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  • 1.
    Aho, Anna Carin
    et al.
    Linnaeus University, Sweden.
    Hultsjö, Sally
    Psychiat Clin, Sweden; Jönköping University, Sweden.
    Hjelm, Katarina
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Experiences of being parents of young adults living with recessive limb-girdle muscular dystrophy from a salutogenic perspective2017In: Neuromuscular Disorders, ISSN 0960-8966, E-ISSN 1873-2364, Vol. 27, no 6, p. 585-595Article in journal (Refereed)
    Abstract [en]

    Recessive limb-girdle muscular dystrophies (LGMD2) involve progressive muscle weakness. Parental support is important for young adults living with LGMD2, but no study has been identified focusing on the parents experiences. The salutogenic perspective concentrates on how daily life is comprehended, managed and found meaningful, i.e. the persons sense of coherence. The aim of this study was to describe, from a salutogenic perspective, experiences of being parents of young adults living with LGMD2. Nineteen participants were included. Data were collected by semi-structured interviews and the self-administrated 13-item sense of coherence questionnaire. Interview data were analysed with content analysis and related to self-rated sense of coherence. The result shows experiences of being influenced, not only by thoughts and emotions connected to the disease but also by caregiving duties and the young adults well-being. Simultaneously, difficulty in fully grasping the disease was expressed and uncertainty about progression created worries about future management. Trying their best to support their young adults to experience well-being and to live fulfilled lives, the importance of having a social network, support from concerned professionals and eventually access to personal assistance was emphasized. The need to have meaningful pursuits of ones own was also described. The median sense of coherence score was 68 (range 53-86). Those who scored high (amp;gt;= 68) described satisfaction with social network, external support provided, work and leisure activities to a greater extent than those who scored low (amp;lt;68). The result shows that the young adults disease has a major impact on the parents lives. Assessment of how the parents comprehend, manage and find meaning in everyday life may highlight support needed to promote their health. (C) 2017 Elsevier B.V. All rights reserved.

  • 2.
    Ahsani Ghahreman, Sarang
    Linköping University, Department of Social and Welfare Studies.
    En del av spelet: En studie av fotbollsdomarnas tillvaro i Gästrikland2008Independent thesis Advanced level (degree of Master (One Year)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    There is a clear difference between the way football players and leaders regard the role of the referee, compared to the way the refereeing body looks at it. The refereeing body regard themselves as fundamental for the existence of the sport, while the other mentioned parties merely see them as functional justice makers. This view places the referees outside the field of football. This establishes a football culture, which is conflicted when it comes to the role of the referees on the field. The conflict comes to its edge in youth football, where the referees are under severe pressure. The only way for the referees to handle this pressure is through experience and respect, which is essential for creation of a well working referring role. Thus, a change in the football culture is necessary in order to include the referees in the football family and change the general conception of the referees’ role and function.

  • 3.
    Ardern, Clare
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. La Trobe Univ, Australia.
    Ekas, Guri Ranum
    Oslo Univ Hosp, Norway; Norwegian Sch Sport Sci, Norway; Univ Oslo, Norway.
    Grindem, Hege
    Norwegian Sch Sport Sci, Norway.
    Moksnes, Havard
    Norwegian Sch Sport Sci, Norway.
    Anderson, Allen
    Tennessee Orthopaed Alliance, TN USA.
    Chotel, Franck
    Hop Femme Mere Enfant, France.
    Cohen, Moises
    Univ Fed Sao Paulo, Brazil.
    Forssblad, Magnus
    Karolinska Inst, Sweden.
    Ganley, Theodore J.
    Childrens Hosp Philadelphia, PA 19104 USA.
    Feller, Julian A.
    Epworth Healthcare, Australia; La Trobe Univ, Australia.
    Karlsson, Jon
    Univ Gothenburg, Sweden.
    Kocher, Mininder S.
    Boston Childrens Hosp, MA USA; Harvard Med Sch, MA USA.
    LaPrade, Robert F.
    Steadman Philippon Res Inst, CO USA; Steadman Clin, CO USA.
    McNamee, Michael
    Swansea Univ, Wales.
    Mandelbaum, Bert
    Santa Monica Orthopaed and Sports Med Grp, CA USA.
    Micheli, Lyle
    Boston Childrens Hosp, MA USA; Harvard Med Sch, MA USA; Micheli Ctr Sports Injury Prevent, MA USA.
    Mohtadi, Nicholas G. H.
    Univ Calgary, Canada.
    Reider, Bruce
    Univ Chicago, IL 60637 USA.
    Roe, Justin P.
    North Sydney Orthopaed and Sports Med Ctr, Australia.
    Seil, Romain
    Ctr Hosp Luxembourg, Luxembourg; Luxembourg Inst Hlth, Luxembourg.
    Siebold, Rainer
    Ruprecht Karls Univ Heidelberg, Germany; ATOS Klin, Germany.
    Silvers-Granelli, Holly J.
    FIFA Med Ctr Excellence, CA USA.
    Soligard, Torbjorn
    Int Olymp Comm, Switzerland; Univ Calgary, Canada.
    Witvrouw, Erik
    Univ Ghent, Belgium.
    Engebretsen, Lars
    Oslo Univ Hosp, Norway; Norwegian Sch Sport Sci, Norway; Univ Oslo, Norway; Int Olymp Comm, Switzerland.
    Prevention, diagnosis and management of paediatric ACL injuries2018In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 52, no 20, p. 1297-1298Article in journal (Other academic)
    Abstract [en]

    n/a

  • 4.
    Ardern, Clare
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Aspetar Orthopaed and Sports Medical Hospital, Qatar; La Trobe University, Australia.
    Glasgow, Philip
    Sport Northern Ireland Sports Institute, North Ireland; University of Ulster, North Ireland.
    Schneiders, Anthony
    Central Queensland University, Australia.
    Witvrouw, Erik
    Aspetar Orthopaed and Sports Medical Hospital, Qatar; University of Ghent, Belgium.
    Clarsen, Benjamin
    Norwegian School Sports Science, Norway; Olymp Elite Sports Program Olympiatoppen, Norway.
    Cools, Ann
    University of Ghent, Belgium.
    Gojanovic, Boris
    Hop La Tour, Switzerland; Lausanne University of and Hospital, Switzerland.
    Griffin, Steffan
    University of Birmingham, England.
    Khan, Karim M.
    University of British Columbia, Canada.
    Moksnes, Havard
    Norwegian School Sports Science, Norway; Olymp Elite Sports Program Olympiatoppen, Norway.
    Mutch, Stephen A.
    SPACE Clin, Scotland; Murrayfield Stadium, Scotland.
    Phillips, Nicola
    Cardiff University, Wales.
    Reurink, Gustaaf
    Sports Phys Grp, Netherlands.
    Sadler, Robin
    Manchester City Football Club, England.
    Gravare Silbernagel, Karin
    University of Delaware, DE USA.
    Thorborg, Kristian
    University of Copenhagen, Denmark.
    Wangensteen, Arnlaug
    Aspetar Orthopaed and Sports Medical Hospital, Qatar; Norwegian School Sports Science, Norway.
    Wilk, Kevin E.
    Champ Sports Med, AL USA.
    Bizzini, Mario
    Schulthess Clin, Switzerland.
    2016 Consensus statement on return to sport from the First World Congress in Sports Physical Therapy, Bern2016In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 50, no 14, p. 853-864Article in journal (Refereed)
    Abstract [en]

    Deciding when to return to sport after injury is complex and multifactorial-an exercise in risk management. Return to sport decisions are made every day by clinicians, athletes and coaches, ideally in a collaborative way. The purpose of this consensus statement was to present and synthesise current evidence to make recommendations for return to sport decision-making, clinical practice and future research directions related to returning athletes to sport. A half day meeting was held in Bern, Switzerland, after the First World Congress in Sports Physical Therapy. 17 expert clinicians participated. 4 main sections were initially agreed upon, then participants elected to join 1 of the 4 groups-each group focused on 1 section of the consensus statement. Participants in each group discussed and summarised the key issues for their section before the 17-member group met again for discussion to reach consensus on the content of the 4 sections. Return to sport is not a decision taken in isolation at the end of the recovery and rehabilitation process. Instead, return to sport should be viewed as a continuum, paralleled with recovery and rehabilitation. Biopsychosocial models may help the clinician make sense of individual factors that may influence the athletes return to sport, and the Strategic Assessment of Risk and Risk Tolerance framework may help decision-makers synthesise information to make an optimal return to sport decision. Research evidence to support return to sport decisions in clinical practice is scarce. Future research should focus on a standardised approach to defining, measuring and reporting return to sport outcomes, and identifying valuable prognostic factors for returning to sport.

  • 5.
    Arundale, Amelia
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Kvist, Joanna
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Hägglund, Martin
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Football Research Group, Linköping University, Linköping, Sweden.
    Fältström, Anne
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Region Jönköping County, Rehabilitation Centre, Ryhov County Hospital, Jönköping, Sweden.
    Jumping performance based on duration of rehabilitation in female football players after anterior cruciate ligament reconstruction2018In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, p. 1-8Article in journal (Refereed)
    Abstract [en]

    Purpose

    To determine if female football players who had longer durations of rehabilitation, measured in months, after anterior cruciate ligament reconstruction would have lower tuck jump scores (fewer technique flaws) and smaller asymmetries during drop vertical jump landing.

    Methods

    One-hundred-and-seventeen female football players, aged 16ᅵ25 years, after primary unilateral ACL reconstruction (median 16 months, range 6ᅵ39) were included. Athletes reported the duration of rehabilitation they performed after anterior cruciate ligament reconstruction. Athletes also performed the tuck jump and drop vertical jump tests. Outcome variables were: tuck jump score, frontal plane knee motion and probability of peak knee abduction moment during drop vertical jump landing.

    Results

    There was no difference in tuck jump score based on duration of rehabilitation (n.s.). No interaction (n.s.), difference between limbs (n.s.), or duration of rehabilitation (n.s.) was found for peak knee abduction moment during drop vertical jump landing. No interaction (n.s.) or difference between limbs (n.s.) was found for frontal plane knee motion, but there was a difference based on duration of rehabilitation (P?=?0.01). Athletes with >?9 months of rehabilitation had more frontal plane knee motion (medial knee displacement) than athletes with <?6 months (P?=?0.01) or 6ᅵ9 months (P?=?0.03).

    Conclusion

    As there was no difference in tuck jump score or peak knee abduction moment based on duration of rehabilitation, the results of this study press upon clinicians the importance of using objective measures to progress rehabilitation and clear athletes for return to sport, rather than time alone.

  • 6.
    Asker, Martin
    et al.
    Karolinska Inst, Sweden; Naprapathogskolan Scandinavian Coll Naprapath Man, Sweden.
    Holm, Lena W.
    Karolinska Inst, Sweden.
    Kallberg, Henrik
    Publ Hlth Agcy Sweden, Sweden.
    Waldén, Markus
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Hassleholm Kristianstad Ystad Hosp, Sweden.
    Skillgate, Eva
    Karolinska Inst, Sweden; Naprapathogskolan Scandinavian Coll Naprapath Man, Sweden.
    Female adolescent elite handball players are more susceptible to shoulder problems than their male counterparts2018In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 26, no 7, p. 1892-1900Article in journal (Refereed)
    Abstract [en]

    Shoulder problems are frequent among senior elite handball players. The objective of this study was to assess the prevalence of shoulder problems among adolescent elite handball players and to investigate potential differences in gender, school grade, playing position and playing level. During the 2014 and 2015 pre-season periods, 471 players (age 15-18 years, 54% female) completed a comprehensive baseline questionnaire regarding history of any shoulder pain and shoulder problems experienced during the past season. The players were monitored weekly for one competition season (September-April) regarding shoulder problems and the amount of match and training. Generalised linear models with a binomial link function were used to calculate a prevalence ratio (PR) with 95% confidence interval (CI) to compare the subgroups of players. In total, 110 players (23%) reported having substantial shoulder problems (defined as moderate/severe reduction in training volume, or moderate/severe reduction in performance, or complete inability to participate) at some point during the follow-up season, of which almost half reported complete inability to participate. Of those players reporting substantial problems, 43% (95% CI 39-48) did so for at least 3 consecutive weeks during the season. The prevalence was significantly higher in female players (PR 1.46, 95% 1.04-2.06) and in backcourt players (PR 1.58, 95% CI 1.08-2.32), but no differences were found for school grade (PR 1.21 95% CI 0.88-1.67) or playing level (PR 1.09 95% CI 0.76-1.56). The prevalence of substantial shoulder problems in adolescent elite handball players is high, especially among females, and this warrants further studies on risk factors for shoulder injury and the development of prevention strategies in handball players already before the age of 15. These findings also highlight the importance of introducing a clinical monitoring programme on a routine basis and improving the medical support, taking gender-related aspects into consideration, at handball-profiled secondary schools. II.

  • 7.
    Asker, Martin
    et al.
    Karolinska Institute, Sweden; Naprapathogskolan Scandinavian Coll Naprapath Man, Sweden.
    Waldén, Markus
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Hässleholm Kristianstad Ystad Hospital, Sweden.
    Kallberg, Henrik
    Karolinska Institute, Sweden; Public Health Agency Sweden, Sweden.
    Holm, Lena W.
    Karolinska Institute, Sweden; University of Toronto, Canada.
    Skillgate, Eva
    Karolinska Institute, Sweden; Naprapathogskolan Scandinavian Coll Naprapath Man, Sweden.
    A prospective cohort study identifying risk factors for shoulder injuries in adolescent elite handball players: the Karolinska Handball Study (KHAST) study protocol2017In: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 18, article id 485Article in journal (Refereed)
    Abstract [en]

    Background: Handball is a physical contact sport that includes frequent overhead throwing, and this combination leads to a high rate of shoulder injuries. Several factors have been associated with shoulder injuries in overhead athletes, but strong scientific evidence is lacking for most suggested risk factors. We therefore designed the Karolinska Handball Study (KHAST) with the aim to identify risk factors for shoulder injuries in adolescent male and female elite handball players studying at handball-profiled secondary schools in Sweden. Secondary objectives are to investigate whether shoulder function changes during the competition season and whether the physical profile of the players changes during their time in secondary school. Methods: Players aged 15 to 19 years were included during the pre-season period of the 2014-2015 and the 2015-2016 seasons. At inclusion, players signed informed consent and filled in a questionnaire regarding playing position, playing level, previous handball experience, history of shoulder problems and athletic identity. Players also completed a detailed test battery at baseline evaluating the shoulder, neck and trunk. Players were then prospectively monitored weekly during the 2014-2015 and/or 2015-2016 competitive seasons regarding injuries and training/match workload. Results from the annual routine physical tests in the secondary school curriculum including bench press, deep squat, hand grip strength, clean lifts, squat jumps, counter movement jumps, amp;lt;30 m sprints, chins, dips and Coopers test will be collected until the end of the competitive season 2017-2018. The primary outcome is the incidence of shoulder injuries and shoulder problems. The secondary outcome is the prevalence of shoulder injuries and shoulder problems. Discussion: Shoulder problems are frequent among handball players and a reduction of these injuries is therefore warranted. However, in order to introduce appropriate preventive measures, a detailed understanding of the underlying risk factors is needed. Our study has a high potential to identify important risk factors for shoulder injuries in adolescent elite handball players owing to a large study sample, a high response rate, data collection during consecutive seasons, and recording of potential confounding factors.

  • 8.
    Bengtsson, Håkan
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Match-related risk factors for injury in male professional football2017Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: Injuries are common in professional football, especially during matches, and they cause suffering for players, in both the short and the long term. It is therefore important to try to prevent these injuries. One of the most important steps in injury prevention is to fully understand the different risk factors that contribute to these injuries.

    Aim: The aim of this thesis was therefore to investigate several match-related factors that have been suggested to be important for the risk of sustaining injuries during professional football matches.

    Methods: The thesis consists of four papers, and all analyses are based on data gathered during a large-scale prospective cohort study that has been running since 2001: the UEFA Elite Club Injury Study. Medical teams from 61 clubs have been involved in this study, and they have prospectively gathered data about football exposure and injuries for their first team players.

    Associations between the following factors and injuries have been analysed: • Match characteristics in terms of match venue, match result, and competition • Match congestion, both short and long term, and at team and individual player level • Number of completed training sessions between return to sport after an injury and the first match exposure

    Results: All match characteristics studied were shown to be associated with injury rates, with higher injury rates during home matches compared with away matches, in matches that were lost or drawn compared with matches won, and in domestic league and Champions League matches compared with Europa League and other cup matches. It was also shown that injury rates, muscle injury rates in particular, were higher if the recovery time between matches was short. This association between match congestion and injury rates was shown when match congestion was considered at both team and individual player level. Finally, the odds of injury during the first match exposure after a period of absence due to injury was found to be higher if players had completed few training sessions between return to sport and their first match.

    Conclusion: There are several match-related risk factors that contribute to the injury rate during professional football matches. A better understanding of these risk factors will help teams to make better estimations of the injury risks to which players are exposed in different situations (e.g. during periods of match congestion and when players return to sport after an injury). Knowledge about risk factors will also offer the possibility of reducing the number of injuries for football teams by addressing them with appropriate measures.

    List of papers
    1. Match Injury Rates in Professional Soccer Vary With Match Result, Match Venue, and Type of Competition
    Open this publication in new window or tab >>Match Injury Rates in Professional Soccer Vary With Match Result, Match Venue, and Type of Competition
    2013 (English)In: American Journal of Sports Medicine, ISSN 0363-5465, E-ISSN 1552-3365, Vol. 41, no 7, p. 1505-1510Article in journal (Refereed) Published
    Abstract [en]

    Background: Player activities in soccer matches are influenced by the match result and match venue. It is not known whether injury rates are influenced by these factors. Purpose: To investigate whether there are associations between injury rates and the match result, venue, and type of competition in male soccer. Study Design: Cohort study; Level of evidence, 3. Methods: Twenty-six professional clubs from 10 countries were followed prospectively during 9 seasons (2001-2002 to 2009-2010). All matches, and injuries occurring in these matches, were registered by the teams medical staff. An injury was registered if it resulted in player absence from training or matches. Information about match result, venue, and type of competition for all reported matches was gathered by the authors from online databases. Injury rates in matches with varying match characteristics were compared by use of generalized estimating equations. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Results: A total of 2738 injuries during 6010 matches were registered. There were no associations between odds of 1 injury occurrence and match result or type of competition, whereas the odds were decreased in matches played away compared with home matches (OR, 0.89; 95% CI, 0.80-0.99). The odds of 2 or more injury occurrences in a match were increased in matches resulting in a draw (OR, 1.39; 95% CI, 1.15-1.69) or loss (OR, 1.66; 95% CI, 1.38-1.98) compared with matches won and were decreased in other cup matches compared with league matches (OR, 0.57; 95% CI, 0.39-0.84) and in matches played away compared with home matches (OR, 0.70; 95% CI, 0.60-0.82). Finally, injuries with more than 1 weeks absence occurred more frequently in Champions League matches compared with league matches both for matches with 1 injury (OR, 1.26; 95% CI, 1.09-1.45) and matches with 2 or more injuries (OR, 1.57; 95% CI, 1.13-2.20). Conclusion: The odds of 2 or more injury occurrences in professional soccer were higher in matches resulting in a loss or a draw compared with a win, whereas the odds of injury occurrences were lower in matches played away compared with home matches. The rate of moderate and severe injuries increased with the importance of the match.

    Place, publisher, year, edition, pages
    SAGE Publications (UK and US): No SAGE Choice, 2013
    Keywords
    athletic injuries; competition; football; performance; risk factors
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-105047 (URN)10.1177/0363546513486769 (DOI)000330524000011 ()
    Available from: 2014-03-06 Created: 2014-03-06 Last updated: 2017-12-05
    2. Muscle injury rates in professional football increase with fixture congestion: an 11-year follow-up of the UEFA Champions League injury study
    Open this publication in new window or tab >>Muscle injury rates in professional football increase with fixture congestion: an 11-year follow-up of the UEFA Champions League injury study
    2013 (English)In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 47, no 12, p. 743-747Article in journal (Refereed) Published
    Abstract [en]

    Background The influence of fixture congestion on injury rates and team performance has only been scarcely investigated.

    Aim To study associations between recovery time and match load and injury rates and team performance in professional football.

    Methods Exposure and time loss injuries were registered prospectively from 27 teams over 11 seasons. Matches were grouped according to recovery days before each match (≤3 vs >3 days, and ≤4 vs ≥6 days). Injury rates and team performance were compared between groups. Match load in match sequences containing five consecutive matches was determined by the number of days separating the first match and the last training session during that match sequence. Linear regression was used to study associations between match load and injury rates and team performance.

    Results Team performance showed no association with match load, or recovery days prior to matches, except for Europa League matches that indicated more matches lost with short recovery (≤3 days) (p=0.048). Total injury rates and muscle injury rates were increased in league matches with ≤4 days compared with ≥6 days’ recovery (RR 1.09, 95% CI 1.00 to 1.18, and RR 1.32, 95% CI 1.15 to 1.51, respectively), specifically hamstring and quadriceps injuries. High match load was associated with increase in muscle injury rate in matches in the same match sequence (p=0.012), and increase in ligament injury rate in training in the subsequent match sequence (p=0.003).

    Conclusions Fixture congestion was associated with increased muscle injury rates but had no, or very limited, influence on team performance.

    Place, publisher, year, edition, pages
    BMJ Publishing Group, 2013
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-97448 (URN)10.1136/bjsports-2013-092383 (DOI)000322868800008 ()23851296 (PubMedID)
    Note

    Funding Agencies|Union of European Football Associations (UEFA)||Swedish National Centre for Research in Sports, and Praktikertjanst AB||

    Available from: 2013-09-12 Created: 2013-09-12 Last updated: 2017-12-06Bibliographically approved
  • 9.
    Bengtsson, Håkan
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Ekstrand, Jan
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Waldén, Markus
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Hägglund, Martin
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Muscle injury rate in professional football is higher in matches played within 5 days since the previous match: a 14-year prospective study with more than 130 000 match observations2018In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 52, no 17, p. 1116-1122Article in journal (Refereed)
    Abstract [en]

    Background The association between match congestion and injury rates in professional football has yielded conflicting results. Aim To analyse associations between match congestion on an individual player level and injury rates during professional football matches. Methods Data from a prospective cohort study of professional football with 133 170 match observations were analysed with Poisson regressions. Associations between short-term match congestion, defined as number of days between two match exposures (3, 4, 5, 6 and 7-10 days) and injury rates were analysed. To analyse the influence of long-term match congestion, defined as individual match exposure hours in the 30 days preceding a match, observations were categorised into three groups (low, 4.5; medium, amp;gt;4.5to 7.5; and high, amp;gt;7.5hours). Results No differences in total match injury rates were found between the reference category (3 days) and the other categories of short-term congestion. Muscle injury rates were significantly lower in matches preceded by 6 (rate ratio (RR) 0.79; 95%CI 0.65 to 0.95) or 7-10 days (RR 0.81; 95%CI 0.71 to 0.93) compared with 3 days since the last match exposure. No differences in total and muscle injury rates between the three long-term match congestion groups were found. Conclusions In this study of male professional football players, there were no match congestion-related differences in total match injury rates, but muscle injury rates during matches were lower when players were given at least 6days between their match exposures.

  • 10.
    Bertills, Karin
    et al.
    Jonkoping Univ, Sweden.
    Granlund, Mats
    Jonkoping Univ, Sweden.
    Dahlström, Örjan
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences. Linköping University, The Swedish Institute for Disability Research.
    Augustine, Lilly
    Kristianstad Univ, Sweden.
    Relationships between physical education (PE) teaching and student self-efficacy, aptitude to participate in PE and functional skills: with a special focus on students with disabilities2018In: Physical Education and Sport Pedagogy, ISSN 1740-8989, E-ISSN 1742-5786, Vol. 23, no 4, p. 387-401Article in journal (Refereed)
    Abstract [en]

    Background: Students with disability show an increasing incidence of school failure. Quality teaching and appropriate support may foster high self-efficacy, a predictive factor for successful school outcomes. Physical Education (PE) can provide students with a context in which self-efficacy and participation are promoted leading to improved academic achievement. The transition into secondary school can be challenging for many students with increased educational demands, developmental changes and individual social identification coinciding. A disability may add to the challenge of success.Methods: Three groups of students, aged 13 years and enrolled in Swedish mainstream schools were targeted (n=439). Groups included students with 1.A diagnosed disability, 2.Low grades in PE (D-F) and 3.High grades (A-C) in PE. Questionnaires were collected and analyzed from 30/439 students with a diagnosed disability (physical, neuro-developmental and intellectual) from 26 classes, their classmates and their PE-teachers (n=25). Relationships between student self-reports and PE-teachers self-ratings were investigated. Also examined was the potential to which students functional skills could predict elevated general school self-efficacy, PE specific self-efficacy and aptitude to participate in PE. Results were compared with the total sample and between the three target groups (n=121).Results: For students with disabilities, better self-rated teaching skills were related to lower student perceived general school self-efficacy, PE specific self-efficacy and aptitude to participate in PE. The impact of classroom climate in PE was more obvious among students with disabilities. Perceived functional skills were associated with elevated general school self-efficacy, PE specific self-efficacy and aptitude to participate in PE. Better socio-cognitive functional skills had an overall positive effect on all outcomes. Students with disabilities reported results similar to the total sample, the D-F group scored lower and the A-C group higher than the total sample and the disability group. Elevated self-efficacy in PE is six times less probable in students with disabilities, compared to the A-C group.Conclusions: Our findings that better teacher planning and grading skills, are detrimental to students disadvantaged by disability is contradictive. Improving the establishment and communication of adapted learning standards at the transition to secondary school is a crucial and a predictive factor for promoting positive school experiences for students with disability. Students with disabilities need to be assured that the intended learning outcomes can be reached by doing activities differently than their typically functioning peers. Consideration of class composition is suggested as a means of promoting a positive learning climate, which would particularly benefit students with disabilities. Allocation of resources to support student socio-cognitive skills would improve experiences for the D-F group and likely promote a positive learning environment.

  • 11.
    Bjarnegård, Niclas
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Reg Jonkoping Cty, Sweden.
    Länne, Toste
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Cinthio, M.
    Lund Univ, Sweden.
    Ekstrand, Jan
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Hedman, Kristofer
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Clinical Physiology in Linköping.
    Nylander, Eva
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Clinical Physiology in Linköping.
    Henriksson, J.
    Karolinska Inst, Sweden.
    Vascular characteristics in young women: Effect of extensive endurance training or a sedentary lifestyle2018In: Acta Physiologica, ISSN 1748-1708, E-ISSN 1748-1716, Vol. 223, no 2, article id UNSP e13041Article in journal (Refereed)
    Abstract [en]

    AimTo explore whether high-level endurance training in early age has an influence on the arterial wall properties in young women. MethodsForty-seven athletes (ATH) and 52 controls (CTR), all 17-25 years of age, were further divided into runners (RUN), whole-body endurance athletes (WBA), sedentary controls (SC) and normally active controls (AC). Two-dimensional ultrasound scanning of the carotid arteries was conducted to determine local common carotid artery (CCA) geometry and wall distensibility. Pulse waves were recorded with a tonometer to determine regional pulse wave velocity (PWV) and pulse pressure waveform. ResultsCarotid-radial PWV was lower in WBA than in RUN (P amp;lt; .05), indicating higher arterial distensibility along the arm. Mean arterial pressure was lower in ATH than in CTR and in RUN than in WBA (P amp;lt; .05). Synthesized aortic augmentation index (AI@75) was lower among ATH than among CTR (-12.8 1.6 vs -2.6 +/- 1.2%, P amp;lt; .001) and in WBA than in RUN (-16.4 +/- 2.5 vs -10.7 +/- 2.0%, P amp;lt; .05), suggesting a diminished return of reflection waves to the aorta during systole. Carotid-femoral PWV and intima-media thickness (IMT), lumen diameter and radial distensibility of the CCA were similar in ATH and CTR. ConclusionElastic artery distensibility and carotid artery IMT are not different in young women with extensive endurance training over several years and in those with sedentary lifestyle. On the other hand, our data suggest that long-term endurance training is associated with potentially favourable peripheral artery adaptation, especially in sports where upper body work is added. This adaptation, if persisting later in life, could contribute to lower cardiovascular risk.

    The full text will be freely available from 2019-01-22 16:37
  • 12.
    Bjorneboe, John
    et al.
    Norwegian School Sport Science, Norway.
    Kristensson, Karolina
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Waldén, Markus
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Bengtsson, Håkan
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Ekstrand, Jan
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Hägglund, Martin
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Ronsen, Ola
    Aker Solut, Norway.
    Einar Andersen, Thor
    Norwegian School Sport Science, Norway.
    Role of illness in male professional football: not a major contributor to time loss2016In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 50, no 11, p. 699-702Article in journal (Refereed)
    Abstract [en]

    Background There are limited data on the nature, type and incidence of illness in football. Previous studies indicate that gastrointestinal and respiratory tract illnesses are most common. Aim To describe the incidence and burden of illness in male professional football. Methods Over the 4-year study period, 2011-2014, 73 professional football teams in Europe participated, with a total of 1 261 367 player-days recorded. All time-loss illnesses were recorded by the medical staff of each club. A recordable illness episode was any physical or psychological symptom (not related to injury) that resulted in the player being unable to participate fully in training or match play. Results A total of 1914 illness episodes were recorded. The illness incidence was 1.5 per 1000 player-days, meaning that, on average, a player experienced an illness episode every second season, with a median of 3 days absence per illness episode. Severe illness (absence amp;gt;4 weeks) constituted 2% of all illnesses. Respiratory tract illness was the most common (58%), followed by gastrointestinal illness (38%). Respiratory tract illness, gastrointestinal illness and cardiovascular illness caused the highest illness burden. Conclusions The illness incidence among male professional football players is low compared with the injury incidence. We found that the highest illness burden was caused by illness to the respiratory tract, gastrointestinal tract and cardiovascular system.

  • 13.
    Borjesson, Marcus
    et al.
    Swedish Def Univ, Sweden; Karlstad Univ, Sweden.
    Lundqvist, Carolina
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Gustafsson, Henrik
    Karlstad Univ, Sweden; Karlstad Univ, Sweden; Norwegian Sch Sport Sci, Norway.
    Davis, Paul
    Umea Univ, Sweden.
    Flotation REST as a Stress Reduction Method: The Effects on Anxiety, Muscle Tension, and Performance2018In: JOURNAL OF CLINICAL SPORT PSYCHOLOGY, ISSN 1932-9261, Vol. 12, no 3, p. 333-346Article in journal (Refereed)
    Abstract [en]

    The purpose of the study was to investigate the influence of flotation REST upon skilled and less skilled golfers anxiety in terms of physiological indicators of stress, self-rated anxiety scores, muscle tension, and the effect on golf putting. Prior to performing the putting task participants underwent a treatment of flotation REST or a period of resting in an armchair. Participants completed both treatments in a randomized order with a two-week interval. The results showed that both flotation REST and the armchair treatment reduced systolic blood pressure and heart rate, with no differences between treatments or athlete skill levels. No significant differences between treatments were revealed regarding self-ratings, level of muscle tension or putting precision. The results indicate that flotation REST may be useful for reducing negative symptoms related to stress and anxiety in general; however, no support for direct positive effects on golf performance were found.

  • 14.
    Boström, A.
    et al.
    Linköping University, Department of Clinical and Experimental Medicine. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping. Linköping University, Faculty of Medicine and Health Sciences.
    Thulin, K.
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Norrköping.
    Fredriksson, M.
    Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science.
    Reese, D.
    IFK Norrköping, Norrköping, Sweden.
    Rockborn, Peter
    Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Norrköping. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences.
    Hammar, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Risk factors for acute and overuse sport injuries in Swedish children 11 to 15 years old: What about resistance training with weights?2016In: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 26, no 3, p. 317-323Article in journal (Refereed)
    Abstract [en]

    To determine the 1-year self-reported incidence of overuse and traumatic sport injuries and risk factors for injuries in children participating in a summer sports camp representing seven different sports. 4363 children, 11 to 15 years old participating in a summer camp in seven different sports answered a questionnaire. Injury in this cross-sectional study was defined as a sport-related trauma or overload leading to pain and dysfunction preventing the person from participation in training or competition for at least 1 week. A number of risk factors for injury were investigated such as sex, age, number of hours spent on training in general, and on resistance training with weights. Nearly half [49%, 95% confidence interval (CI) 48–51%] of the participants had been injured as a result of participation in a sport during the preceding year, significantly more boys than girls (53%, 95% CI 50–55% vs 46%, 95% CI 43–48%; P < 0.001). Three factors contributed to increased incidence of sport injuries: age, sex, and resistance training with weights. Time spent on resistance training with weights was significantly associated with sport injuries in a logistic regression analysis. In children age 11 to 15 years, the risk of having a sport-related injury increased with age and occurred more often in boys than in girls. Weight training was the only modifiable risk factor that contributed to a significant increase in the incidence of sport injuries.

  • 15.
    Cardell, David
    Linköping University, Department of Thematic Studies, Department of Child Studies. Linköping University, Faculty of Arts and Sciences.
    Underhållningsidrott som upplevelseindustri: Review of Hans Lundberg (2009) Kommunikativt entreprenörskap [diss.]2010In: Idrottsforum.org/Nordic sport science forum, ISSN 1652-7224Article, book review (Other academic)
    Abstract [sv]

    Utvecklingen av idrotten – ursprungligen den obefläckade kampen mellan vackra nakna grekiska ynglingar, överflyttad till engelska public school-gräsmattor med på- och välklädda, och inte alltid så vackra överklassynglingar, i något skede som folklig kultur med brödrafolksambitioner, till dagens underhållningsidrott med ekonomiska snarare än ädla motiv – har beskrivits i många texter av skilda slag, inklusive avhandlingar. Det har stundtals klagats på en alltför deterministisk hållning inför utvecklingen, som vore den obehindrad, okontrollerbar, oförklarlig – och värst av allt, inte i behov av förklaring. Inte sällan tar studier avstamp i fait accompli som utvecklingens krona, snapshots från en ny tid. Men även i snävt avgränsade tidsrymder kan skeenden fångas, vilket Hans Lundberg, gammal forumrecensent och nybliven ekonomie doktor visar i sin avhandling Kommunikativt entreprenörskap: Underhållningsidrott som totalupplevelse före, under och efter formeringen av den svenska upplevelseindustrin 1999–2008 (Växjö University Press). Vi bad en annan forumrecensent, tillika nybliven idrottsvetenskaplig licentiat, David Cardell om en recension av Lundbergs idé- och empiritäta bok. Sin recension, som på ett närmast impressionistiskt sätt fångar avhandlingen essenser i smått och stort, avslutar Cardell med reflektionen att textens ställvisa svårgenomtränglighet till trots är Lundbergs dióktorsopus läsvärt för alla som uppmärksammat och häpnat inför idrottens senmoderna utveckling, och kanske än mer angelägen för den som inte ens noterat denna utveckling.

  • 16.
    Carlén, Anna
    et al.
    Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Clinical Physiology in Linköping. Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine.
    Åström Aneq, Meriam
    Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Clinical Physiology in Linköping. Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine.
    Nylander, Eva
    Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Clinical Physiology in Linköping. Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine.
    Gustafsson, Mikael
    Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping. Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine.
    Loaded treadmill walking and cycle ergometry to assess work capacity: a retrospective comparison in 424 firefighters.2017In: Clinical Physiology and Functional Imaging, ISSN 1475-0961, E-ISSN 1475-097X, Vol. 37, no 1, p. 37-44Article in journal (Refereed)
    Abstract [en]

    The fitness of firefighters is regularly evaluated using exercise tests. We aimed to compare, with respect to age and body composition, two test modalities for the assessment work capacity. A total of 424 Swedish firefighters with cycle ergometer (CE) and treadmill (TM) tests available from Jan 2004 to Dec 2010 were included. We compared results from CE (6 min at 200 W, 250 W or incremental ramp exercise) with TM (6 min at 8° inclination, 4·5 km h(-1) or faster, wearing 24-kg protective equipment). Oxygen requirements were estimated by prediction equations. It was more common to pass the TM test and fail the supposedly equivalent CE test (20%), than vice versa (0·5%), P<0·001. Low age and tall stature were significant predictors of passing both CE and TM tests (P<0·05), while low body mass predicted accomplishment of TM test only (P = 0·006). Firefighters who passed the TM but failed the supposedly equivalent CE test within 12 months had significantly lower body mass, lower BMI, lower BSA and shorter stature than did those who passed both tests. Calculated oxygen uptake was higher in TM tests compared with corresponding CE tests (P<0·001). Body constitution affected approval differently depending on the test modality. A higher approval rate in TM testing suggests lower cardiorespiratory requirements compared with CE testing, even though estimated oxygen uptake was higher during TM testing. The relevance of our findings in relation to the occupational demands needs reconsidering.

  • 17.
    Carter, Josh
    et al.
    Bond Institute of Health and Sport, Faculty of Health Science and Medicine, Bond University, Australia.
    Marshall, Nick
    Surflife Physio, Miami, Australia.
    Abbott, Allan
    Bond Institute of Health and Sport, Faculty of Health Science and Medicine, Bond University, Australia / Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden / Department of Physiotherapy, Karolinska University Hospital, Sweden.
    Shoulder Pain and Dysfunction in Young Surf Lifesavers2015In: Physical Therapy in Sport, ISSN 1466-853X, E-ISSN 1873-1600, Vol. 16, no 2, p. 162-168Article in journal (Refereed)
    Abstract [en]

    Objectives

    To determine the incidence and prevalence of significantly interrupting shoulder pain (SIP) in young surf lifesavers and to determine association with training dosage and the ‘combined elevation test’.

    Participants

    54 surf lifesavers aged 10 – 18 from the Gold Coast, Australia.

    Methods and Outcome Measures

    Retrospective survey of SIP and training dosage. Cross-sectional measures of the combined elevation test.

    Design

    Retrospective.

    Results

    56.5% of female surf lifesavers reported a history of SIP compared to males with 48.5%. Females had a higher combined elevation score compared to males, 28.32±SD8.52cm and 26.09±SD6.64cm, respectively. Young surf lifesavers had an incidence rate of 2.1 SIP episodes per thousand hours of training, an incidence proportion of 51.9% and prevalence of 18.5%. Combined elevation had low level positive trends with training dosages and statistically significant negative correlation with board paddling sessions per week (r= -0.287, p=<0.05). Those with a history of SIP had a statistically significant higher number of sessions (p=0.008), duration (p=0.015) and distance (p=0.005) swimming per week.

    Conclusion

    Young surf lifesavers with a history of SIP have greater swimming dosage not associated with decrease in combined elevation score. More board paddling sessions per week decreased the combined elevation score of young surf lifesavers.

  • 18.
    Dahlström, Örjan
    Linköping University, The Swedish Institute for Disability Research. Linköping University, Department of Behavioural Sciences and Learning, Disability Research.
    Community-based Football – A safe health intervention?2011Conference paper (Refereed)
  • 19.
    Dinis, Paulo
    et al.
    Ctr Hosp and Univ Coimbra, Portugal; Ctr Saude Mil Coimbra, Portugal.
    Teixeira, Rogerio
    Ctr Hosp and Univ Coimbra, Portugal; Univ Coimbra, Portugal.
    Dores, Helder
    Hosp Forcas Armadas, Portugal.
    Correia, Pedro
    Ctr Hosp and Univ Coimbra, Portugal; Ctr Saude Mil Coimbra, Portugal.
    Lekedal, Hanna
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Bergman, Malin
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Cachulo, Maria Carmo
    Ctr Hosp and Univ Coimbra, Portugal.
    Cardoso, Joaquim
    Ctr Saude Mil Coimbra, Portugal.
    Goncalves, Lino
    Ctr Hosp and Univ Coimbra, Portugal.
    Exercise-induced cardiac remodeling in athletes and in special forces soldiers2018In: REVISTA PORTUGUESA DE CARDIOLOGIA, ISSN 0870-2551, Vol. 37, no 3, p. 249-256Article in journal (Refereed)
    Abstract [en]

    Introduction: Exercise-induced cardiac remodeling is frequent in athletes. This adaptation is structurally manifested by an increase in cardiac dimensions and mass. Soldiers are also subject to intense physical exercise, although with different characteristics. Objective: To compare exercise-induced cardiac remodeling in competitive athletes and in soldiers on a special forces training course. Methods: We studied 17 soldiers (all male and Caucasian, mean age 21 3 years) who completed a special forces course and 17 basketball players (47.3% male, 64.7% Caucasian, mean age 21 +/- 3 years). Assessment included a transthoracic echocardiogram and analysis of myocardial mechanics. This assessment was performed at the beginning and end of the military course and the sports season, respectively. Results: Cardiac remodeling was observed in both groups. The soldiers presented a predominantly eccentric pattern, with increased left ventricular (LV) size (49.7 +/- 3.2 vs. 52.8 +/- 3.4 mm; p amp;lt; 0.01), increased LV mass (93.1 +/- 7.7 vs. 100.2 +/- 11.4 g/m2; p amp;lt; 0.01) and decreased relative wall thickness (0.40 +/- 0.1 vs. 0.36 +/- 0.1; p = 0.05). The basketball players showed a concentric pattern, with decreased LV size (52.0 +/- 4.7 vs. 50.4 +/- 4.7 mm; p = 0.05), and increased relative wall thickness (0.33 +/- 0.1 vs. 0.36 +/- 0.1; p = 0.05). Although there was no significant difference in LV myocardial strain in the groups separately, when compared there was a significant decrease (-20.2 +/- 1.6% vs. -19.4 +/- 2.1%; p = 0.03). Conclusion: Cardiac remodeling was frequent, with an eccentric pattern in soldiers and a concentric pattern in basketball players. Myocardial deformation may represent a physiological adaptation to physical exercise. (C) 2017 Sociedade Portuguesa de Cardiologia. Published by Elsevier Espana, S.L.U. All rights reserved.

  • 20.
    Ekstrand, Jan
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Lee, Justin C.
    University of London Imperial Coll Science Technology and Med, England.
    Healy, Jeremiah C.
    University of London Imperial Coll Science Technology and Med, England.
    MRI findings and return to play in football: a prospective analysis of 255 hamstring injuries in the UEFA Elite Club Injury Study2016In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 50, no 12, p. 738-743Article in journal (Refereed)
    Abstract [en]

    Aim The present study evaluated whether the MRI parameters of hamstring injuries in male professional football players correlate with time to return to play (RTP). Methods 46 elite European football teams were followed prospectively for hamstring injuries between 2007 and 2014. Club medical staff recorded individual player exposure and time-loss after hamstring injury. MRI parameters were evaluated by two independent radiologists and correlated with the RTP data. Results A total of 255 grade 1 and 2 injuries were evaluated in this study. RTP was longer for grade 2 than grade 1 injuries (24 +/- 13, 95% CI 21 to 26 days vs 18 +/- 15, 95% CI 16 to 20 days; mean difference: 6, 95% CI 2 to 9 days, p=0.004, d=0.39). 84% of injuries affected the biceps femoris (BF) muscle, whereas 12% and 4% affected the semimembranosus (SM) and semitendinosus (ST), respectively. No difference in lay-off time was found for injuries to the three different muscles (BF 20 +/- 15 days, SM 18 +/- 11 days, ST 23 +/- 14 days; p=0.83). The recurrence rate was higher for BF injuries than for SM and ST injuries combined (18% vs 2%, p=0.009). The size of the oedema weakly correlated with time to RTP (r(2)=6-12%). No correlation was found between location of injury and time to RTP. The majority of the intramuscular injuries affected the MT junction (56% in grade 1 and 2 injuries), but no difference in lay-off time was found between the different types of injuries. Conclusions The radiological grade and size of the oedema correlate with time to RTP for both, grade 1 and 2 injuries. No correlations were found between time to RTP and the location and type of injury.

  • 21.
    Ekstrand, Jan
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Lundqvist, Daniel
    Linköping University, Department of Behavioural Sciences and Learning, Education and Sociology. Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Lagerbäck, Lars
    Linköping University.
    Vouillamoz, Marc
    UEFA, Switzerland.
    Papadimitiou, Niki
    UEFA, Switzerland.
    Karlsson, Jon
    Linköping University. Gothenburg University, Gothenburg, Sweden.
    Is there a correlation between coaches leadership styles and injuries in elite football teams?: A study of 36 elite teams in 17 countries2018In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 52, no 8, p. 527-531Article in journal (Refereed)
    Abstract [en]

    Background Do coaches’ leadership styles affect injury rates and the availability of players in professional football? Certain types of leadership behaviour may cause stress and have a negative impact on players’ health and well-being.

    Aim To investigate the transformational leadership styles of head coaches in elite men’s football and to evaluate the correlation between leadership styles, injury rates and players’ availability.

    Methods Medical staff from 36 elite football clubs in 17 European countries produced 77 reports at four postseason meetings with a view to assessing their perception of the type of leadership exhibited by the head coaches of their respective teams using the Global Transformational Leadership scale. At the same time, they also recorded details of individual players’ exposure to football and time-loss injuries.

    Results There was a negative correlation between the overall level of transformational leadership and the incidence of severe injuries (rho=−0.248; n=77; p=0.030); high levels of transformational leadership were associated with smaller numbers of severe injuries. Global Transformational Leadership only explained 6% of variation in the incidence of severe injuries (r2=0.062). The incidence of severe injuries was lower at clubs where coaches communicated a clear and positive vision, supported staff members and gave players encouragement and recognition. Players’ attendance rates at training were higher in teams where coaches gave encouragement and recognition to staff members, encouraged innovative thinking, fostered trust and cooperation and acted as role models.

    Conclusions There is an association between injury rates and players’ availability and the leadership style of the head coach.

  • 22.
    Ekstrand, Jan
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. UEFA Medical Comm, Switzerland.
    Waldén, Markus
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Hägglund, Martin
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Hamstring injuries have increased by 4% annually in mens professional football, since 2001: a 13-year longitudinal analysis of the UEFA Elite Club injury study2016In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 50, no 12, p. 731-737Article in journal (Refereed)
    Abstract [en]

    Background There are limited data on hamstring injury rates over time in football. Aim To analyse time trends in hamstring injury rates in male professional footballers over 13 consecutive seasons and to distinguish the relative contribution of training and match injuries. Methods 36 clubs from 12 European countries were followed between 2001 and 2014. Team medical staff recorded individual player exposure and time-loss injuries. Injuries per 1000 h were compared as a rate ratio (RR) with 95% CI. Injury burden was the number of lay off days per 1000 h. Seasonal trend for injury was analysed using linear regression. Results A total of 1614 hamstring injuries were recorded; 22% of players sustained at least one hamstring injury during a season. The overall hamstring injury rate over the 13-year period was 1.20 injuries per 1000 h; the match injury rate (4.77) being 9 times higher than the training injury rate (0.51; RR 9.4; 95% CI 8.5 to 10.4). The time-trend analysis showed an annual average 2.3% year on year increase in the total hamstring injury rate over the 13-year period (R-2=0.431, b=0.023, 95% CI 0.006 to 0.041, p=0.015). This increase over time was most pronounced for training injuries-these increased by 4.0% per year (R-2=0.450, b=0.040, 95% CI 0.011 to 0.070, p=0.012). The average hamstring injury burden was 19.7 days per 1000 h (annual average increase 4.1%) (R-2=0.437, b=0.041, 95% CI 0.010 to 0.072, p=0.014). Conclusions Training-related hamstring injury rates have increased substantially since 2001 but match-related injury rates have remained stable. The challenge is for clubs to reduce training-related hamstring injury rates without impairing match performance.

  • 23.
    Fagher, Kristina
    et al.
    Department of Health Sciences, Lund University, Sweden.
    Forsberg, Anna
    Department of Health Sciences, Lund University, Sweden, Skåne University Hospital, Lund, Sweden.
    Jacobsson, Jenny
    Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Athletics Research Center, Linköping University, Sweden.
    Timpka, Toomas
    Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Health and Developmental Care, Center for Public Health. Linköping University, Department of Medical and Health Sciences, Division of Community Medicine.
    Dahlström, Örjan
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, The Swedish Institute for Disability Research. Linköping University, Faculty of Arts and Sciences. Athletics Research Center, Linköping University, Sweden.
    Lexell, Jan
    Department of Health Sciences, Lund University, Sweden, Skåne University Hospital, Lund, Sweden.
    Paralympic athletes’ perceptions of their experiences of sports-related injuries, risk factors and preventive possibilities2016In: European Journal of Sport Science, ISSN 1746-1391, E-ISSN 1536-7290, Vol. 22, no 8, p. 1240-1249Article in journal (Refereed)
    Abstract [en]

    Our knowledge of sports-related injuries in para-sport is limited and there are no data on how Paralympic athletes themselves perceive an injury. The aim of this qualitative study was to explore Paralympic athletes' perceptions of their experiences of sports-related injuries, risk factors and preventive possibilities. Eighteen Swedish Paralympic athletes with vision impairment, intellectual impairment, spinal cord injury, cerebral palsy, myelomeningocele, dysplasia and neuromuscular disorder, representing 10 different para-sports, were interviewed. The qualitative phenomenographic method was used to interpret the data. The analysis revealed nine categories of perceptions of experiences. The athletes perceived that their impairments were involved in the cause and consequential chains associated with a sports-related injury. Other categories that denoted and described these injuries were: sport overuse, risk behaviour, functional limitations, psychological stressors, the normalised pain, health hazards, individual possibilities to prevent sports-related injuries and unequal prerequisites. This qualitative study revealed that Paralympic athletes' perceptions of their experiences of sports-related injuries are complex and multifactorial, and in several ways differ from able-bodied athletes. This needs to be considered in the sports health and safety work within the Paralympic Movement as well as in the design of future injury surveillance systems and preventive programmes

  • 24.
    Fagher, Kristina
    et al.
    Department of Health Sciences, Lund University, Sweden.
    Jacobsson, Jenny
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Timpka, Toomas
    Region Östergötland, Center for Health and Developmental Care, Center for Public Health. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Medical and Health Sciences, Division of Community Medicine.
    Dahlström, Örjan
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, The Swedish Institute for Disability Research. Linköping University, Faculty of Arts and Sciences. Athletics Research Center, Linköping University, Sweden.
    Lexell, Jan
    Department of Health Sciences, Lund University, Sweden; Skåne University Hospital, Lund, Sweden.
    The sports-related injuries and illnesses in paralympic sport study (SRIIPSS): a study protocol for a prospective longitudinal study2016In: BMC Sports Science, Medicine and Rehabilitation, ISSN 2052-1847, Vol. 8, no 1, article id 28Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Paralympic sport provides sporting opportunities for athletes with a disability, with the Paralympic Games as the main event. Participation in sport is, however, associated with a significant risk for sustaining injuries and illnesses. Our knowledge of sports-related injuries and illnesses in Paralympic sport is very limited and there are no large-scale epidemiological cohort studies. The purpose here is to present a protocol for a prospective longitudinal study: The Sports-Related Injuries and Illnesses in Paralympic Sport Study (SRIIPSS).

    METHODS/DESIGN:

    An argument-based method for investigation of design problems was used to structure the study protocol. The primary requirement of the protocol is to allow prospective studies over time and include exposure to both training and competition. To reflect the complexity of Paralympic sport with athletes' pre-existing impairments, use of assistive equipment, pain and other and medical issues, it is required that the data collection system is specifically adapted to Paralympic sport. To allow the collection of data, at the same time as there is limited access to coaches and medical personnel, it is advantageous that data can be collected online directly from the athletes. Based on this a self-report athlete monitoring system will be developed, where the athletes can enter data weekly via their mobile phones or lap-tops. Data will be collected from around 100 Swedish Paralympic athletes for approximately 1 year, which will allow us to i) prospectively estimate the annual incidence of sports-related injuries and illnesses and ii) explore risk factors and mechanisms for sustaining sports-related injuries and illnesses based on athlete exposure and training loads.

    DISCUSSION:

    For effective implementation of injury and illness prevention measures, comprehensive epidemiological knowledge is required. This study will be the first prospective longitudinal self-report study of sports-related injuries and illnesses in Paralympic sport over a longer period of time. The results will eventually contribute to the development of evidence-based preventive measures specifically adapted to Paralympic sport in order to provide safe and healthy sport participation. Thereby, the project will be of relevance for Paralympic athletes at all levels and to the Paralympic Movement.

  • 25.
    Furness, James
    et al.
    Bond University, Gold Coast, Queensland, Australia.
    Hing, Wanyne A.
    Bond University, Gold Coast, Queensland, Australia.
    Abbott, Allan
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences. Bond University, Gold Coast, Queensland, Australia.
    Walsh, Joe
    Bond University, Gold Coast, Queensland, Australia.
    Sheppard, Jeremy M.
    Hurley Surfing Australia High Performance Centre.
    Climstein, Mike
    Retrospective analysis of chronic injuries in recreational and competitive surfers: injury, location, type and mechanism2014In: International Journal of Aquatic Research and Education, ISSN 1932-9997, E-ISSN 1932-9253, Vol. 8, no 3, p. 277-287Article in journal (Refereed)
    Abstract [en]

    Only two studies have reported on chronic musculoskeletal surfing injuries. They found over half of the injuries were non-musculoskeletal, but did not consider mechanisms of injury. This study identified the location, type, and mechanisms of chronic injury in Australian recreational and competitive surfers using a cross-sectional retrospective observational design. A total of 1,348 participants (91.3% males, 43.1% competitive surfers) reported 1,068 chronic injuries, 883 of which were classified as major. Lower back (23.2%), shoulder (22.4%), and knee (12.1%) regions had the most chronic injuries. Competitive surfers had significantly (p < .05) more lower back, ankle/foot, and head/face injuries than recreational surfers. Injuries were mostly musculoskeletal with only 7.8% being of non-musculoskeletal origin. Prolonged paddling was the highest frequency (21.1%) for mechanism of injury followed by turning maneuvers (14.8%). The study results contribute to the limited research on chronic surfing injuries.

  • 26.
    Fältström, Anne
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Region Jönköping County, Rehabilitation Centre, Ryhov County Hospital, Jönköping, Sweden.
    One ACL injury is enough! Focus on female football players: PhD Academy Award2017In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 51, no 16, p. 1235-1236Article in journal (Other academic)
  • 27.
    Fältström, Anne
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    One Anterior Cruciate Ligament injury is enough!: Focus on female football players2016Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: Anterior cruciate ligament (ACL) injury is a severe and common injury, and females have 2-4 times higher injury risk compared to men. Return to sport (RTS) is a common goal after an ACL reconstruction (ACLR), but only about two thirds of patients RTS. Young patients who RTS may have a 30-40 times increased risk of sustaining an additional ACL injury to the ipsi- or contralateral knee compared with an uninjured person.

    Aims: The overall aim of this thesis was to increase the knowledge about female football players with ACLR, and patients with bilateral ACL injuries, and to identify predictors for additional ipsi- and/or contralateral ACLR.

    Methods: This thesis comprises four studies. Study I and II were cross-sectional, including females who sustained a primary ACL rupture while playing football and underwent ACLR 6–36 months prior to study inclusion. In study I, 182 females were included at a median of 18 months (IQR 13) after ACLR. All players completed a battery of questionnaires. Ninety-four players (52%) returned to football and were playing at the time of completing the questionnaires, and 88 (48%) had not returned. In study II, 77 of the 94 active female football players (from study I) with an ACLR and 77 kneehealthy female football players were included. A battery of tests was used to assess postural control (the Star excursion balance test) and hop performance (the one-leg hop for distance, the five jump test and the side hop). Movement asymmetries in the lower limbs and trunk were assessed with the drop vertical jump and the tuck jump using two-dimensional analyses. Study III, was a cohort study including all patients with a primary ACLR (n=22,429) registered in the Swedish national ACL register between January 2005 and February 2013. Data extracted from the register to identify predictors for additional ACLR were: patient age at primary ACLR, sex, activity performed at the time of ACL injury, primary injury to the right- or left knee, time between injury and primary ACLR, presence of any concomitant injuries, graft type, Knee injury and Osteoarthritis Outcome Score and Euroqol Index Five Dimensions measured pre-operatively. Study IV was cross-sectional. In this study, patient-reported knee function, quality of life and activity level in 66 patients with bilateral ACL injuries was investigated and outcomes were compared with 182 patients with unilateral ACLR.

    Results: Factors associated with returning to football in females were; short time between injury and ACLR (0–3 months, OR 5.6; 3–12 months OR 4.7 vs. reference group >12 months) and high motivation (study I). In all functional tests, the reconstructed and uninvolved limbs did not differ, and players with ACLR and controls differed only minimally. Nine to 49% of the players with ACLR and controls had side-to-side differences and movement asymmetries and only one fifth had results that met the recommended guidelines for successful outcome on all the different tests (study II). Main predictors for revision and contralateral ACLR were younger age (fourfold increased rate for <16 vs. >35-year-old patients), having ACLR early after the primary injury (two to threefold increased rate for ACLR within 3 months vs. >12 months), and incurring the primary injury while playing football (study III). Patients with bilateral ACL injuries reported poorer knee function and quality of life compared to those who had undergone unilateral ACLR. They had a high activity level before their first and second ACL injuries but an impaired activity level at follow-up after their second injury (study IV).

    Conclusions: Female football players who returned to football after an ACLR had high motivation and had undergone ACLR within one year after injury. Players with ACLR had similar functional performance to healthy controls. Movement asymmetries, which in previous studies have been associated with increased risk for primary and secondary ACL injury, occurred to a high degree in both groups. The rate of additional ACLR seemed to be increased in a selected group of young patients who desire to return to strenuous sports like football quickly after primary ACLR. Sustaining a contralateral ACL injury led to impaired knee function and activity level.

    List of papers
    1. Factors associated with playing football after anterior cruciate ligament reconstruction in female football players.
    Open this publication in new window or tab >>Factors associated with playing football after anterior cruciate ligament reconstruction in female football players.
    2016 (English)In: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 26, no 11, p. 1343-1352Article in journal (Refereed) Published
    Abstract [en]

    This study investigated whether player-related factors (demographic, personality, or psychological factors) or the characteristics of the anterior cruciate ligament (ACL) injury were associated with the return to playing football in females after ACL reconstruction (ACLR). We also compared current knee function, knee related quality of life and readiness to return to sport between females who returned to football and those who had not returned. Females who sustained a primary ACL rupture while playing football and underwent ACLR 6-36 months ago were eligible. Of the 460 contacted, 274 (60%) completed a battery of questionnaires, and 182 were included a median of 18 months (IQR 13) after ACLR. Of these, 94 (52%) returned to football and were currently playing, and 88 (48%) had not returned. Multiple logistic regression analysis identified two factors associated with returning to football: short time between injury and ACLR (0-3 months, OR 5.6; 3-12 months OR 4.7 vs reference group > 12 months) and high motivation. Current players showed higher ratings for current knee function, knee-related quality of life, and psychological readiness to return to sport (P < 0.001). Undergoing ACLR sooner after injury and high motivation to return to sports may impact a player's return to football after ACLR.

    Place, publisher, year, edition, pages
    Wiley-Blackwell, 2016
    Keywords
    ACL; knee; return to sport; soccer
    National Category
    Physiotherapy
    Identifiers
    urn:nbn:se:liu:diva-123889 (URN)10.1111/sms.12588 (DOI)000386938300009 ()26589671 (PubMedID)
    Note

    Funding agencies:The authors acknowledge statistician Henrik Magnusson. The study was supported financially by Futurum-The Academy for Healthcare, Jonkoping County Council, the Medical Research Council of Southeast Sweden, the Faculty of Health Sciences at Linkoping University, and the Swedish National Centre for Research in Sports (CIF).

    Available from: 2016-01-13 Created: 2016-01-13 Last updated: 2017-11-30Bibliographically approved
    2. Functional Performance Among Active Female Soccer Players After Unilateral Primary Anterior Cruciate Ligament Reconstruction Compared With Knee-Healthy Controls
    Open this publication in new window or tab >>Functional Performance Among Active Female Soccer Players After Unilateral Primary Anterior Cruciate Ligament Reconstruction Compared With Knee-Healthy Controls
    2017 (English)In: American Journal of Sports Medicine, ISSN 0363-5465, E-ISSN 1552-3365, Vol. 45, no 2, p. 377-385Article in journal (Refereed) Published
    Abstract [en]

    Background: Good functional performance with limb symmetry is believed to be important to minimize the risk of injury after a return to pivoting and contact sports after anterior cruciate ligament reconstruction (ACLR).

    Purpose: This study aimed to investigate any side-to-side limb differences in functional performance and movement asymmetries in female soccer players with a primary unilateral anterior cruciate ligament (ACL)–reconstructed knee and to compare these players with knee-healthy controls from the same soccer teams.

    Study Design: Cross-sectional study; Level of evidence, 3.

    Methods: This study included 77 active female soccer players at a median of 18 months after ACLR (interquartile range [IQR], 14.5 months; range, 7-39 months) and 77 knee-healthy female soccer players. The mean age was 20.1 ± 2.3 years for players with an ACL-reconstructed knee and 19.5 ± 2.2 years for controls. We used a battery of tests to assess postural control (Star Excursion Balance Test) and hop performance (1-legged hop for distance, 5-jump test, and side hop). Movement asymmetries in the lower limbs and trunk were assessed with the drop vertical jump and the tuck jump using 2-dimensional analyses.

    Results: The reconstructed and uninvolved limbs did not differ in any of the tests. In the 5-jump test, players with an ACL-reconstructed knee performed worse than controls (mean 8.75 ± 1.05 m vs 9.09 ± 0.89 m; P = .034). On the drop vertical jump test, the ACL-reconstructed limb had significantly less knee valgus motion in the frontal plane (median 0.028 m [IQR, 0.049 m] vs 0.045 m [IQR, 0.043 m]; P = .004) and a lower probability of a high knee abduction moment (pKAM) (median 69.2% [IQR, 44.4%] vs 79.8% [IQR, 44.8%]; P = .043) compared with the control players’ matched limb (for leg dominance). Results showed that 9% to 49% of players in both groups performed outside recommended guidelines on the different tests. Only 14 players with an ACL-reconstructed knee (18%) and 15 controls (19%) had results that met the recommended guidelines for all 5 tests (P = .837).

    Conclusion: The reconstructed and uninvolved limbs did not differ, and players with an ACL-reconstructed knee and controls differed only minimally on the functional performance tests, indicating similar function. It is worth noting that many players with an ACL-reconstructed knee and controls had movement asymmetries and a high pKAM pattern, which have previously been associated with an increased risk for both primary and secondary ACL injury in female athletes.

    Place, publisher, year, edition, pages
    Sage Publications, 2017
    Keywords
    soccer, anterior cruciate ligament, proprioception, physical therapy, return to sports, test battery
    National Category
    Physiotherapy Sport and Fitness Sciences Other Medical Sciences not elsewhere specified Otorhinolaryngology Orthopaedics
    Identifiers
    urn:nbn:se:liu:diva-131850 (URN)10.1177/0363546516667266 (DOI)000394776900015 ()28146394 (PubMedID)2-s2.0-85011605308 (Scopus ID)
    Note

    Funding agencies: Futurum the Academy for Healthcare; Region Jonkoping County; Medical Research Council of Southeast Sweden; Faculty of Health Sciences at Linkoping University; Swedish Research Council for Sport Science; Swedish Football Association

    Available from: 2016-10-11 Created: 2016-10-11 Last updated: 2018-01-14Bibliographically approved
    3. Predictors for additional anterior cruciate ligament reconstruction: data from the Swedish national ACL register.
    Open this publication in new window or tab >>Predictors for additional anterior cruciate ligament reconstruction: data from the Swedish national ACL register.
    Show others...
    2016 (English)In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 24, no 3, p. 885-894Article in journal (Refereed) Published
    Abstract [en]

    PURPOSE: To identify predictors for additional anterior cruciate ligament (ACL) reconstruction.

    METHODS: Patients from the Swedish national ACL register who underwent ACL reconstruction between January 2005 and February 2013 (follow-up duration 6-104 months) were included. Cox regression analyses included the following independent variables regarding primary injury: age, sex, time between injury and primary ACL reconstruction, activity at primary injury, concomitant injuries, injury side, graft type, and pre-surgery KOOS and EQ-5D scores.

    RESULTS: Among ACL reconstruction procedures, 93 % involved hamstring tendon (HT) autografts. Graft type did not predict additional ACL reconstruction. Final regression models only included patients with HT autograft (n = 20,824). Of these, 702 had revision and 591 contralateral ACL reconstructions. The 5-year post-operative rates of revision and contralateral ACL reconstruction were 4.3 and 3.8 %, respectively. Significant predictors for additional ACL reconstruction were age (fourfold increased rate for <16-year-old patients vs. >35-year-old patients), time between injury and primary surgery (two to threefold increased rate for ACL reconstruction within 0-90 days vs. >365 days), and playing football at primary injury.

    CONCLUSION: This study identified younger age, having ACL reconstruction early after the primary injury, and incurring the primary injury while playing football as the main predictors for revision and contralateral ACL reconstruction. This suggests that the rate of additional ACL reconstruction is increased in a selected group of young patients aiming to return to strenuous sports after primary surgery and should be taken into consideration when discussing primary ACL reconstruction, return to sports, and during post-surgery rehabilitation. LEVEL OF EVIDENCE: II.

    National Category
    Physiotherapy Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-115943 (URN)10.1007/s00167-014-3406-6 (DOI)000371300400036 ()25366191 (PubMedID)
    Note

    Funding agencies:The study was financially supported by Futurum-the academy for healthcare, County Council, Jonkoping, the Faculty of Health Sciences at Linkoping University, and the Swedish National Centre for Research in Sports (CIF).

    Available from: 2015-03-24 Created: 2015-03-24 Last updated: 2018-10-29Bibliographically approved
    4. Patient-Reported Knee Function, Quality of Life, and Activity Level After Bilateral Anterior Cruciate Ligament Injuries
    Open this publication in new window or tab >>Patient-Reported Knee Function, Quality of Life, and Activity Level After Bilateral Anterior Cruciate Ligament Injuries
    2013 (English)In: American Journal of Sports Medicine, ISSN 0363-5465, E-ISSN 1552-3365, Vol. 41, no 12, p. 2805-2813Article in journal (Refereed) Published
    Abstract [en]

    Background: About 12% of patients who have undergone primary anterior cruciate ligament (ACL) reconstruction sustain a contralateral ACL injury within 5 years. less thanbrgreater than less thanbrgreater thanPurpose: To investigate patient-reported knee function, quality of life, and activity level in patients with bilateral ACL injuries. less thanbrgreater than less thanbrgreater thanStudy Design: Cohort study; Level of evidence, 3. less thanbrgreater than less thanbrgreater thanMethods: A search of hospital records identified 147 patients, aged 18 to 45 years, with bilateral ACL injuries. Of these, 83 met the inclusion criteria, having had their first ACL injury up to 12 years ago with no other major injuries to the knee joint. Sixty-six of these patients (80% of total; 47% female; mean age, 29.1 7.2 years) answered a questionnaire packet. Patients who had undergone unilateral ACL reconstruction (n = 182) were used for comparison. less thanbrgreater than less thanbrgreater thanResults: Patients with bilateral ACL injuries had a median Lysholm knee score of 82 (range, 34-100). The mean EuroQol index (EQ-5D) score of the overall health status was 0.77 +/- 0.22, and the mean EQ-5D visual analog scale score was 75.5 +/- 17.6. The median Tegner activity level was 9 (range, 1-9) before any injuries, 7 (range, 1-9) before the second ACL injury, and 4 (range, 1-9) at the time of follow-up. The activity level before the second injury was higher compared with the follow-up for patients who had undergone unilateral ACL reconstruction. At follow-up, 23% of the patients with bilateral ACL injuries returned to their previous activity, and 12% of patients returned to the same level as before their injuries compared with 43% (P = .004) and 28% (P = .01) in patients who had undergone unilateral ACL reconstruction, respectively. Patients with bilateral ACL injuries had significantly lower values in the Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales for pain, function in sports and recreation, and knee-related quality of life as well as the ACL Deficiency Quality of Life (ACL-QOL) score compared with patients who had undergone unilateral ACL reconstruction. less thanbrgreater than less thanbrgreater thanConclusion: Patients with bilateral ACL injuries reported poorer knee function and quality of life compared with those who had undergone unilateral ACL reconstruction. Their activities had changed, and they were dissatisfied with their current activity level. They had a high activity level before their first and second ACL injuries but an impaired activity level after their contralateral injury at follow-up.

    Place, publisher, year, edition, pages
    SAGE Publications (UK and US): No SAGE Choice, 2013
    Keywords
    knee, ligaments, ACL, contralateral, return to sport, subsequent injury, Tegner activity scale
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-102774 (URN)10.1177/0363546513502309 (DOI)000327473300013 ()
    Note

    Funding Agencies|Futurum-The Academy for Healthcare, Jonkoping County Council||Medical Research Council of Southeast Sweden||Faculty of Health Sciences at Linkoping University||Swedish National Centre for Research in Sports||

    Available from: 2014-01-07 Created: 2013-12-26 Last updated: 2017-12-06
  • 28.
    Fältström, Anne
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Region Jönköping County, Rehabilitation Centre, Ryhov County Hospital, Jönköping, Sweden.
    Hägglund, Martin
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Kvist, Joanna
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Functional Performance Among Active Female Soccer Players After Unilateral Primary Anterior Cruciate Ligament Reconstruction Compared With Knee-Healthy Controls2017In: American Journal of Sports Medicine, ISSN 0363-5465, E-ISSN 1552-3365, Vol. 45, no 2, p. 377-385Article in journal (Refereed)
    Abstract [en]

    Background: Good functional performance with limb symmetry is believed to be important to minimize the risk of injury after a return to pivoting and contact sports after anterior cruciate ligament reconstruction (ACLR).

    Purpose: This study aimed to investigate any side-to-side limb differences in functional performance and movement asymmetries in female soccer players with a primary unilateral anterior cruciate ligament (ACL)–reconstructed knee and to compare these players with knee-healthy controls from the same soccer teams.

    Study Design: Cross-sectional study; Level of evidence, 3.

    Methods: This study included 77 active female soccer players at a median of 18 months after ACLR (interquartile range [IQR], 14.5 months; range, 7-39 months) and 77 knee-healthy female soccer players. The mean age was 20.1 ± 2.3 years for players with an ACL-reconstructed knee and 19.5 ± 2.2 years for controls. We used a battery of tests to assess postural control (Star Excursion Balance Test) and hop performance (1-legged hop for distance, 5-jump test, and side hop). Movement asymmetries in the lower limbs and trunk were assessed with the drop vertical jump and the tuck jump using 2-dimensional analyses.

    Results: The reconstructed and uninvolved limbs did not differ in any of the tests. In the 5-jump test, players with an ACL-reconstructed knee performed worse than controls (mean 8.75 ± 1.05 m vs 9.09 ± 0.89 m; P = .034). On the drop vertical jump test, the ACL-reconstructed limb had significantly less knee valgus motion in the frontal plane (median 0.028 m [IQR, 0.049 m] vs 0.045 m [IQR, 0.043 m]; P = .004) and a lower probability of a high knee abduction moment (pKAM) (median 69.2% [IQR, 44.4%] vs 79.8% [IQR, 44.8%]; P = .043) compared with the control players’ matched limb (for leg dominance). Results showed that 9% to 49% of players in both groups performed outside recommended guidelines on the different tests. Only 14 players with an ACL-reconstructed knee (18%) and 15 controls (19%) had results that met the recommended guidelines for all 5 tests (P = .837).

    Conclusion: The reconstructed and uninvolved limbs did not differ, and players with an ACL-reconstructed knee and controls differed only minimally on the functional performance tests, indicating similar function. It is worth noting that many players with an ACL-reconstructed knee and controls had movement asymmetries and a high pKAM pattern, which have previously been associated with an increased risk for both primary and secondary ACL injury in female athletes.

  • 29.
    Giambini, Hugo
    et al.
    Mayo Clin, MN 55905 USA.
    Hatta, Taku
    Mayo Clin, MN USA.
    Gorny, Krzysztof R.
    Mayo Clin, MN USA.
    Widholm, Per
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Center for Medical Image Science and Visualization (CMIV). Region Östergötland, Center for Diagnostics, Department of Radiology in Linköping.
    Karlsson, Anette
    Linköping University, Department of Biomedical Engineering, Division of Biomedical Engineering. Linköping University, Faculty of Science & Engineering. Linköping University, Center for Medical Image Science and Visualization (CMIV).
    Dahlqvist Leinhard, Olof
    Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Radiation Physics. Linköping University, Center for Medical Image Science and Visualization (CMIV).
    Adkins, Mark C.
    Mayo Clin, MN USA.
    Zhao, Chunfeng
    Mayo Clin, MN 55905 USA; Mayo Clin, MN USA.
    An, Kai-Nan
    Mayo Clin, MN 55905 USA; Mayo Clin, MN USA.
    INTRAMUSCULAR FAT INFILTRATION EVALUATED BY MAGNETIC RESONANCE IMAGING PREDICTS THE EXTENSIBILITY OF THE SUPRASPINATUS MUSCLE2018In: Muscle and Nerve, ISSN 0148-639X, E-ISSN 1097-4598, Vol. 57, no 1, p. 129-135Article in journal (Refereed)
    Abstract [en]

    Introduction: Rotator cuff (RC) tears result in muscle atrophy and fat infiltration within the RC muscles. An estimation of muscle quality and deformation, or extensibility, is useful in selecting the most appropriate surgical procedure. We determined if noninvasive quantitative assessment of intramuscular fat using MRI could be used to predict extensibility of the supraspinatus muscle. Methods: Seventeen cadaveric shoulders were imaged to assess intramuscular fat infiltration. Extensibility and histological evaluations were then performed. Results: Quantitative fat infiltration positively correlated with histological findings and presented a positive correlation with muscle extensibility (r=0.69; P=0.002). Extensibility was not significantly different between shoulders graded with a higher fat content versus those with low fat when implementing qualitative methods. Discussion: A noninvasive prediction of whole-muscle extensibility may directly guide pre-operative planning to determine if the torn edge could efficiently cover the original footprint while aiding in postoperative evaluation of RC repair.

  • 30.
    Gomez-Piqueras, Pedro
    et al.
    Univ Castilla La Mancha, Spain.
    Gonzalez-Villora, Sixto
    Univ Castilla La Mancha, Spain.
    Grassi, Alberto
    Ist Ortoped Rizzoli, Italy.
    Gojanovic, Boris
    Hop Tour, Switzerland.
    Hägglund, Martin
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Waldén, Markus
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Are we making SMART decisions regarding return to training of injured football players? Preliminary results from a pilot study2018In: Isokinetics and exercise science, ISSN 0959-3020, E-ISSN 1878-5913, Vol. 26, no 2, p. 115-123Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: "When will I be able to play again?" is the most frequent question asked by injured athletes. Due to the complex nature of sports injury, deciding when an injured athlete may safely return to training is a critical and difficult decision. OBJECTIVE: To study if the Safe Multidimensional Algorithm for Return to Training (SMART) scores, applied before the release to full return to training after injury differs between football players who suffer a subsequent re-injury and football players who do not. METHOD: Seventy one male professional football players were prospectively monitored for injuries during two seasons. The SMART tool was applied in injured players with an absence amp;gt; 10 days. The injured player had to carry out 17 multidimensional tests included in the algorithm in his final days of the planned rehabilitation. The results of the SMART were compared between players who sustained re-injuries and those who did not. RESULTS: Fifty-five injuries with absence amp;gt; 10 days were recorded and re-injuries occurred in 12 of these cases (22%). There was a lower re-injury rate in players who presented a better recovery in pain (p amp;lt; 0.001), agility (RR 21.0, 95% CI: 2.0 to 213.2), advanced agility (RR 26.7, 95% CI: 4.9 to 142.8), anxiety (RR 8.6, 95% CI: 2.0 to 36.2), depression (RR 10.3, 95% CI: 1.5 to 65.7), self-perception (p amp;lt; 0.001), advanced skills mode (RR 20.5, 95% CI: 3.3 to 125.9) and group skills mode (p amp;lt; 0.001). CONCLUSIONS: A multidimensional approach of Return to Training that includes objective measures may indicate potential deficiencies in the recovery of injured players.

  • 31.
    Gouttebarge, Vincent
    et al.
    ACES, Academic Medical Center, Amsterdam / Amsterdam Collaboration for Health and Safety in Sports / Dept. of Orthopaedic Surgery, Academic Medical Center, Amsterdam / World Players Union, Hoofddorp .
    Aoki, Haruhito
    St. Marianna University School of Medicine, Kawasaki, Japan.
    Ekstrand, Jan
    Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Medical and Health Sciences, Division of Community Medicine.
    Verhagen, Evert A L M
    Amsterdam Collaboration for Health and Safety in Sports / Dept. of Public and Occupational Health, VU, University Medical Center, Amsterdam.
    Kerkhoffs, Gino M M J
    ACES, Academic Medical Center, Amsterdam / Amsterdam Collaboration for Health and Safety in Sports / Dept. of Orthopaedic Surgery, Academic Medical Center, Amsterdam .
    Are severe musculoskeletal injuries associated with symptoms of common mental disorders among male European professional footballers?2016In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 24, no 12, p. 3934-3942Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To explore the associations of severe musculoskeletal injuries (joint and muscles) and surgeries with symptoms of common mental disorders (distress, anxiety/depression, sleeping disturbance, adverse alcohol behaviour , smoking, adverse nutrition behaviour) among male European professional footballers.

    METHODS: Cross-sectional analyses were conducted on electronic questionnaires completed by professional footballers recruited from the national players' unions of Finland, France, Norway, Spain or Sweden. The number of severe (time loss of more than 28 days) musculoskeletal injuries (total, joint, muscle) and surgeries during a professional football career was examined through four questions, while symptoms of common mental disorders were evaluated through validated scales.

    RESULTS: A total of 540 professional footballers (mean age of 27 years; 54 % playing in the highest leagues) participated in the study. Sixty-eight per cent of the participants had already incurred one or more severe joint injuries and 60 % one or more severe muscle injuries. Prevalence of symptoms of common mental disorders ranged from 3 % for smoking to 37 % for anxiety/depression and 58 % for adverse nutrition behaviour. The number of severe musculoskeletal injuries during a football career was positively correlated with distress, anxiety and sleeping disturbance, while the number of surgeries was correlated with adverse alcohol behaviour and smoking. Professional footballers who had sustained one or more severe musculoskeletal injuries during their career were two to nearly four times more likely to report symptoms of common mental disorders than professional footballers who had not suffered from severe musculoskeletal injuries.

    CONCLUSION: It can be concluded that the number of severe musculoskeletal injuries and surgeries during a career is positively correlated and associated with symptoms of common mental disorders among male European professional footballers. This study emphasises the importance of applying a multidisciplinary approach to the clinical care and support of professional footballers, especially when a player faces lengthy periods without training and competition as a consequence of recurrent severe joint or muscle injuries.

    LEVEL OF EVIDENCE: III.

  • 32.
    Holmberg, Joakim
    Linköping University, Department of Management and Engineering, Solid Mechanics. Linköping University, Faculty of Science & Engineering.
    Classification of Paralympic Athletes using Musculoskeletal Simulations2016Conference paper (Other academic)
  • 33.
    Holmberg, Joakim
    Linköping University, Department of Management and Engineering, Mechanics. Linköping University, The Institute of Technology.
    Cross-country Skiing Biomechanics using the AnyBody Modeling System2007Conference paper (Other academic)
  • 34.
    Holmberg, Joakim
    et al.
    Linköping University, Department of Management and Engineering, Mechanics . Linköping University, The Institute of Technology.
    Lund Ohlsson, Marie
    MittUniversitet.
    Biomekaniska simuleringar adderar insikt om längdskidåkning2010In: Svensk Idrottsforskning: Organ för Centrum för Idrottsforskning, ISSN 1103-4629, Vol. 19, no 1, p. 38-40Article in journal (Other (popular science, discussion, etc.))
    Abstract [sv]

    Varför ska man kopiera de som är bäst? När man väl lärt sig deras teknik så har de bästa kanske redan gått vidare och utvecklat ännu bättre tekniker? Med biomekaniska simuleringar adderas insikt så att man kan utveckla sin teknik och ligga i framkant, istället för i svallvågorna.

  • 35.
    Holmberg, Joakim
    et al.
    Linköping University, Department of Management and Engineering, Mechanics. Linköping University, The Institute of Technology.
    Lund Ohlsson, Marie
    Department of Engineering and Sustainable Development, Mid Sweden University, Sweden .
    Danvind, Jonas
    Department of Engineering and Sustainable Development, Mid Sweden University, Sweden .
    Letter: Musculoskeletal simulations: a complementary tool for classification of athletes with physical impairments2012In: Prosthetics and orthotics international, ISSN 0309-3646, E-ISSN 1746-1553, Vol. 36, no 3, p. 396-397Article in journal (Other academic)
    Abstract [en]

    n/a

  • 36.
    Holmberg, Joakim
    et al.
    Linköping University, Department of Management and Engineering, Mechanics. Linköping University, The Institute of Technology.
    Wagenius, P.
    Mid Sweden University.
    A biomechanical model of a double‐poling skier2003In: In International Society of Biomechanics XIXth Congress on The human body in motion, CD Rom Abstracts and Proceedings, Milburn, P. (Ed.), University of Otago, Dunedin, New Zealand, 6‐11 July, 2003Conference paper (Other academic)
  • 37.
    Holmberg, L. Joakim
    Linköping University, Department of Management and Engineering, Mechanics. Linköping University, The Institute of Technology.
    A simulation study on the necessity of muscle contraction dynamics in cross-country skiingManuscript (preprint) (Other academic)
    Abstract [en]

    Competitive cross-country skiing is considered to be a fast and powerful dynamic movement. It is unknown what level of complexity that is needed in a musculoskeletal model of a skiing movement, e.g. double-poling. Therefore, a simulation study is carried out to explore the influence of muscle model choice. The theoretical framework of two types of muscle models and their respective implementations are given. These models are a Hill-type model with contraction dynamics and a constant force model, respectively. Results show that it is necessary to incorporate muscle contraction dynamics to estimate individual muscle behaviour in double-poling. Moreover, it may be bad practice to model different body parts with different muscle models; the musculoskeletal system is not a collection of discrete uncoupled body parts and kinetic effects will propagate through the system.

  • 38.
    Holmberg, L. Joakim
    Linköping University, Department of Management and Engineering, Mechanics. Linköping University, The Institute of Technology.
    Biomekanisk simulering av längdskidåkning2012In: Svensk idrottsmedicin, ISSN 1103-7652, Vol. 31, no 3, p. 11-13Article in journal (Other (popular science, discussion, etc.))
  • 39.
    Holmberg, L. Joakim
    et al.
    Linköping University, Department of Management and Engineering, Mechanics. Linköping University, The Institute of Technology.
    Holmberg, Hans-Christer
    Mittuniversitetet.
    The role of triceps in double-poling biomechanics, an introductory study2007In: 4th International Congress on Science and Skiing: Book of Abstracts / [ed] E. Müller, S. Lindinger, T. Stöggl & V. Fastenbauer, Salzburg, 2007, p. 184-Conference paper (Other academic)
  • 40.
    Holmberg, L. Joakim
    et al.
    Linköping University, Department of Management and Engineering, Mechanics. Linköping University, The Institute of Technology.
    Lund, A. M.
    Mid Sweden University.
    A musculoskeletal full‐body simulation of cross‐country skiing2008In: Proc. IMechE Vol. 222 Part P: J. Sports Engineering and Technology, ISSN 1754-3371, Vol. 222, no 1, p. 11-22Article in journal (Refereed)
    Abstract [en]

    This paper presents a measurement-driven, musculoskeletal, full-body simulation model for biomechanical analysis of the double-poling (DP) technique in cross-country skiing. DP is a fast and powerful full-body movement; therefore, it is interesting to examine whether inverse dynamics using static optimization is working for a musculoskeletal full-body model with high accelerations, a large range of motion, and realistic loads. An experiment was carried out to measure motion and pole force of a skier on a double-poling ergometer. Using the measurement data, a simulation model was implemented in the AnyBody Modeling System (AnyBody Technology A/S, Denmark). Experimental results of motion and pole force from the DP ergometer, and also simulation results of relative muscle force profiles, are presented. These results agree with results found in literature when the kinematics and external kinetics are similar. Consequently, it should be possible to use computer simulations of this type for cross-country skiing simulations. With a simulation model, it is possible to perform optimization studies and to ask and answer ‘what if’ questions. Solutions to such problems are not easy to obtain by traditional testing alone.

  • 41.
    Holmberg, L. Joakim
    et al.
    Linköping University, Department of Management and Engineering, Mechanics. Linköping University, The Institute of Technology.
    Lund, A. M.
    Using double‐poling simulations to study the load distribution between teres major and latissimus dorsi2007In: In Science and Nordic Skiing, Linnamo, V., Komi, P.V. and Müller, E. (Eds.), Meyer and Meyer Sport, Oxford, UK / [ed] Vesa Linnamo, Paavo V. Komi, Erich Müller, Meyer and Meyer Sport, Oxford, UK , 2007, p. 81-89Chapter in book (Other academic)
    Abstract [en]

    Between June 18-20 2006, the Vuokatti Sports Institute in Finland - arguably the world's finest ski training facility - played host to the International Congress on Science and Nordic Skiing."Science and Nordic Skiing" brings together the very latest in cutting edge research and developments into Nordic Skiing - ski jumping and cross-country skiing to biomechanics and the effects of cold weather on exercise - presented by some of the world's foremost experts in the field."Science and Nordic Skiing" is destined to become an invaluable and practical reference for sports scientists, coaches, skiers and anyone involved in this exciting area of winter sports.It presents the very latest research and development in the world of science and Nordic skiing.

  • 42.
    Holmberg, L. Joakim
    et al.
    Linköping University, The Institute of Technology. Linköping University, Department of Management and Engineering, Mechanics.
    Lund Ohlsson, Marie
    Linköping University, The Institute of Technology. Linköping University, Department of Management and Engineering, Mechanics.
    Danvind, Jonas
    Mittuniversitetet.
    Can Simulations Assist in Classification Development?2013In: Equipment and Technology in Paralympic Sports, International Paralympic Committee , 2013Conference paper (Other academic)
    Abstract [en]

    There is a critical need for research that describes the extent to which impairments of varying type, severity and distribution impact performance in Paralympic sports. It is important with evidence-based judgment on how the impairments aect performance. In the following, we present a complementary evidence-based tool for classication.

    Let us start with an example. We recently presented a study (Holmberg et al., 2012)1 that utilized two full-body musculoskeletal simulation models of cross-country skiing (double-poling). The models were identical except that one carried no muscles in the right lower leg and foot; thus mimicking a lower leg prosthesis. It was hypothesized that a lower leg prosthesis would inuence muscular work throughout the whole body. Results showed that to generate the same motion and external work, an able-bodied skier only had to produce about 80% metabolic muscle work compared to a disabled skier (with a non-active right lower leg prosthesis).

    In reality there is always psychological factors present and it is probably not possible to nd two human beings (one fully functional and one impaired) with the same tness, size, strength and technique. Thus, it is hard to nd the unbiased eect of an impairment on performance in a speci c sport. The example above shows the strength of using simulations because a  musculoskeletal model yields quantitative data on the unbiased eect of dierent functional impairments.

    In cross-country skiing, athletes with functional impairments are, in 'competition format' classification, assigned to dierent categories with weight factors. Athletes perform their race and the result list is presented as race time multiplied by weight factor. In the future, musculoskeletal simulations may assist in answering how a specic functional impairment aects performance and thereby improve the fairness in assigning weight factors for classication.

  • 43.
    Holmberg, L. Joakim
    et al.
    Linköping University, Department of Management and Engineering, Mechanics. Linköping University, The Institute of Technology.
    Lund Ohlsson, Marie
    Department of Engineering and Sustainable Development, Mid Sweden University, Östersund, Sweden.
    Supej, Matej
    Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia.
    Holmberg, Hans-Christer
    Swedish Winter Sports Research Centre, Department of Health Sciences, Mid Sweden University, Östersund.
    Skiing efficiency versus performance in double-poling ergometry2013In: Computer Methods in Biomechanics and Biomedical Engineering, ISSN 1025-5842, E-ISSN 1476-8259, Vol. 16, no 9, p. 987-992Article in journal (Refereed)
    Abstract [en]

    This study is on how leg utilisation may affect skiing efficiency and performance in double-poling ergometry. Three experiments were conducted, each with a different style of the double-poling technique: traditional with small knee range-of-motion and fixed heels (TRAD); modern with large knee range-of-motion and fixed heels (MOD1) and modern with large knee range-of-motion and free heels (MOD2). For each style, motion data were extracted with automatic marker recognition of reflective markers and applied to a 3D full-body musculoskeletal simulation model. Skiing efficiency (skiing work divided by metabolic muscle work) and performance (forward impulse) were computed from the simulation output. Skiing efficiency was 4.5%, 4.1% and 4.1% for TRAD, MOD1 and MOD2, respectively. Performance was 111, 143 and 149Ns for TRAD, MOD1 and MOD2, respectively. Thus, higher lower body utilisation increased the performance but decreased the skiing efficiency. These results demonstrate the potential of musculoskeletal simulations for skiing efficiency estimations.

  • 44.
    Hägglund, Martin
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Waldén, Markus
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Hassleholm Kristianstad Ystad Hosp, Dept Orthopaed, Hassleholm, Sweden.
    Risk factors for acute knee injury in female youth football.2016In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 24, no 3, p. 737-746Article in journal (Refereed)
    Abstract [en]

    Purpose: To prospectively evaluate risk factors for acute time-loss knee injury, in particular ACL injury, in female youth football players.andlt;br /andgt;Methods: Risk factors were studied in 4556 players aged 12-17 years from a randomised controlled trial during the 2009 season. Covariates were both intrinsic (body mass index, age, relative age effect, onset of menarche, previous acute knee injury or ACL injury, current knee complaints, and familial disposition of ACL injury) and extrinsic (no. of training sessions/week, no. of matches/week, match exposure ratio, match play with other teams, and artificial turf exposure). Hazard ratios (HRs) and 95 % confidence intervals (CIs) were calculated from individual variable and multiple Cox regression analyses.andlt;br /andgt;Results: Ninety-six acute knee injuries were recorded, 21 of them ACL injuries. Multiple Cox regression showed a fourfold higher ACL injury rate for players with familial disposition of ACL injury (HR 3.57; 95 % CI 1.48-8.62). Significant predictor variables for acute knee injury were age andgt;14 years (HR 1.97; 95 % CI 1.30-2.97), knee complaints at the start of the season (HR 1.98; 95 % CI 1.30-3.02), and familial disposition of ACL injury (HR 1.96; 95 % CI 1.22-3.16). No differences in injury rates were seen when playing on artificial turf compared with natural grass.andlt;br /andgt;Conclusion: Female youth football players with a familial disposition of ACL injury had an increased risk of ACL injury and acute knee injury. Older players and those with knee complaints at pre-season were more at risk of acute knee injury. Although the predictive values were low, these factors could be used in athlete screening to target preventive interventions.andlt;br /andgt;Level Of Evidence: II.

  • 45.
    Jennersjö, Pär
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Ludvigsson, Johnny
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping.
    Länne, Toste
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Center for Medical Image Science and Visualization (CMIV). Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Nyström, Fredrik H.
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Endocrinology.
    Östgren, Carl Johan
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in West Östergötland, "Primary Health Care in Motala".
    Pedometer-determined physical activity level and change in arterial stiffness in Type 2 diabetes over 4 years2016In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 33, no 7, p. 992-997Article in journal (Refereed)
    Abstract [en]

    Aim To explore prospectively the correlation between the level of pedometer-determined physical activity at the start of the study and the change in pulse wave velocity from baseline to 4 years later in people with Type 2 diabetes.

    Methods We analysed data from 135 men and 53 women with Type 2 diabetes, aged 54–66 years. Physical activity was measured with waist-mounted pedometers on 3 consecutive days and the numbers of steps/day at baseline were classified into four groups: <5000 steps/day, 5000–7499 steps/day, 7500–9999 steps/day and ≥10 000 steps/day. Pulse wave velocity was measured using applanation tonometry over the carotid and femoral arteries at baseline and after 4 years.

    Results The mean (±sd; range) number of steps/day was 8022 (±3765; 956–20 921). The participants with the lowest level of physical activity had a more pronounced increase in the change in pulse wave velocity compared with the participants with the highest. When change in pulse wave velocity was analysed as a continuous variable and adjusted for sex, age, diabetes duration, HbA1c, BMI, systolic blood pressure, pulse wave velocity at baseline, β-blocker use, statin use, unemployment, smoking and diabetes medication, the number of steps/day at baseline was significantly associated with a less steep increase in change in pulse wave velocity (P=0.005). Every 1000 extra steps at baseline corresponded to a lower increase in change in pulse wave velocity of 0.103 m/s.

    Conclusions We found that a high level of pedometer-determined physical activity was associated with a slower progression of arterial stiffness over 4 years in middle-aged people with Type 2 diabetes.

  • 46.
    Karlsson, Linn
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Chronic Pain and Exercise: Studies on pain intensity, biochemistry, adherence and attitudes2017Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Chronic pain is common in western countries and entails considerable consequences for the afflicted individuals as well as for the society. Furthermore, chronic pain is complex including an advanced interplay between biological-, psychological- and social aspects. Treatment of chronic pain attempts to decrease pain intensity and increase physical-, psychological- and social functioning. However, the treatment of chronic pain is still not optimized. Different types of physical activity and exercise (PA&E) are commonly applied as non-pharmacological treatment strategies for chronic pain, but the most efficient type and dose of PA&E are unclear. In addition, adherence to prescribed PA&E is often troublesome, which further complicates the application of PA&E as treatment for chronic pain.

    The aim of this thesis is to increase the knowledge about PA&E as treatment for chronic pain regarding pain intensity, biochemical substances, adherence and attitudes.

    The findings of this thesis were that a long-term, home-based PA&E intervention comprising strength exercises as well as stretch exercises decreased pain intensity and increased function in women with chronic neck- and shoulder pain. Using microdialysis technique, differences in pain modulatory biochemical substances were found, before the intervention, in painful trapezius muscle compared to pain-free trapezius muscle. In addition, alterations in pain modulatory substances in painful trapezius muscle after the intervention were found, which possibly could imply peripheral physiological effects of PA&E. Furthermore, psychological factors could be associated to the effects of and adherence to the PA&E intervention. An intention to be physically active were expressed by patients with chronic pain, but a discordance between the intention and PA&E-behaviour were evident, even though the PA&E were experienced as valuable.

    In conclusion, this thesis strengthens the importance of PA&E as treatment for chronic pain. Especially, this thesis increases the knowledge about; possible peripheral pain inhibitory effects after long-term exercise; how psychological factors might affect the results of PA&E; and also about important behavioural aspects that might affect adherence to prescribed PA&E. This thesis highlights the need of more research on physiological pain inhibitory effects of long-term PA&E in chronic pain. Furthermore, improved methods for ensured adherence to prescribed PA&E are necessary in order to optimize the effect of PA&E as treatment for chronic pain.

    List of papers
    1. Evaluation of pain and function after two home exercise programs in a clinical trial on women with chronic neck pain - with special emphasises on completers and responders
    Open this publication in new window or tab >>Evaluation of pain and function after two home exercise programs in a clinical trial on women with chronic neck pain - with special emphasises on completers and responders
    2014 (English)In: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 15, no 6Article in journal (Refereed) Published
    Abstract [en]

    Background: Different types of exercises can help manage chronic neck pain. Supervised exercise interventions are widely used, but these protocols require substantial resources. The aim of this trial, which focused on adherence, was to evaluate two home exercise interventions. Methods: This parallel group randomized controlled trial included 57 women randomly allocated into two groups - a strength training group (STRENGTH, 34 subjects) and a stretching group (STRETCH, 23 subjects). The interventions focused on the neck and shoulder muscles and lasted for 12 months. The STRENGTH group performed weight training and ended each session with stretching exercises. These stretching exercises constituted the entirety of the STRETCH groups training session. Both groups were instructed to exercise three times per week. All the participants kept an exercise diary. In addition, all participants were offered support via phone and e-mail. The primary outcomes were pain intensity and function. The trial included a four-to six-month and a twelve-month follow-up. A completer in this study exercised at least 1,5 times per week during eight unbroken weeks. A responder in this study reported clinically significant improvements on pain and function. The statistical analyses used the Mann Whitney U-test, Wilcoxon signed-rank test, and X-2 test. Results: At four-to six-months, the numbers of completers were 19 in the STRENGTH group and 17 in the STRETCH group. At twelve months, the corresponding numbers were 11 (STRENGTH) and 10 (STRETCH). At four-to six-months, the proportions of subjects reporting clinically important changes (STRENGTH and STRETCH) were for neck pain: 47% and 41%, shoulder pain: 47% and 47%, function: 37% and 29%. At twelve months, the corresponding numbers were for neck pain: 45% and 40%, shoulder pain: 55% and 50%, function: 55% and 20%. Conclusions: No differences in the two primary outcomes between the two interventions were found, a finding that may be due to the insufficient statistical power of the study. Both interventions based on home exercises improved the two primary outcomes, but the adherences were relatively low. Future studies should investigate ways to improve adherence to home exercise treatments.

    Place, publisher, year, edition, pages
    BioMed Central, 2014
    Keywords
    Neck pain; Shoulder pain; Home exercise; Strength training; Stretching; Function
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-104117 (URN)10.1186/1471-2474-15-6 (DOI)000329854700003 ()
    Available from: 2014-02-07 Created: 2014-02-07 Last updated: 2017-12-06
    2. Intramuscular pain modulatory substances before and after exercise in women with chronic neck pain
    Open this publication in new window or tab >>Intramuscular pain modulatory substances before and after exercise in women with chronic neck pain
    Show others...
    2015 (English)In: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 19, no 8, p. 1075-1085Article in journal (Refereed) Published
    Abstract [en]

    BackgroundIn peripheral tissue, several substances influence pain and pain modulation. Exercise has been found to decrease pain and improve function for chronic pain conditions, but how and why exercise produces beneficial effects remains unclear. This study investigates whether aspects of pain and concentrations of substances with algesic, analgesic and metabolic functions differ between women with chronic neck shoulder pain (CNSP) and healthy women (CON) and whether changes are found after an exercise intervention for CNSP. MethodsForty-one women with CNSP and 24 CON subjects were included. The participants attended two microdialysis sessions with 4-6 months between the experiments. During this period, the CNSP subjects underwent an exercise intervention. Expression levels of substance P, beta-endorphin, cortisol, glutamate, lactate and pyruvate as well as pain intensity and pressure pain thresholds were analysed. ResultsAt baseline, higher concentrations of glutamate and beta-endorphin and lower concentrations of cortisol in CNSP than CON were found. After exercise, decreased levels of substance P and possibly of glutamate, increased levels of beta-endorphin and cortisol as well as decreased pain intensity and increased pain pressure thresholds were found for CNSP. ConclusionsThe findings at baseline indicated algesic and analgesic alterations in the painful trapezius muscles. The findings for CNSP after the exercise intervention, with changes in peripheral substances and decreased pain intensity and sensitivity, could reflect a long-term physiological effect of the exercise.

    Place, publisher, year, edition, pages
    WILEY-BLACKWELL, 2015
    National Category
    Physiotherapy Physiology
    Identifiers
    urn:nbn:se:liu:diva-121426 (URN)10.1002/ejp.630 (DOI)000360180300005 ()25430591 (PubMedID)
    Note

    Funding Agencies|Swedish Research Council [K2011-69X-21874-01-6]; Swedish Council for Working Life and Social Research [2010-0913]

    Available from: 2015-09-18 Created: 2015-09-18 Last updated: 2018-01-11
    3. Associations between psychological factors and the effect of home-based physical exercise in women with chronic neck and shoulder pain.
    Open this publication in new window or tab >>Associations between psychological factors and the effect of home-based physical exercise in women with chronic neck and shoulder pain.
    Show others...
    2016 (English)In: SAGE open medicine, E-ISSN 2050-3121, Vol. 4, article id 2050312116668933Article in journal (Refereed) Published
    Abstract [en]

    BACKGROUND: Exercise is often used in the treatment of chronic neck and shoulder muscle pain. It is likely that psychological aspects have an impact on the results of exercise-based treatments.

    OBJECTIVES: (1) To examine the associations between psychological factors and the effect of a home-based physical exercise intervention. (2) To examine differences in psychological factors at baseline between (a) subjects who continued in the trial and those who did not and (b) subjects who completed the intervention and those who did not.

    METHOD: A total of 57 women with chronic neck and shoulder pain were included in a home-based exercise intervention trial. Pain intensity, disability, and psychological factors (anxiety and depression symptoms, catastrophizing, fear-avoidance beliefs, self-efficacy, and pain acceptance) were measured at baseline, after 4-6 months, and after 1 year of exercise. Associations between the psychological factors and changes in pain intensity and disability were analysed, as well as differences in psychological factors at baseline between subjects who continued in and completed the intervention, and those who did not.

    RESULTS: Associations between positive changes in pain intensity and disability were found for low fear-avoidance beliefs and low-pain self-efficacy at baseline. In addition, fear-avoidance beliefs at baseline were higher in the subjects who dropped out of the intervention than in those who continued. Pain acceptance at baseline was higher in the subjects who completed the intervention at the end of the trial.

    CONCLUSION: Particularly, fear-avoidance beliefs and pain self-efficacy should be taken into consideration when implementing home-based physical exercise as treatment for chronic neck pain. In addition, high pain acceptance might improve the adherence to prescribed exercise.

    Place, publisher, year, edition, pages
    Sage Publications, 2016
    Keywords
    Exercise, neck pain, psychological factors
    National Category
    Public Health, Global Health, Social Medicine and Epidemiology Psychiatry General Practice
    Identifiers
    urn:nbn:se:liu:diva-135743 (URN)10.1177/2050312116668933 (DOI)27688880 (PubMedID)
    Available from: 2017-03-20 Created: 2017-03-20 Last updated: 2018-05-15
  • 47.
    Klompstra, Leonie
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Physical activity in patients with heart failure: motivations, self-efficacy and the potential of exergaming2016Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: Adherence to recommendations for physical activity is low in patients with heart failure (HF). It is essential to explore to what extent and why patients with HF are physically active. Self-efficacy and motivation for physical activity are important in becoming more physically active, but the role of self-efficacy in the relationship between motivation and physical activity in patients with HF is unknown. Alternative approaches to motivate and increase self-efficacy to exercise are needed. One of these alternatives might be using exergames (games to improve physical exercise). Therefore, it is important to obtain more knowledge on the potential of exergaming to increase physical activity.

    The overall aim was to describe the physical activity in patients with HF, with special focus on motivations and self-efficacy in physical activity, and to describe the potential of exergaming to improve exercise capacity.

    Methods: Study I (n = 154) and II (n = 101) in this thesis had a cross-sectional survey design. Study III (n = 32) was a 12-week pilot intervention study, including an exergame platform at home, with a pretest-posttest design. Study IV (n = 14) described the experiences of exergaming in patients who participated in the intervention group of a randomized controlled study in which they had access to an exergame platform at home.

    Results: In total, 34% of the patients with HF had a low level of physical activity, 46% had a moderate level, 23% reported a high level. Higher education, higher selfefficacy, and higher motivation were significantly associated with a higher amount of physical activity. Barriers to exercise were reported to be difficult to overcome and psychological motivations were the most important motivations to be physically active. Women had significantly higher total motivation to be physically active. Self-efficacy mediated the relationship between exercise motivation and physical activity; motivation leads to a higher self-efficacy towards physical activity.

    More than half of the patients significantly increased their exercise capacity after 12 weeks of using an exergame platform at home. Lower NYHA-class and shorter time since diagnosis were factors significantly related to the increase in exercise capacity. The mean time spent exergaming was 28 minutes per day. Having grandchildren and being male were related to more time spent exergaming.

    The analysis of the qualitative data resulted in three categories describing patients’ experience of exergaming: (i) making exergaming work, (ii) added value of exergaming, (iii) no appeal of exergaming.

    Conclusion: One-third of the patients with HF had a low level of physical activity in their daily life. Level of education, exercise self-efficacy, and motivation were important factors to take into account when advising patients with HF about physical activity. In addition to a high level of motivation to be physically active, it is important that patients with HF have a high degree of exercise self-efficacy.

    Exergaming has the potential to increase exercise capacity in patients with HF. The results also showed that this technology might be suitable for some patients while others may prefer other kinds of physical activity.

    List of papers
    1. Physical activity in patients with heart failure: barriers and motivations with special focus on sex differences
    Open this publication in new window or tab >>Physical activity in patients with heart failure: barriers and motivations with special focus on sex differences
    2015 (English)In: Patient Preference and Adherence, ISSN 1177-889X, E-ISSN 1177-889X, Vol. 9, p. 1603-1610Article in journal (Refereed) Published
    Abstract [en]

    Background: Adherence to recommendations for physical activity is low in both male and female patients with heart failure (HF). Men are more physically active than women. In order to successfully promote physical activity, it is therefore essential to explore how much and why HF patients are physically active and if this is related to sex. The aim of this study was therefore to evaluate physical activity in HF patients, to describe the factors related to physical activity, and to examine potential barriers and motivations to physical activity with special focus on sex differences. Methods: The study had a cross-sectional survey design. HF patients living at home received a questionnaire during May-July 2014, with questions on physical activity (from the Short Form-International Physical Activity Questionnaire), and potential barriers and motivations to physical activity. Results: A total of 154 HF patients, 27% women, with a mean age of 70 +/- 10 were included. In total, 23% of the patients reported a high level of physical activity, 46% a moderate level, and 34% a low level. Higher education, self-efficacy, and motivation were significantly associated with a higher amount of physical activity. Symptoms or severity of the disease were not related to physical activity. All the potential barriers to exercise were reported to be of importance. Psychological motivations were most frequently rated as being the most important motivation (41%) to be physically active. Physical motivations (33%) and social motivations were rated as the least important ones (22%). Women had significantly higher total motivation to be physically active. These differences were found in social, physical, and psychological motivations. Discussion: One-third of the HF patients had a low level of physical activity in their daily life. Severity of the disease or symptoms were not related, whereas level of education, exercise self-efficacy, and motivation were important factors to take into account when advising a HF patient about physical activity. Women reported higher motivation to be physically active than men, but there was no difference in the reported level of physical activity.

    Place, publisher, year, edition, pages
    DOVE MEDICAL PRESS LTD, 2015
    Keywords
    barriers; sex differences; heart failure; motivation; physical activity; self-efficacy
    National Category
    Nursing Health Care Service and Management, Health Policy and Services and Health Economy
    Identifiers
    urn:nbn:se:liu:diva-123091 (URN)10.2147/PPA.S90942 (DOI)000364289900001 ()26635469 (PubMedID)
    Available from: 2015-12-03 Created: 2015-12-03 Last updated: 2017-12-01
    2. Exergaming to increase the exercise capacity and daily physical activity in heart failure patients: a pilot study
    Open this publication in new window or tab >>Exergaming to increase the exercise capacity and daily physical activity in heart failure patients: a pilot study
    2014 (English)In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 14, no 119Article in journal (Refereed) Published
    Abstract [en]

    Background

    Regular daily physical activity is recognised as important in heart failure (HF) patients, but adherence to physical activity is low (<50%). To improve adherence to exercise in HF patients, alternative approaches to motivate and increase self-efficacy to exercise are needed. Therefore, we have studied a new phenomenon: exergames (games to improve physical exercise). The aims of the study were to assess the influence of the exergame platform Nintendo Wii on exercise capacity and daily physical activity in heart failure patients, to study factors related to exercise capacity and daily physical activity, and to assess patients’ adherence to exergaming.

    Methods

    A 12-week pilot study with a pretest-posttest design was conducted. The intervention consisted of an instruction on how to use the Wii and 12 weeks’ access to Wii at home. The main variables tested were exercise capacity (measured with a six-minute walking test), daily physical activity (measured with an activity monitor), and time exergaming (daily self-report with a diary). Bivariate correlations were used to assess associations between symptom experience, self-efficacy, motivation, anxiety, and depression.

    Results

    In total, 32 heart failure patients were included. More than half of the patients (53%) significantly increased their exercise capacity after 12 weeks. No significant difference was found in daily physical activity between baseline and 12 weeks. Lower NYHA class and shorter time since diagnosis were factors significantly related to the increase in exercise capacity. The daily mean time spent exergaming was 28 minutes, and having grandchildren and being male were related to more time spent exergaming.

    Conclusion

    Exergaming has the potential to increase exercise capacity in elderly, chronically ill cardiac patients. Although the daily physical activity did not change over time, exergaming was feasible for heart failure patients and might be a rehabilitation option for patients with heart failure

    Place, publisher, year, edition, pages
    BioMed Central, 2014
    Keywords
    Active video game, Adherence, Exercise capacity, Exergame, Heart failure, Physical activity
    National Category
    Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-112402 (URN)10.1186/1471-2318-14-119 (DOI)000346030500004 ()25407612 (PubMedID)
    Available from: 2014-11-25 Created: 2014-11-25 Last updated: 2017-12-05Bibliographically approved
  • 48.
    Kvist, Joanna
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Physiotherapy.
    Good, Lars
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Orthopaedics and Sports Medicine. Östergötlands Läns Landsting, Orthopaedic Centre, Department of Orthopaedics Linköping.
    Tagesson (Sonesson), Sofi
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Physiotherapy. Östergötlands Läns Landsting, Orthopaedic Centre, Department of Orthopaedics Linköping.
    Changes in knee motion pattern after anterior cruciate ligament injury - A case report2007In: Clinical Biomechanics, ISSN 0268-0033, E-ISSN 1879-1271, Vol. 22, no 5, p. 551-556Article in journal (Refereed)
    Abstract [en]

    Background: After an anterior cruciate ligament injury, the contra-lateral non-injured leg has been found to adapt towards the injured leg. Accordingly, in order to study changes in knee motion pattern after an anterior cruciate ligament injury, the ideal is to compare the same leg prior to and after the injury. However, this is very seldom possible. The purpose of the present study was to describe changes in static and dynamic sagittal tibial translation, electromyographic activity and muscle torque relevant to an anterior cruciate ligament tear in one patient evaluated both before and after the injury.

    Methods: A male soccer player was examined 11 weeks before and eight weeks after an anterior cruciate ligament injury. Sagittal tibial translation was measured with the CA-4000 electrogoniometer, statically during Lachman's test, and dynamically during isokinetic muscle testing, one-legged squat and level walking. The electromyographic activity of mm. quadriceps and hamstrings, was registered simultaneously during the one-legged squat test.

    Findings: Static tibial translation was increased by ∼2 mm, while dynamic tibial translation was decreased by 0.4 mm at isokinetic testing, 0.9 mm at one-legged squat and 2.4 mm during level walking compared to before the injury. Muscle torque decreased 30% and 35% for the quadriceps and the hamstrings muscle, respectively. The electromyographic activity revealed similar activation levels in quadriceps and a doubled level of activation in hamstring compared to before the injury.

    Interpretation: In spite of an increase in static tibial translation eight weeks after an anterior cruciate ligament injury, the tibial translation decreased during activity, thus indicating that the patient could stiffen the knee in order to protect it against increased shear forces.

  • 49.
    Lai, Courtney C. H.
    et al.
    La Trobe University, Australia.
    Ardern, Clare
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. La Trobe University, Australia; Aspetar Orthopaed and Sports Medical Hospital, Qatar.
    Feller, Julian A.
    OrthoSport Victoria, Australia.
    Webster, Kate E.
    La Trobe University, Australia.
    Eighty-three per cent of elite athletes return to preinjury sport after anterior cruciate ligament reconstruction: a systematic review with meta-analysis of return to sport rates, graft rupture rates and performance outcomes2018In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 52, no 2, p. 128-138Article, review/survey (Refereed)
    Abstract [en]

    Objectives The primary objective was to calculate the rate of return to sport (RTS) following anterior cruciate ligament (ACL) reconstruction in elite athletes. Secondary objectives were to estimate the time taken to RTS, calculate rates of ACL graft rupture, evaluate postsurgical athletic performance and identify determinants of RTS. Design Pooled RTS and graft rupture rates were calculated using random effects proportion meta-analysis. Time to RTS, performance data and determinants of RTS were synthesised descriptively. Data sources MEDLINE, EMBASE, AMED, CINAHL, AMI, PEDro, SPORTDiscus and The Cochrane Library were searched from inception to 19 January 2016. Hand searching of 10 sports medicine journals and reference checking were also performed. Eligibility criteria for selecting studies Studies were included if they reported the ratio of elite athletes who returned to their preinjury level of sport following ACL reconstruction. Twenty-four studies were included. Results The pooled RTS rate was 83% (95% CI 77% to 88%). The mean time to RTS ranged from 6 to 13 months. The pooled graft rupture rate was 5.2% (95% CI 2.8% to 8.3%). Six out of nine studies that included a noninjured control group found no significant deterioration in athletic performance following ACL reconstruction. Indicators of greater athletic skill or value to the team were associated with RTS. Summary and conclusions Eighty-three per cent of elite athletes returned to sport following ACL reconstruction, while 5.2% sustained a graft rupture. Most athletes who returned to sport performed comparably with matched, uninjured controls. This information may assist in guiding expectations of athletes and clinicians following ACL reconstruction.

  • 50.
    Larsson, David
    et al.
    Lund University, Sweden.
    Ekstrand, Jan
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Karlsson, Magnus K.
    Skåne University Hospital, Lund University Malmö, Malmö, Skåne, Sweden.
    Fracture epidemiology in male elite football players from 2001 to 2013: How long will this fracture keep me out?2016In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 50, no 12, p. 759-763Article in journal (Refereed)
    Abstract [en]

    Background Determining fracture risk and rehabilitation periods after specific fractures in professional football is essential for team planning. Aim To identify fracture epidemiology and absences after different types of fractures in male professional football players. Methods 2439 players from 41 professional male teams in 10 countries were followed prospectively from 2001 to 2013. Team medical staff registered fractures, absences after fractures and player exposure. Results 364 fractures were recorded, with an incidence of 0.27/1000 h of exposure (95% CI 0.25 to 0.30). The incidence of traumatic fractures was 0.25 (0.22 to 0.27) and that of stress fractures was 0.03 (0.02 to 0.04). 45% of traumatic fractures and 86% of stress fractures affected the lower extremities. Absence after a fracture was 32 days (1-278) (median (range)), compared to that after a traumatic fracture of 30 days (1-278) and a stress fracture of 65 days (6-168) (pamp;lt;0.001). Annual fracture incidence was stable during the study period (R-2=0.051, b=-0.011 (95% CI -0.043 to 0.021)). Young players had a relative risk of 10.9 (3.3 to 35.6) of sustaining stress fractures compared to old players (pamp;lt;0.01). The fracture incidence did not differ between individuals in different playing positions (p=0.10). Summary A male professional football team can expect 1 to 2 fractures per season. There are more traumatic fractures than stress fractures; while most fractures affect the lower extremities, stress fractures yield longer absences than traumatic fractures and young players have more stress fractures than old players. There is no difference in risk among players at different playing positions.

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