure of the cells to TNF-α significantly decreased cell viability, as shown with crystal violet staining. TNF-α furthermore significantly increased the amount of caspase-10 and caspase-3 mRNA, as well as both BID and cleaved-poly ADP ribosome polymerase (c-PARP) protein. Incubation of SP together with TNF-α resulted in a decreased amount of BID and c-PARP, and in a reduced lactate dehydrogenase release, as compared to incubation with TNF-α alone. The SP effect was blocked with a NK-1 R inhibitor.

    DISCUSSION: This study shows that SP, through stimulation of the NK-1 R, has the ability to reduce TNF-α-induced apoptosis of human tenocytes. Considering that SP has previously been shown to stimulate tenocyte proliferation, the study confirms SP as a potent regulator of cell-turnover in tendon tissue, capable of stimulating hypercellularity through different mechanisms. This gives further support for the theory that the upregulated amount of SP seen in tendinosis could contribute to hypercellularity.

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  • 13. Bangsbo, Jens
    et al.
    Blackwell, Joanna
    Boraxbekk, Carl-Johan
    Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR). Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI). DRCMR, University of Copenhagen, Denmark.
    Caserotti, Paolo
    Dela, Flemming
    Evans, Adam B.
    Jespersen, Astrid Pernille
    Gliemann, Lasse
    Kramer, Arthur F.
    Lundbye-Jensen, Jesper
    Lykke Mortensen, Erik
    Juul Lassen, Aske
    Gow, Alan J.
    Harridge, Stephen D.R.
    Hellsten, Ylva
    Kjaer, Michael
    Kujala, Urho M.
    Rhodes, Ryan E.
    Pike, Elizabeth C.J.
    Skinner, Timothy
    Skovgaard, Thomas
    Troelsen, Jens
    Tulle, Emmanuelle
    Tully, Mark A.
    van Uffelen, Jannique G.Z.
    Viña, Jose
    Copenhagen Consensus statement 2019: physical activity and ageing2019In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 53, no 14, p. 856-858Article in journal (Refereed)
    Abstract [en]

    From 19th to 22nd November 2018, 26 researchers representing nine countries and a variety of academic disciplines met in Snekkersten, Denmark, to reach evidence-based consensus about physical activity and older adults. It was recognised that the term ‘older adults’ represents a highly heterogeneous population. It encompasses those that remain highly active and healthy throughout the life-course with a high intrinsic capacity to the very old and frail with low intrinsic capacity. The consensus is drawn from a wide range of research methodologies within epidemiology, medicine, physiology, neuroscience, psychology and sociology, recognising the strength and limitations of each of the methods. Much of the evidence presented in the statements is based on longitudinal associations from observational and randomised controlled intervention studies, as well as quantitative and qualitative social studies in relatively healthy community-dwelling older adults. Nevertheless, we also considered research with frail older adults and those with age-associated neurodegenerative diseases, such as Alzheimer’s and Parkinson’s disease, and in a few cases molecular and cellular outcome measures from animal studies. The consensus statements distinguish between physical activity and exercise. Physical activity is used as an umbrella term that includes both structured and unstructured forms of leisure, transport, domestic and work-related activities. Physical activity entails body movement that increases energy expenditure relative to rest, and is often characterised in terms of intensity from light, to moderate to vigorous. Exercise is defined as a subset of structured physical activities that are more specifically designed to improve cardiorespiratory fitness, cognitive function, flexibility balance, strength and/or power. This statement presents the consensus on the effects of physical activity on older adults’ fitness, health, cognitive functioning, functional capacity, engagement, motivation, psychological well-being and social inclusion. It also covers the consensus on physical activity implementation strategies. While it is recognised that adverse events can occur during exercise, the risk can be minimised by carefully choosing the type of activity undertaken and by consultation with the individual’s physician when warranted, for example, when the individual is frail, has a number of co-morbidities, or has exercise-related symptoms, such as chest pain, heart arrhythmia or dizziness. The consensus was obtained through an iterative process that began with the presentation of the state-of-the-science in each domain, followed by group and plenary discussions. Ultimately, the participants reached agreement on the 30-item consensus statements.

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  • 14. Bateman, Marcus
    et al.
    Evans, Jonathan P
    Vuvan, Viana
    Jones, Val
    Watts, Adam C
    Phadnis, Joideep
    Bisset, Leanne M
    Vicenzino, Bill
    Development of a core outcome set for lateral elbow tendinopathy (COS-LET) using best available evidence and an international consensus process2022In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 56, no 12, p. 657-666Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To develop a core outcome set for lateral elbow tendinopathy (COS-LET) and to provide guidance for outcome evaluation in future studies.

    METHODS: We implemented a multi-stage mixed-methods design combining two systematic reviews, domain mapping of outcome measurement instruments to the core domains of tendinopathy, psychometric analysis of instruments, two patient focus groups and a Delphi study incorporating two surveys and an international consensus meeting. Following the OMERACT guidelines, we used a 70% threshold for consensus.

    RESULTS: 38 clinicians/researchers and 9 patients participated. 60 instruments were assessed for inclusion. The only instrument that was recommended for the COS-LET was Patient Rated Tennis Elbow Evaluation (PRTEE) for the disability domain. Interim recommendations were made to use: the PRTEE function subscale for the function domain; PRTEE pain subscale items 1, 4 and 5 for the pain over a specified time domain; pain-free grip strength for the physical function capacity domain; a Numerical Rating Scale measuring pain on gripping for the pain on activity/loading domain; and time off work for the participation in life activities domain. No recommendations could be made for the quality-of-life, patient rating of condition and psychological factors domains.

    CONCLUSIONS: The COS-LET comprises the PRTEE for the disability domain. Interim-use recommendations included PRTEE subscales, time off work, pain-free grip strength and a Numerical Rating Scale measuring pain on gripping. Further work is required to validate these interim measures and develop suitable measures to capture the other domains.

  • 15.
    Bjur, Dennis
    et al.
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB), Anatomy. Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Alfredson, Håkan
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Forsgren, Sture
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB), Anatomy.
    Presence of the neuropeptide Y 1 receptor in tenocytes and blood vessel walls in the human Achilles tendon2009In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 43, no 13, p. 1136-1142Article in journal (Refereed)
    Abstract [en]

    Background: There are still questions concerning the mechanisms of development of chronic pain and impaired function of tendons (tendinosis). Aspects that are known to occur are cell proliferation, angiogenesis and altered blood flow regulation. Neuropeptide NPY (NPY) is widely distributed in the body and has powerful effects in relation to these processes. NPY has its effects via the G-protein-coupled Y receptors. There is no information concerning the presence or absence of NPY receptors in Achilles tendons or other tendons.

    Objective: To clarify the expression patterns of the NPY receptors Y1 and Y2 in normal and tendinosis Achilles tendons of man.

    Methods: Immunohistochemical methods were used. Examination on NPY was carried out in parallel.

    Results: The tenocytes showed strong immunoreactions for the Y1 receptor. The immunoreactions were more intense in the tenocytes of the tendinosis tendons than in those of the non-tendinosis tendons. The rounded/oval tenocytes typically seen in tendinosis tendons exhibited marked Y1 receptor reactions on their exterior. Pronounced Y1 reactions were seen in the smooth muscle of the arterioles of both tendinosis and non-tendinosis tendons. No reactions for the Y2 receptor were noted. NPY was detected in nerve fascicles and in the perivascular innervation.

    Conclusions: The present study shows that there is a morphologic correlate for the occurrence of pronounced NPY effects via the Y1 receptor in both tenocytes, this especially being a fact for tendinosis tendons, and blood vessel walls in the Achilles tendon. The findings are of particular interest as NPY is known to have proliferative, angiogenic and blood vessel regulating effects. The effects of targeting the Y1 receptor in tendinosis is an interesting task to be further evaluated.

  • 16.
    Bleakley, Chris
    et al.
    Health Sciences, Faculty of Life and Health Sciences, Ulster University, Newtownabbey, United Kingdom.
    Wagemans, Jente
    Department of Rehabilitation Science and Physiotherapy, University of Antwerp Faculty of Medicine and Health Sciences, Antwerp, Belgium.
    Netterström-Wedin, Fredh
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Understanding chronic ankle instability: model rich, data poor2021In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 55, no 9, p. 463-464Article in journal (Other academic)
  • 17. Bo, Kari
    et al.
    Artal, Raul
    Barakat, Ruben
    Brown, Wendy J.
    Davies, Gregory A. L.
    Dooley, Michael
    Evenson, Kelly R.
    Haakstad, Lene A. H.
    Kayser, Bengt
    Kinnunen, Tarja I.
    Larsén, Karin
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Sports medicine. The Swedish School of Sport and Health Sciences, Stockholm, Sweden.
    Mottola, Michelle F.
    Nygaard, Ingrid
    van Poppel, Mireille
    Stuge, Britt
    Khan, Karim M.
    Exercise and pregnancy in recreational and elite athletes: 2016/2017 evidence summary from the IOC expert group meeting, Lausanne. Part 5. Recommendations for health professionals and active women2018In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 52, no 17, p. 1080-1085Article in journal (Refereed)
  • 18.
    Cronström, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation. Department of Health Sciences, Lund University, Lund, Sweden.
    Tengman, Eva
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Häger, Charlotte
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Risk factors for contra-lateral secondary anterior cruciate ligament injury: a systematic review with meta-analysis2021In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 55, no Suppl 1, p. A75-A76, article id 193Article in journal (Refereed)
    Abstract [en]

    Background: There is limited knowledge about which risk factors that contribute to the high numbers of contra-lateral anterior cruciate ligament (C-ACL) injury after primary ACL injury.

    Objective:  To systematically review intrinsic risk factors for sustaining a C-ACL injury.

    Design: A systematic review with meta-analysis according to the PRISMA guidelines. Four databases (MEDLINE, CINAHL, EMBASE, Sport Discus) were searched from inception to January 2020. Meta-analyses were performed and expressed as odds ratios (OR).

    Setting: The included studies describe a variety of sport settings and activity levels.

    Participants: The review comprises studies including males and/or females of any age with ACL injury.

    Assessment of Risk Factors: The review comprises longitudinal studies investigating any intrinsic risk factor for future C-ACL injury.

    Main Outcome Measurements: C-ACL injury

    Results: Thirty-five moderate-to-high quality studies were eligible for meta-analysis, including up to ~59 000 individuals. The following factors all independently increased the odds of sustaining a C-ACL: Returning to a high activity level (OR: 3.26, 95% CI: 2.10–5.06), BMI < 25 (OR: 2.73, 95% CI: 1.73–4.36), Age ≤ 18 years (OR: 2.42, 95% CI: 1.51–3.88), Family history of ACL injury (OR: 2.07, 95% CI: 1.54–2.80), Primary ACL reconstruction performed ≤ 3 months post injury (OR: 1.65, 95% CI: 1.32–2.06), Female sex (OR: 1.35, 95% CI: 1.14–1.61) and Concomitant meniscal injury (OR 1.21, 95% CI: 1.03–1.42). There were no associations between the odds of sustaining a C-ACL injury and Smoking status, Pre-injury activity level, Playing soccer compared to other sports or Timing of return to sport.

    Conclusions: Demographic factors such as female sex, young age and family history of ACL injury, as well as early reconstruction and returning to a high activity level all contribute to the risk of sustaining a C-ACL injury. Studies on modifiable sensorimotor risk factors are warranted.

  • 19.
    Cronström, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation. Department of Health Sciences, Lund University, Lund, Sweden.
    Tengman, Eva
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Häger, Charlotte
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Risk factors for graft rupture after anterior cruciate ligament reconstruction: a systematic review with meta-analysis2021In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 55, no Suppl 1, p. A76-A76, article id 194Article in journal (Refereed)
    Abstract [en]

    Background: Underlying factors contributing to increased risk of graft rupture after anterior cruciate ligament reconstruction (ACLR) are not well described.

    Objective: To systematically review intrinsic risk factors for sustaining a graft rupture.

    Design: A systematic review with meta-analysis according to the PRISMA guidelines. Four databases (MEDLINE, CINAHL, EMBASE, Sport Discus) were searched from inception to January 2020. Meta-analyses (random effect model) were performed and expressed as odds ratios (OR).

    Setting: The included studies describe a variety of sport settings and activity levels.

    Participants: The review comprises studies including males and/or females of any age who have had ACLR.

    Assessment of Risk Factors: All longitudinal studies investigating any intrinsic risk factor for future graft rupture were included.

    Main Outcome Measurements: Graft rupture.

    Results: Seventy-seven studies were eligible for meta-analysis. The following factors all independently increased the odds of sustaining a graft rupture after ACLR: Age ≤ 18 years (OR: 3.87, 95% CI: 2.32–6.46), higher pre-primary injury activity level (OR: 2.43, 95% CI: 1.56–3.82), family history of ACL injury (OR: 1.98, 95% CI: 1.50–2.62), returning to a high activity level (OR: 1.87, 95% CI: 1.11–3.15), and increased lateral tibial slope (OR: 1.64, 95% CI: 1.13–2,38). None of the following factors were found to be associated with future graft rupture; sex, smoking status, generalized joint laxity, timing of surgery or return to sport (RTS), playing soccer compared to other sports, hop performance at time of RTS or concomitant meniscal or collateral ligament injuries.

    Conclusions: Young age, family history of ACL injury, high tibial slope and previous and current high activity level should be considered when screening for increased risk of graft rupture following ACLR. Future studies on the possible role of sensorimotor factors, e.g., muscle activation and/or strength and proprioception for future graft ruptures are warranted.

  • 20.
    Danielson, Patrik
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB), Anatomy.
    Reviving the "biochemical" hypothesis for tendinopathy: new findings suggest the involvement of locally produced signal substances2009In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 43, no 4, p. 265-268Article in journal (Refereed)
    Abstract [en]

    Studies of recent years on human tendinopathies have provided us with evidence of a local, non-neuronal production in tendon cells (tenocytes) of signal substances traditionally confined to neurons. These substances include acetylcholine, catecholamines, substance P, and glutamate. Furthermore, the receptors for several of these substances have been found on nerve fascicles and in blood vessel walls, as well as on the tenocytes themselves, of the tendon tissue. The findings provide the basis for locally produced signal substances to influence pain signaling, vascular regulation, and/or tissue changes in tendinopathy. This reinforces a previously presented "biochemical" hypothesis for tendinopathy, suggesting that biochemical mediators in the tendon tissue might influence/irritate nociceptors, in or around the tendon, to cause chronic tendon pain. The potential clinical implications of the studies are considerable.

  • 21.
    Danielson, Patrik
    et al.
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB), Anatomy.
    Scott, Alex
    Univ British Columbia, Dept Phys Therapy, Vancouver, BC V5Z 1M9, Canada.
    Teaming up to beat tendon pain: clinical and research excellence own the podium at ISTS (International Scientific Tendinopathy Symposium).2013In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 47, no 9, p. 532-532Article in journal (Refereed)
  • 22. Emtner, M.
    et al.
    Wadell, Karin
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Effects of exercise training in patients with chronic obstructive pulmonary disease: a narrative review for FYSS (Swedish Physical Activity Exercise Prescription Book)2016In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 50, no 6, p. 368-371Article, review/survey (Refereed)
    Abstract [en]

    The aims of this review were to determine the level of evidence for exercise training in the management of patients with chronic obstructive pulmonary disease (COPD) and provide evidence-based recommendations on exercise training. This review was performed in PubMed and Cochrane Library. Included studies investigated patients with COPD who had been randomised to exercise training or no training. Six systematic reviews were included. The methodological quality was scored using a grading system (GRADE). The analysis showed that aerobic and resistance training in patients in a stable state of COPD results in improved health-related quality of life and decreased dyspnoea, anxiety and depression (moderately strong scientific evidence, grade +++), and increased physical capacity and decreased dyspnoea in daily activities (limited scientific evidence, grade ++). In patients with an acute exacerbation, aerobic and resistance training, performed directly after the exacerbation, results in improved health-related quality of life (moderately strong scientific evidence, grade +++), improved exercise capacity and decreased mortality and hospitalisation (limited scientific evidence, grade ++). Thus, patients with COPD should be recommended to take part in exercise training.

  • 23.
    Fahlström, Martin
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine. Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Alfredson, Håkan
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Ultrasound and Doppler findings in the Achilles tendon among middle-aged recreational floor-ball players in direct relation to a match.2010In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 44, no 2, p. 140-143Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: In this study, structure, blood flow and thickness in the Achilles tendon related to tendon-loading activity were investigated. DESIGN: Examination by ultrasound (US) and colour Doppler (CD) immediately before and after 1 h of floor-ball matchplay. SETTING: Sports Medicine Unit, Umeå University, Sweden. PARTICIPANTS: 36 Achilles tendons in 18 middle-aged (mean 39 years) recreational male floor-ball players. MAIN OUTCOME MEASUREMENTS: Structure and high blood flow (HBF)/neovessels (NV) in the tendons were registered. Tendon thickness was measured 3 and 4.5 cm above the upper calcaneus and at the thickest part of the tendon. RESULTS: The US examination showed that 11/36 tendons (30.5%) in nine individuals had structural changes before and after the floor-ball match. In 7/36 tendons (five with structural changes), there were HBF/NV before, and after, the match. In six of these seven tendons, the blood flow was higher after than before the match. In three more tendons (two with structural changes), there were HBF/NV after, but not before, the match. After the match, mean tendon thickness had decreased significantly in both normal tendons and tendons with structural changes at the 3-cm level (6.0 (1.0) mm to 5.8 (0.9) mm; p<0.019), at the 4.5-cm level (5.7 (1.1) mm to 5.5 (1.0) mm; p<0.044), and at the thickest part (6.6 (1.1) mm to 6.3 (1.2) mm; p<0.000). CONCLUSIONS: In about 1/3 of the tendons, there were structural changes, about half of those tendons also had HBF/NV, which was higher after, than before, the match. Mean tendon thickness in both normal tendons and tendons with structural changes had decreased significantly after a 1-h floor-ball match.

  • 24.
    Gaida, J
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine. Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB), Anatomy. School of Primary Health Care, Monash University, Melbourne, Australia.
    Alfredson, Håkan
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Forsgren, Sture
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB), Anatomy.
    Cook, J
    School of Primary Health Care, Monash University, Melbourne, Australia.
    Decreased tumour necrosis factor alpha (tnf-a) in serum of patients with achilles tendinopathy: further evidence against the role of inflammation in the chronic stage2014In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 48, no 7, p. 597-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Altered expression of several cytokines and growth factors has been shown in biopsies of tendinopathy tissue. Biopsy studies are however challenged by capacity to obtain i) healthy tissue for comparison, ii) multiple samples to monitor cytokine dynamics, and iii) tissue from recent onset tendinopathy. An alternative is to study cytokines in blood samples. Whether cytokines in blood samples reflect tissue levels and the degree of tendinopathy is unknown.

    OBJECTIVE: To measure serum concentration of six cytokines and growth factors suggested to have a role in tendon response to load among individuals with chronic Achilles tendinopathy and controls.

    DESIGN: In this cross-sectional study, serum cytokine concentrations were measured from fasting blood samples on the BioPlex-200.

    SETTING: Sports Medicine Unit, Umeå University.

    PARTICIPANTS: Participants were recreationally active individuals. Achilles tendinopathy (n=22) was diagnosed on clinical criteria and confirmed with ultrasound examination. The control group (n=10) had no history of tendon pain and had normal ultrasound findings.

    INDEPENDENT VARIABLES: Serum concentration of tumour necrosis factor alpha (TNF-α), interleukin-1 beta (IL-1β), basic fibroblast growth factor (bFGF), platelet derived growth factor BB (PDGF-BB), interferon gamma (IFN-γ), and vascular-derived endothelial growth factor (VEGF) were the independent variables.

    MAIN OUTCOME MEASUREMENTS: A diagnosis of Achilles tendinopathy (yes/no) was defined as the key outcome variable prior to data collection.

    RESULTS: TNF-α concentration was lower in the tendinopathy group than the control group (P=.018); there were no other group differences.

    CONCLUSIONS: The observations indicate a lowering of the TNF-α concentration in the chronic phase of Achilles tendinopathy. As TNF-α levels are elevated in chronic inflammatory conditions, this reinforces that chronic Achilles tendinopathy is not an inflammatory disorder. Collecting a blood sample to study disease biomarkers leaves the tendon intact and therefore this design can be used to study cytokine dynamics with multiple sampling during disease progression and recovery.

  • 25.
    Gisslèn, Karl
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Gyulai, C
    Söderman, Kerstin
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Alfredson, Håkan
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    High prevalence of jumper's knee and sonographic changes in Swedish elite junior volleyball players compared to matched controls.2005In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, ISSN 1473-0480, Vol. 39, no 5, p. 298-301Article in journal (Refereed)
  • 26.
    Gisslén, Karl
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Alfredson, Håkan
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Neovascularisation and pain in jumper's knee: a prospective clinical and sonographic study in elite junior volleyball players.2005In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 39, no 7, p. 423-428Article in journal (Refereed)
  • 27.
    Gisslén, Karl
    et al.
    Umeå University, Faculty of Medicine, Surgical and Perioperative Sciences, Sports Medicine.
    Gyulai, Csaba
    Nordström, Peter
    Umeå University, Faculty of Medicine, Surgical and Perioperative Sciences, Sports Medicine.
    Alfredson, Håkan
    Umeå University, Faculty of Medicine, Surgical and Perioperative Sciences, Sports Medicine.
    Normal clinical and ultrasound findings indicate a low risk to sustain jumper's knee patellar tendinopathy: a longitudinal study on Swedish elite junior volleyball players.2007In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 41, no 4, p. 253-258Article in journal (Refereed)
  • 28.
    Herraiz-Adillo, Ángel
    et al.
    Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
    Ahlqvist, Viktor H.
    Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
    Higueras-Fresnillo, Sara
    Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden; Department of Physical Education, Sport and Human Motricity, Universidad Autónoma de Madrid, Madrid, Spain.
    Hedman, Kristofer
    Department of Clinical Physiology in Linköping, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
    Hagström, Emil
    Department of Medical Sciences Cardiology, Uppsala University, Uppsala, Sweden.
    Fortuin-de Smidt, Melony C.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Daka, Bledar
    School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg Sahlgrenska Academy, Göteborg, Sweden.
    Lenander, Cecilia
    Department of Clinical Sciences in Malmö, Centre for Primary Health Care Research, Lund University, Lund, Sweden.
    Berglind, Daniel
    Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden; Centre for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden.
    Östgren, Carl Johan
    Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden; Centre of Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.
    Rådholm, Karin
    Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden; The George Institute for Global Health, University of New South Wales, NSW, Sydney, Australia.
    Ortega, Francisco B.
    Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute and CIBEROBN Physiopathology of Obesity and Nutrition, University of Granada, Granada, Spain; Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
    Henriksson, Pontus
    Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
    Physical fitness in male adolescents and atherosclerosis in middle age: a population-based cohort study2024In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 58, no 8, p. 411-420Article in journal (Refereed)
    Abstract [en]

    Objectives: To examine the associations between physical fitness in male adolescents and coronary and carotid atherosclerosis in middle age.

    Methods: This population-based cohort study linked physical fitness data from the Swedish Military Conscription Register during adolescence to atherosclerosis data from the Swedish CArdioPulmonary bioImage Study in middle age. Cardiorespiratory fitness was assessed using a maximal cycle-ergometer test, and knee extension muscular strength was evaluated through an isometric dynamometer. Coronary atherosclerosis was evaluated via Coronary Computed Tomography Angiography (CCTA) stenosis and Coronary Artery Calcium (CAC) scores, while carotid plaques were evaluated by ultrasound. The associations were analysed using multinomial logistic regression, adjusted (marginal) prevalences and restricted cubic splines.

    Results: The analysis included 8986 male adolescents (mean age 18.3 years) with a mean follow-up of 38.2 years. Physical fitness showed a reversed J-shaped association with CCTA stenosis and CAC, but no consistent association was observed for carotid plaques. After adjustments, compared with adolescents in the lowest tertile of cardiorespiratory fitness and muscular strength, those in the highest tertile had 22% (OR 0.78; 95% CI 0.61 to 0.99) and 26% (OR 0.74; 95% CI 0.58 to 0.93) lower ORs for severe (≥50%) coronary stenosis, respectively. The highest physical fitness group (high cardiorespiratory fitness and muscular strength) had 33% (OR 0.67; 95% CI 0.52 to 0.87) lower OR for severe coronary stenosis compared with those with the lowest physical fitness.

    Conclusion: This study supports that a combination of high cardiorespiratory fitness and high muscular strength in adolescence is associated with lower coronary atherosclerosis, particularly severe coronary stenosis, almost 40 years later.

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  • 29.
    Jonsson, Per
    et al.
    Umeå University, Faculty of Medicine, Surgical and Perioperative Sciences, Sports Medicine.
    Alfredson, Håkan
    Umeå University, Faculty of Medicine, Surgical and Perioperative Sciences, Sports Medicine.
    Superior results with eccentric compared to concentric quadriceps training in patients with jumper's knee: a prospective randomised study2005In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 39, no 11, p. 847-850Article in journal (Refereed)
  • 30.
    Jonsson, Per
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Alfredson, Håkan
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Sunding, Kerstin
    Fahlström, Martin
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Cook, Jill
    New regimen for eccentric calf muscle training in patients with chronic insertional Achilles tendinopathy: results of a pilot-study2008In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 42, no 9, p. 746-749Article in journal (Refereed)
  • 31.
    Nordström, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Nordström, Peter
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Ekstrand, Jan
    Football Research Group, Division of Community Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
    Sports-related concussion increases the risk of subsequent injury by about 50% in elite male football players2014In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 48, no 19, p. 1447-1450Article in journal (Refereed)
    Abstract [en]

    Background Little is known about the short-term and long-term sequelae of concussion, and about when athletes who have sustained such injuries can safely return to play. Purpose To examine whether sports-related concussion increases the risk of subsequent injury in elite male football players. Study design Prospective cohort study. Methods Injuries were registered for 46 male elite football teams in 10 European countries in the 2001/ 2002-2011/ 2102 seasons. Two survival models were used to analyse whether concussion increased the subsequent risk of an injury in the first year. Results During the follow-up period, 66 players sustained concussions and 1599 players sustained other injuries. Compared with the risk following other injuries, concussion was associated with a progressively increased risk of a subsequent injury in the first year (0 to <3 months, HR=1.56, 95% CI 1.09 to 2.23; 3 to <6 months, HR=2.78, 95% CI 1.58 to 4.89; 6-12 months, HR=4.07, 95% CI 2.14 to 7.76). In the second model, after adjustment for the number of injuries in the year preceding the concussion, this injury remained significantly associated with the risk of subsequent injury in the first year (HR=1.47, 95% CI 1.05 to 2.05). Conclusions Concussion was a risk factor for sustaining subsequent injury within the following year. In-depth medical evaluation, which includes neurological and cognitive assessment, is warranted within the concussion management and return-to-play process.

  • 32.
    Purdam, C R
    et al.
    Department of Physical Therapies, Australian Institute of Sport, Belconnen, Australia.
    Jonsson, Per
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Alfredson, Håkan
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Lorentzon, Ronny
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Cook, J L
    La Trobe University Musculoskeletal Research Centre, Victoria, Australia.
    Khan, K M
    Department of Family Practice and School of Human Kinetics, University of British Columbia, Canada.
    A pilot study of the eccentric decline squat in the management of painful chronic patellar tendinopathy2004In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 38, no 4, p. 395-397Article in journal (Refereed)
    Abstract [en]

    Objectives: This non-randomised pilot study investigated the effect of eccentric quadriceps training on 17 patients (22 tendons) with painful chronic patellar tendinopathy.

    Methods: Two different eccentric exercise regimens were used by subjects with a long duration of pain with activity (more than six months). (a) Nine consecutive patients (10 tendons; eight men, one woman; mean age 22 years) performed eccentric exercise with the ankle joint in a standard (foot flat) position. (b) Eight patients (12 tendons; five men, three women; mean age 28 years) performed eccentric training standing on a 25° decline board, designed to increase load on the knee extensor mechanism. The eccentric training was performed twice daily, with three sets of 15 repetitions, for 12 weeks. Primary outcome measures were (a) 100 mm visual analogue scale (VAS), where the subject recorded the amount of pain during activity, and (b) return to previous activity. Follow up was at 12 weeks, with a further limited follow up at 15 months.

    Results: Good clinical results were obtained in the group who trained on the decline board, with six patients (nine tendons) returning to sport and showing a significantly reduced amount of pain over the 12 week period. Mean VAS scores fell from 74.2 to 28.5 (p  =  0.004). At 15 months, four patients (five tendons) reported satisfactory results (mean VAS 26.2). In the standard squat group the results were poor, with only one athlete returning to previous activity. Mean VAS scores in this group were 79.0 at baseline and 72.3 at 12 weeks (p  =  0.144).

    Conclusion: In a small group of patients with patellar tendinopathy, eccentric squats on a decline board produced encouraging results in terms of pain reduction and return to function in the short term. Eccentric exercise using standard single leg squats in a similar sized group appeared to be a less effective form of rehabilitation in reducing pain and returning subjects to previous levels of activity.

     

  • 33. Rabago, D
    et al.
    Best, T M
    Zgierska, A E
    Zeisig, Eva
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Ryan, M
    Crane, D
    A systematic review of four injection therapies for lateral epicondylosis: prolotherapy, polidocanol, whole blood and platelet-rich plasma2009In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 43, no 7, p. 471-481Article, review/survey (Refereed)
    Abstract [en]

    OBJECTIVE: To appraise existing evidence for prolotherapy, polidocanol, autologous whole blood and platelet-rich plasma injection therapies for lateral epicondylosis (LE). DESIGN: Systematic review. DATA SOURCES: Medline, Embase, CINAHL, Cochrane Central Register of Controlled Trials, Allied and Complementary Medicine. Search strategy: names and descriptors of the therapies and LE. STUDY SELECTION: All human studies assessing the four therapies for LE. MAIN RESULTS: Results of five prospective case series and four controlled trials (three prolotherapy, two polidocanol, three autologous whole blood and one platelet-rich plasma) suggest each of the four therapies is effective for LE. In follow-up periods ranging from 9 to 108 weeks, studies reported sustained, statistically significant (p<0.05) improvement in visual analogue scale primary outcome pain score measures and disease-specific questionnaires; relative effect sizes ranged from 51% to 94%; Cohen's d ranged from 0.68 to 6.68. Secondary outcomes also improved, including biomechanical elbow function assessment (polidocanol and prolotherapy), presence of abnormalities and increased vascularity on ultrasound (autologous whole blood and polidocanol). Subjects reported satisfaction with therapies on single-item assessments. All studies were limited by small sample size. CONCLUSIONS: There is strong pilot-level evidence supporting the use of prolotherapy, polidocanol, autologous whole blood and platelet-rich plasma injections in the treatment of LE. Rigorous studies of sufficient sample size, assessing these injection therapies using validated clinical, radiological and biomechanical measures, and tissue injury/healing-responsive biomarkers, are needed to determine long-term effectiveness and safety, and whether these techniques can play a definitive role in the management of LE and other tendinopathies.

  • 34. Rio, Ebonie Kendra
    et al.
    Mc Auliffe, Sean
    Kuipers, Irene
    Girdwood, Michael
    Alfredson, Håkan
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Bahr, Roald
    Cook, Jill L.
    Coombes, Brooke
    Fu, Siu Ngor
    Grimaldi, Alison
    de Vos, Robert-Jan
    Lewis, Jeremy S.
    Maffulli, Nicola
    Malliaras, Peter
    Magnusson, S. P.
    Oei, Edwin H. G.
    Purdam, Craig Robert
    Rees, Jonathan D.
    Scott, Alex
    Silbernagel, Karin Gravare
    Speed, Cathy
    van den Akker-Scheek, Inge
    Vicenzino, Bill T.
    Weir, Adam
    Wolf, Jennifer Moriatis
    Zwerver, Johannes
    ICON PART-T 2019-International Scientific Tendinopathy Symposium Consensus: recommended standards for reporting participant characteristics in tendinopathy research (PART-T)2020In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 54, no 11, p. 627-630Article in journal (Refereed)
    Abstract [en]

    We aimed to establish consensus for reporting recommendations relating to participant characteristics in tendon research. A scoping literature review of tendinopathy studies (Achilles, patellar, hamstring, gluteal and elbow) was followed by an online survey and face-to-face consensus meeting with expert healthcare professionals (HCPs) at the International Scientific Tendon Symposium, Groningen 2018. We reviewed 263 papers to form statements for consensus and invited 30 HCPs from different disciplines and geographical locations; 28 completed the survey and 15 attended the meeting. There was consensus that the following data should be reported for cases and controls: sex, age, standing height, body mass, history of tendinopathy, whether imaging was used to confirm pathology, loading tests, pain location, symptom duration and severity, level of disability, comorbidities, physical activity level, recruitment source and strategies, and medication use history. Standardised reporting of participant characteristics aims to benefit patients and clinicians by guiding researchers in the conduct of their studies. We provide free resources to facilitate researchers adopting our recommendations.

  • 35.
    Sagelv, Edvard H
    et al.
    School of Sport Sciences, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway.
    Hopstock, Laila Arnesdatter
    Department of Health and Care Sciences, Faculty of Health Sciences, University of Tromso Department of Community Medicine, Tromsø, Norway.
    Morseth, Bente
    School of Sport Sciences, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway.
    Hansen, Bjørge H
    Department of Sport Science and Physical Education, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway.
    Steene-Johannessen, Jostein
    Department of Sport Medicine, Norwegian School of Sport Sciences, Oslo, Norway.
    Johansson, Jonas
    Department of Community Medicine, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway.
    Nordström, Anna
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. School of Sport Sciences, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway.
    Saint-Maurice, Pedro F
    National Cancer Institute Division of Cancer Epidemiology and Genetics, Maryland, Rockville, United States.
    Løvsletten, Ola
    Department of Community Medicine, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway.
    Wilsgaard, Tom
    Department of Community Medicine, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway.
    Ekelund, Ulf
    Department of Sport Medicine, Norwegian School of Sport Sciences, Oslo, Norway; Department of Chronic Diseases and Ageing, The Norwegian Institute for Public Health, Oslo, Norway.
    Tarp, Jakob
    Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus Universitet, Aarhus, Denmark.
    Device-measured physical activity, sedentary time, and risk of all-cause mortality: an individual participant data analysis of four prospective cohort studies2023In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 57, no 22, p. 1457-1463Article, review/survey (Refereed)
    Abstract [en]

    Objectives: To examine whether moderate-to-vigorous physical activity (MVPA) modifies the association between sedentary time and mortality and vice versa, and estimate the joint associations of MVPA and sedentary time on mortality risk.

    Methods: This study involved individual participant data analysis of four prospective cohort studies (Norway, Sweden, USA, baseline: 2003-2016, 11 989 participants ≥50 years, 50.5% women) with hip-accelerometry-measured physical activity and sedentary time. Associations were examined using restricted cubic splines and fractional polynomials in Cox regressions adjusted for sex, education, body mass index, smoking, alcohol, study cohort, cardiovascular disease, cancer, and/or diabetes, accelerometry wear time and age.

    Results: 6.7% (n=805) died during follow-up (median 5.2 years, IQR 4.2 years). More than 12 daily sedentary hours (reference 8 hours) was associated with mortality risk only among those accumulating <22 min of MVPA per day (HR 1.38, 95% CI 1.10 to 1.74). Higher MVPA levels were associated with lower mortality risk irrespective of sedentary time, for example, HR for 10 versus 0 daily min of MVPA was 0.85 (95% CI 0.74 to 0.96) in those accumulating <10.5 daily sedentary hours and 0.65 (95% CI 0.53 to 0.79) in those accumulating ≥10.5 daily sedentary hours. Joint association analyses confirmed that higher MVPA was superior to lower sedentary time in lowering mortality risk, for example, 10 versus 0 daily min of MVPA was associated with 28-55% lower mortality risk across the sedentary time spectrum (lowest risk, 10 daily sedentary hours: HR 0.45, 95% CI 0.31 to 0.65).

    Conclusions: Sedentary time was associated with higher mortality risk but only in individuals accumulating less than 22 min of MVPA per day. Higher MVPA levels were associated with lower mortality risk irrespective of the amount of sedentary time.

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  • 36.
    Scott, Alex
    et al.
    University of British Columbia.
    Docking, Sean
    Monash University, Melbourne.
    Vicenzino, Bill
    University of Queensland, Brisbane.
    Alfredson, Håkan
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Zwerver, Johannes
    University Medical Center Groningen, Center for Sports Medicine, Groningen.
    Lundgreen, Kirsten
    Oslo Sports Trauma Research Center.
    Finlay, Oliver
    Lee Valley Athletics Centre and Hospital of St John and St Elizabeth, London.
    Pollock, Noel
    e and Hospital of St John and St Elizabeth, London.
    Cook, Jill L.
    Monash University, Melbourne.
    Fearon, Angela
    University of British Columbia.
    Purdam, Craig R.
    Australian Institute of Sport, Canberra.
    Hoens, Alison
    Physiotherapy Association of British Columbia, Vancouver Coastal Health and Research Institute, University of British Columbia, Vancouver.
    Rees, Jonathan D.
    Goetz, Thomas J.
    University of Queensland, Brisbane.
    Danielson, Patrik
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB), Anatomy. Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Sports and exercise-related tendinopathies: a review of selected topical issues by participants of the second International Scientific Tendinopathy Symposium (ISTS) Vancouver 20122013In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 47, no 9, p. 536-+Article in journal (Refereed)
    Abstract [en]

    In September 2010, the first International Scientific Tendinopathy Symposium (ISTS) was held in Umea, Sweden, to establish a forum for original scientific and clinical insights in this growing field of clinical research and practice. The second ISTS was organised by the same group and held in Vancouver, Canada, in September 2012. This symposium was preceded by a round-table meeting in which the participants engaged in focused discussions, resulting in the following overview of tendinopathy clinical and research issues. This paper is a narrative review and summary developed during and after the second ISTS. The document is designed to highlight some key issues raised at ISTS 2012, and to integrate them into a shared conceptual framework. It should be considered an update and a signposting document rather than a comprehensive review. The document is developed for use by physiotherapists, physicians, athletic trainers, massage therapists and other health professionals as well as team coaches and strength/conditioning managers involved in care of sportspeople or workers with tendinopathy.

  • 37. Scott, Alex
    et al.
    Squier, Kipling
    Alfredson, Håkan
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB).
    Bahr, Roald
    Cook, Jill L.
    Coombes, Brooke
    de Vos, Robert-Jan
    Fu, Siu Ngor
    Grimaldi, Alison
    Lewis, Jeremy S.
    Maffulli, Nicola
    Magnusson, S. P.
    Malliaras, Peter
    Mc Auliffe, Sean
    Oei, Edwin H. G.
    Purdam, Craig Robert
    Rees, Jonathan D.
    Rio, Ebonie Kendra
    Silbernagel, Karin Gravare
    Speed, Cathy
    Weir, Adam
    Wolf, Jennifer Moriatis
    van den Akker-Scheek, Inge
    Vicenzino, Bill T.
    Zwerver, Johannes
    ICON 2019: International Scientific Tendinopathy Symposium Consensus: Clinical Terminology2020In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 54, no 5, p. 260-262Article in journal (Refereed)
  • 38. Sjögren, Per
    et al.
    Fisher, Rachel
    Kallings, Lena
    Svenson, Ulrika
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Pathology.
    Roos, Göran
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Pathology.
    Hellenius, Mai-Lis
    Stand up for health-avoiding sedentary behaviour might lengthen your telomeres: secondary outcomes from a physical activity RCT in older people2014In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 48, no 19, p. 1407-1409Article in journal (Refereed)
    Abstract [en]

    Background Telomere length has been associated with a healthy lifestyle and longevity. However, the effect of increased physical activity on telomere length is still unknown. Therefore, the aim was to study the relationship between changes in physical activity level and sedentary behaviour and changes in telomere length. Methods Telomere length was measured in blood cells 6 months apart in 49, 68-year-old, sedentary, overweight individuals taking part in a randomised controlled physical activity intervention trial. The intervention group received individualised physical activity on prescription. Physical activity was measured with a 7-day diary, questionnaires and a pedometer. Sitting time was measured with the short version of The International Physical Activity Questionnaire. Results Time spent exercising as well as steps per day increased significantly in the intervention group. Reported sitting time decreased in both groups. No significant associations between changes in steps per day and changes in telomere length were noted. In the intervention group, there was a negative correlation between changes in time spent exercising and changes in telomere length (rho=-0.39, p=0.07). On the other hand, in the intervention group, telomere lengthening was significantly associated with reduced sitting time (rho=-0.68, p=0.02). Conclusions Reduced sitting time was associated with telomere lengthening in blood cells in sedentary, overweight 68-year-old individuals participating in a 6-month physical activity intervention trial.

  • 39. Stamatakis, Emmanuel
    et al.
    Koster, Annemarie
    Hamer, Mark
    Rangul, Vegar
    Lee, I--Min
    Bauman, Adrian E.
    Atkin, Andrew J.
    Aadahl, Mette
    Matthews, Charles E.
    Mork, Paul Jarle
    Askie, Lisa
    Cistulli, Peter
    Granat, Malcolm
    Palm, Peter
    Crowley, Patrick Joseph
    Stevens, Matthew
    Gupta, Nidhi
    Pulakka, Anna
    Stenholm, Sari
    Arvidsson, Daniel
    Mishra, Gita
    Wennberg, Patrik
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Chastin, Sebastien
    Ekelund, Ulf
    Holtermann, Andreas
    Emerging collaborative research platforms for the next generation of physical activity, sleep and exercise medicine guidelines: the Prospective Physical Activity, Sitting, and Sleep consortium (ProPASS)2020In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 54, no 8, p. 435-437Article in journal (Other academic)
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  • 40.
    Stålnacke, Britt-Marie
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Ohlsson, Anna
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Tegner, Yelverton
    Department of Health Sciences, Luleå Technical University, Boden.
    Sojka, Peter
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Serum concentrations of two biochemical markers of brain tissue damage S-100B and neurone specific enolase are increased in elite female soccer players after a competitive game2006In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 40, no 4, p. 313-316Article in journal (Refereed)
    Abstract [en]

    Background: It is a matter of debate whether or not ordinary heading of the ball in soccer causes injury to brain tissue. Objective: To analyse concentrations of the biochemical markers of brain tissue damage S-100B and neurone specific enolase (NSE) in serum of female elite soccer players in association with a competitive game. Methods: Venous blood samples were obtained from 44 female soccer players before and after a competitive game for analysis. The number of headers and trauma events (falls, collisions, etc) was assessed from videotape recordings for each player. Results: Concentrations of both brain damage markers were increased after the game (S-100B, 0.18 (0.11) v 0.11 (0.05) mg/l (p = 0.000); NSE, 10.14 (1.74) v 9.05 (1.59) mg/l (p = 0.001)). There was a significant correlation between changes in S-100B concentrations and both the number of headers (r = 0.430, p = 0.004) and the number of other trauma events (r = 0.517, p < 0.001). Conclusion: The concentrations of both S-100B and NSE were increased by game associated activities and events. The increases in S-100B concentration were significantly related to the number of headers and other trauma events, which indicates that both these factors may have contributed to these increases.

  • 41. Vicenzino, Bill
    et al.
    de Vos, Robert-Jan
    Alfredson, Håkan
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Sports Medicine.
    Bahr, Roald
    Cook, Jill L.
    Coombes, Brooke K.
    Fu, Siu Ngor
    Silbernagel, Karin Gravare
    Grimaldi, Alison
    Lewis, Jeremy S.
    Maffulli, Nicola
    Magnusson, S. P.
    Malliaras, Peter
    Mc Auliffe, Sean
    Oei, Edwin H. G.
    Purdam, Craig
    Rees, Jonathan D.
    Rio, Ebonie Kendra
    Scott, Alex
    Speed, Cathy
    van den Akker-Scheek, Inge
    Weir, Adam
    Wolf, Jennifer Moriatis
    Zwerver, Johannes
    ICON 2019-International Scientific Tendinopathy Symposium Consensus: There are nine core health-related domains for tendinopathy (CORE DOMAINS): Delphi study of healthcare professionals and patients2020In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 54, no 8, p. 444-451Article in journal (Refereed)
    Abstract [en]

    Background

    The absence of any agreed-upon tendon health-related domains hampers advances in clinical tendinopathy research. This void means that researchers report a very wide range of outcome measures inconsistently. As a result, substantial synthesis/meta-analysis of tendon research findings is almost futile despite researchers publishing busily. We aimed to determine options for, and then define, core health-related domains for tendinopathy.

    Methods

    We conducted a Delphi study of healthcare professionals (HCP) and patients in a three-stage process. In stage 1, we extracted candidate domains from clinical trial reports and developed an online survey. Survey items took the form: 'The 'candidate domain' is important enough to be included as a core health-related domain of tendinopathy'; response options were: agree, disagree, or unsure. In stage 2, we administered the online survey and reported the findings. Stage 3 consisted of discussions of the findings of the survey at the ICON (International Scientific Tendinopathy Symposium Consensus) meeting. We set 70% participant agreement as the level required for a domain to be considered 'core'; similarly, 70% agreement was required for a domain to be relegated to 'not core' (see Results next).

    Results

    Twenty-eight HCP (92% of whom had >10 years of tendinopathy experience, 71% consulted >10 cases per month) and 32 patients completed the online survey. Fifteen HCP and two patients attended the consensus meeting. Of an original set of 24 candidate domains, the ICON group deemed nine domains to be core. These were: (1) patient rating of condition, (2) participation in life activities (day to day, work, sport), (3) pain on activity/loading, (4) function, (5) psychological factors, (6) physical function capacity, (7) disability, (8) quality of life and (9) pain over a specified time. Two of these (2, 6) were an amalgamation of five candidate domains. We agreed that seven other candidate domains were not core domains: range of motion, pain on clinician applied test, clinical examination, palpation, drop out, sensory modality pain and pain without other specification. We were undecided on the other five candidate domains of physical activity, structure, medication use, adverse effects and economic impact.

    Conclusion

    Nine core domains for tendon research should guide reporting of outcomes in clinical trials. Further research should determine the best outcome measures for each specific tendinopathy (ie, core outcome sets).

  • 42. Ward, Ella Rose
    et al.
    Andersson, Gustav
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB), Anatomy. Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Hand Surgery.
    Backman, Ludvig J.
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB), Anatomy.
    Gaida, Jamie E.
    Fat pads adjacent to tendinopathy: more than a coincidence?2016In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 50, no 24, p. 1491-1492Article in journal (Refereed)
  • 43.
    Westman, Anton
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Kirurgi.
    Björnstig, Ulf
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Kirurgi.
    Injuries in Swedish skydiving2007In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 41, no 6, p. 356-364Article in journal (Refereed)
  • 44.
    Westman, Anton
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Rosén, M
    Berggren, P
    Björnstig, Ulf
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Parachuting from fixed objects: descriptive study of 106 fatal events in BASE jumping 1981-20062008In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 42, no 6, p. 431-436Article in journal (Refereed)
    Abstract [en]

    Objective: To analyse the characteristics of fatal incidents in fixed object sport parachuting (building, antenna, span, earth (BASE) jumping) and create a basis for prevention.

    Design: Descriptive epidemiological study.

    Participants: Data on reported fatal injury events (n = 106) worldwide in 1981–2006 retrieved from the BASE fatality list.

    Assessment of risk factors: Human, equipment and environmental factors.

    Main outcome measurements: Identification of typical fatal incident and injury mechanisms for each of the four fixed object types of BASE jumping (building, antenna, span, earth).

    Results: Human factors included parachutist free fall instability (loss of body control before parachute deployment), free fall acrobatics and deployment failure by the parachutist. Equipment factors included pilot chute malfunction and parachute malfunction. In cliff jumping (BASE object type E), parachute opening towards the object jumped was the most frequent equipment factor. Environmental factors included poor visibility, strong or turbulent winds, cold and water. The overall annual fatality risk for all object types during the year 2002 was estimated at about one fatality per 60 participants.

    Conclusions: Participants in BASE jumping should target risk factors with training and technical interventions. The mechanisms described in this study should be used by rescue units to improve the management of incidents.

  • 45. Wheeler, Michael
    et al.
    Green, Daniel
    Ellis, Kathryn
    Cerin, Ester
    Heinonen, Ilkka
    Naylor, Louise
    Larsen, Robyn
    Wennberg, Patrik
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Boraxbekk, Carl-Johan
    Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR). Danish Research Centre for Magnetic Resonance, Copenhagen University Hospital, Hvidovre, Denmark .
    Lewis, Jaye
    Eikelis, Nina
    Lautenschlager, Nicola
    Kingwell, Bronwyn
    Lambert, Gavin
    Owen, Neville
    Dunstan, David
    Distinct effects of acute exercise and breaks in sitting on working memory and executive function in older adults: a three-arm, randomised cross-over trial to evaluate the effects of exercise with and without breaks in sitting on cognition2020In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 54, no 13, p. 776-781Article in journal (Refereed)
    Abstract [en]

    Background: Sedentary behaviour is associated with impaired cognition, whereas exercise can acutely improve cognition.

    Objective: We compared the effects of a morning bout of moderate-intensity exercise, with and without subsequent light-intensity walking breaks from sitting, on cognition in older adults.

    Methods: Sedentary overweight/obese older adults with normal cognitive function (n=67, 67±7 years, 31.2±4.1 kg/m2 ) completed three conditions (6-day washout): SIT (sitting): uninterrupted sitting (8 hours, control); EX+SIT (exercise + sitting): sitting (1 hour), moderate-intensity walking (30min), uninterrupted sitting (6.5 hours); and EX+BR (exercise + breaks): sitting (1 hour), moderate-intensity walking (30min), sitting interrupted every 30min with 3min of light-intensity walking (6.5 hours). Cognitive testing (Cogstate) was completed at four time points assessing psychomotor function, attention, executive function, visual learning and working memory. Serum brain-derived neurotrophic growth factor (BDNF) was assessed at six time points. The 8-hour net area under the curve (AUC) was calculated for each outcome.

    Results: Working memory net AUC z-score·hour (95%CI) was improved in EX+BR with a z-score of +28 (−26 to +81), relative to SIT, −25 (−79 to +29, p=0.04 vs EX+BR). Executive function net AUC was improved in EX+SIT, −8 (− 71 to +55), relative to SIT, −80 (−142 to −17, p=0.03 vs EX+SIT). Serum BDNF net AUC ng/mL·hour (95%CI) was increased in both EX+SIT, +171 (−449 to +791, p=0.03 vs SIT), and EX+BR, +139 (−481 to +759, p=0.045 vs SIT), relative to SIT, −227 (−851 to +396).

    Conclusion: A morning bout of moderate-intensity exercise improves serum BDNF and working memory or executive function in older adults, depending on whether or not subsequent sitting is also interrupted with intermittent light-intensity walking.

  • 46.
    Willberg, Lotta
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Sunding, Kerstin
    Forssblad, Magnus
    Fahlström, Martin
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Alfredson, Håkan
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Sclerosing polidocanol injections or arthroscopic shaving to treat patellar tendinopathy/jumper's knee?: a randomised controlled study2011In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 45, no 5, p. 411-415Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Proximal patellar tendinopathy/jumper's knee (PT/JK) is well known to be difficult to treat. Recent studies using an ultrasound and colour Doppler-based treatment approach on the dorsal side of the tendon, sclerosing polidocanol injections and ultrasound-guided arthroscopic shaving, have shown promising clinical results.

    OBJECTIVES: To compare the clinical effects after treatment with sclerosing polidocanol injections and arthroscopic shaving.

    MATERIAL AND METHODS: 52 patellar tendons (43 men and two women) with ultrasound and colour Doppler-verified diagnosis of PT/JK were randomly assigned to treatment with ultrasound and colour Doppler-guided sclerosing polidocanol injections (group A) or ultrasound and colour Doppler-guided arthroscopic shaving (group B). All patients were involved in patellar tendon loading sports or recreational activities, and had had a long duration of pain symptoms from the proximal patellar tendon. Pain during patellar tendon loading activity, and at rest, before and after treatment (visual analogue scale; VAS), and patient satisfaction with the result of the treatment, was registered.

    RESULTS: After treatment, the patients treated with arthroscopic shaving had a significantly lower VAS score at rest and during activity, and were significantly more satisfied compared with the patients in the sclerosing injection group.

    CONCLUSIONS: Both treatment with ultrasound and colour Doppler-guided sclerosing polidocanol injections and arthroscopic shaving showed good clinical results, but patients treated with arthroscopic shaving had less pain and were more satisfied with the treatment result. Because surgical treatment is a one-stage treatment return to sports was faster in this group.

  • 47. Young, M A
    et al.
    Cook, J L
    Purdam, C R
    Kiss, Z S
    Alfredson, Håkan
    Umeå University, Faculty of Medicine, Surgical and Perioperative Sciences, Sports Medicine.
    Eccentric decline squat protocol offers superior results at 12 months compared with traditional eccentric protocol for patellar tendinopathy in volleyball players.2005In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 39, no 2, p. 102-105Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Conservative treatment of patellar tendinopathy has been minimally investigated. Effective validated treatment protocols are required. OBJECTIVES: To investigate the immediate (12 weeks) and long term (12 months) efficacy of two eccentric exercise programmes for the treatment of patellar tendinopathy. METHODS: This was a prospective randomised controlled trial of 17 elite volleyball players with clinically diagnosed and imaging confirmed patellar tendinopathy. Participants were randomly assigned to one of two treatment groups: a decline group and a step group. The decline group were required to perform single leg squats on a 25 degrees decline board, exercising into tendon pain and progressing their exercises with load. The step group performed single leg squats on a 10 cm step, exercising without tendon pain and progressing their exercises with speed then load. All participants completed a 12 week intervention programme during their preseason. Outcome measures used were the Victorian Institute of Sport Assessment (VISA) score for knee function and 100 mm visual analogue scale (VAS) for tendon pain with activity. Measures were taken throughout the intervention period and at 12 months. RESULTS: Both groups had improved significantly from baseline at 12 weeks and 12 months. Analysis of the likelihood of a 20 point improvement in VISA score at 12 months revealed a greater likelihood of clinical improvements in the decline group than the step group. VAS scores at 12 months did not differ between the groups. CONCLUSIONS: Both exercise protocols improved pain and sporting function in volleyball players over 12 months. This study indicates that the decline squat protocol offers greater clinical gains during a rehabilitation programme for patellar tendinopathy in athletes who continue to train and play with pain.

  • 48.
    Zeisig, Eva
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Fahlström, Martin
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine. Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Öhberg, Lars
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Diagnostic Radiology.
    Alfredson, Håkan
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    A 2-year sonographic follow-up after intratendinous injection therapy in patients with tennis elbow2010In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 44, no 8, p. 584-587Article in journal (Refereed)
    Abstract [en]

    Background Tennis elbow is a tendinopathy affecting the upper extremity. Recent studies have shown high sensitivity for ultrasound (US) examination and high specificity for colour Doppler (CD) examination. There are no mid- or long-term follow-up investigations of the tendon structure and blood flow using these techniques.

    Objective To use US and CD to study structure and blood flow in the extensor origin in patients with tennis elbow treated with intratendinous injections.

    Design Follow-up study

    Setting Sports Medicine Unit, Umeå University.

    Patients 25 patients (28 elbows), mean age 46 years (range 27–66), treated with intratendinous injections due to chronic pain from tennis elbow.

    Method US and CD examination of the extensor origin was carried out at inclusion and at follow-up two years after intratendinous injection treatment with polidocanol and/or a local anaesthetic.

    Main outcome measurements US (structure) and CD (blood flow) findings.

    Results All patients had structural tendon changes and high blood flow at inclusion when given the injection treatment. At the two-year follow-up, structural tendon changes were seen in 20/28 elbows and high blood flow was seen in 4/28 elbows. The majority of patients with a good clinical result after treatment had no visible blood flow (17/20), but the structural changes showed no relation to a good result (13/20 remaining changes).

    Conclusions Doppler findings, but not structure, might be related to the clinical result after intratendinous injection treatment of tennis elbow.

  • 49.
    Zeisig, Eva
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Fahlström, Martin
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Öhberg, Lars
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Diagnostic Radiology.
    Alfredson, Håkan
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Pain relief after intratendinous injections in patients with tennis elbow: results of a randomised study2008In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 42, no 4, p. 267-271Article in journal (Refereed)
  • 50.
    Zeisig, Eva
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Ljung, B-O
    Alfredson, Håkan
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Danielson, Patrik
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB), Anatomy.
    Immunohistochemical evidence of local production of catecholamines in cells of the muscle origins at the lateral and medial humeral epicondyles: of importance for the development of tennis and golfer's elbow?2009In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 43, no 4, p. 269-275Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Tennis elbow (TE) is a painful condition affecting the common extensor origin at the lateral humeral epicondyle. Colour Doppler examination has shown increased blood flow at this site and the sensory, and sympathetic innervation patterns have been delineated. However, it is not known whether there is local production of catecholamines and/or acetylcholine in this tissue, which is the case in patellar and Achilles tendinopathies. OBJECTIVE: To investigate the possible presence of local production of catecholamines and acetylcholine in non-neuronal cells (fibroblasts) in connective tissue at the muscle origin at the lateral humeral epicondyle in patients with TE. DESIGN: Immunohistochemical studies were performed on biopsies taken from the extensor origin in patients with TE and in pain-free controls. For reference purpose, biopsies from the flexor origin in patients with golfer's elbow (GE) were also studied. PATIENTS: Seven patients with TE and four patients with GE. Six healthy asymptomatic individuals served as controls. Method: Immunohistochemistry, using antibodies detecting synthesising enzymes for catecholamines (tyrosine hydroxylase; TH) and acetylcholine (choline acetyltransferase; ChAT). RESULTS: TH-like immunohistochemical reactions were seen in fibroblasts in four of the seven patients with TE and two of the four patients with GE. No such reactions were detected in controls (0/6). No ChAT reactions were seen in any of the investigated specimens. CONCLUSIONS: There is evidence of local, non-neuronal production of catecholamines, but not acetylcholine, in fibroblasts in the tissue at the muscle origin at the lateral and medial epicondyles in patients with TE and GE, respectively, which might have an influence on blood vessel regulation and pain mechanisms in these conditions.

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