Reliability of arterial spin labelling measurements of perfusion within the quadriceps during steady-state exercise

Arterial spin labelling (ASL) provides a potential method to non-invasively determine muscle blood flow and examine the impact of interventions such as supplementation and training. However, it's a method with intrinsically low signal, leading to limitations in accuracy and temporal resolution. To examine these limitations, the current study measured perfusion via ASL on three occasions in the rectus femoris of 10 healthy adults, during light and moderate exercise, over three different exercise durations. For data sampled over 9 min, light intensity exercise gave an average perfusion of 35.0 ± 5.1 ml/min.100g^?1 with a coefficient of variation (COV) of 16% and single intraclass correlation coefficient (ICC) of 0.67. For the moderate bout, perfusion was 51.3 ± 5.6 ml/min.100g^?1 (COV 10%, ICC 0.82). When the same data were analyzed over 5 min 24 s, perfusion was 37.8 ± 11.13 (COV 30%, ICC 0.13) during light and 49.5 ± 8.8 ml/min.100g^?1 (COV 18%, ICC 0.52) during moderate exercise. When sampling was reduced to 1 min 48 s, perfusion was 41.2 ± 13.7 (COV 33%, ICC 0.26) during light and 49.5 ± 13.6 ml/min.100g^?1 (COV 28%, ICC 0.04) during moderate exercise. For 9 min a significant perfusion difference was found between the exercise intensities; however, this was not the case for sampling over 5 min 24 s or 1 min 48 s. Such findings illustrate the potential of ASL to non-invasively monitor muscle perfusion under steady-state conditions, but highlight that extended exercise protocols are necessary in order to generate date of sufficient reliability to be able to discriminate intervention dependent perfusion differences.     

First-rib stress fracture in two adolescent swimmers: a case report

First-rib stress fractures have been described in adolescent athletes in various sports, with only one prior case report of first-rib stress fractures in an adolescent female swimmer. There is a need for research on the cause, management, and prevention of these injuries as they lead to significant morbidity and critical time away from sport for these aspiring athletes. We aimed to describe first-rib stress fractures as a potential cause for non-specific atraumatic chronic shoulder pain in adolescent swimmers and to discuss the different presentations, unique risk factors, treatment, and potential injury prevention strategies of such fractures. We discussed two such cases which were successfully treated with activity modification with restriction of all overhead activity, gradually progressive physical therapy and a return to swimming protocol. First-rib stress fractures can vary in presentation and should be in the differential diagnosis in adolescent swimmers with chronic shoulder pain. These injuries can be successfully managed with rest from overhead activities and physical therapy. Gradual return to competitive swimming can be achieved even with non-union of a first-rib stress fracture. Emphasis on balanced strength training in different muscle groups and proper swimming technique is essential to prevent these injuries.     

Tier-specific evolution of match performance characteristics in the English Premier League: it’s getting tougher at the top

This study investigated the evolution of physical and technical performances in the English Premier League (EPL), with special reference to league ranking. Match performance observations (n = 14,700) were collected using a multiple-camera computerised tracking system across seven consecutive EPL seasons (2006–07 to 2012–13). Final league rankings were classified into Tiers: (A) 1st–4th ranking (n = 2519), (B) 5th–8th ranking (n = 2965), (C) 9th–14th ranking (n = 4448) and (D) 15th–20th ranking (n = 4768). Teams in Tier B demonstrated moderate increases in high-intensity running distance while in ball possession from the 2006–07 to 2012–13 season (P < 0.001; effect size [ES]: 0.68), with Tiers A, C and D producing less pronounced increases across the same period (P < 0.005; ES: 0.26, 0.41 and 0.33, respectively). Large increases in sprint distance were observed from the 2006–07 to 2012–13 season for Tier B (P < 0.001; ES: 1.21), while only moderate increases were evident for Tiers A, C and D (P < 0.001; ES: 0.75, 0.97 and 0.84, respectively). Tier B demonstrated large increases in the number of passes performed and received in 2012–13 compared to 2006–07 (P < 0.001; ES: 1.32–1.53) with small-to-moderate increases in Tier A (P < 0.001; ES: 0.30–0.38), Tier C (P < 0.001; ES: 0.46–0.54) and Tier D (P < 0.001; ES: 0.69–0.87). The demarcation line between 4th (bottom of Tier A) and 5th ranking (top of Tier B) in the 2006–07 season was 8 points, but this decreased to just a single point in the 2012–13 season. The data demonstrate that physical and technical performances have evolved more in Tier B than any other Tier in the EPL and could indicate a narrowing of the performance gap between the top two Tiers.     

A kinematic analysis of the spine during rugby scrummaging on natural and synthetic turfs

Artificial surfaces are now an established alternative to grass (natural) surfaces in rugby union. Little is known, however, about their potential to reduce injury. This study characterises the spinal kinematics of rugby union hookers during scrummaging on third-generation synthetic (3G) and natural pitches. The spine was sectioned into five segments, with inertial sensors providing three-dimensional kinematic data sampled at 40 Hz/sensor. Twenty-two adult, male community club and university-level hookers were recruited. An equal number were analysed whilst scrummaging on natural or synthetic turf. Players scrummaging on synthetic turf demonstrated less angular velocity in the lower thoracic spine for right and left lateral bending and right rotation. The general reduction in the range of motion and velocities, extrapolated over a prolonged playing career, may mean that the synthetic turf could result in fewer degenerative injuries. It should be noted, however, that this conclusion considers only the scrummaging scenario.