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Effect of flexase oil on the prognosis of actual anterior cruciate ligament rupture: a randomized, placebo-controlled trial.

Tang H, Xu Z, Lin J, Sun W and Xiw Y. Ben J Transl Res. 2022;14(10):7252-7259.

Full text is freely available

Take home message

People who supplemented their diet with flaxseed oil experienced slightly better results two years after anterior cruciate ligament (ACL) reconstruction than participants in a control group.

Background

Although we often focus on surgery and rehabilitation to optimize outcomes after an ACL injury, we may also want to consider other strategies to improve one’s prognosis. Flaxseed oil, which contains α-linolenic acid (an omega-3 fatty acid), may suppress inflammation and be beneficial. However, the impact of linseed oil supplementation on recovery after ACL reconstruction remains unclear.

Study aim

Tang and colleagues completed a randomized, placebo-controlled trial to investigate the impact of dietary flaxseed oil on outcomes in people undergoing ACL reconstruction.

Methods

The authors randomized 142 participants undergoing ACL reconstruction into two equal groups. The experimental group took six linseed oil capsules (9 grams total, 4.2 grams of α-linolenic acid) per day. The control group took six corn oil capsules (9 grams total, minimum α-linolenic acid) per day. Dietary supplements were continued for two years after ACL reconstruction. The researchers contacted participants by telephone every two weeks to ensure compliance with study guidelines. After the two-year intervention period, participants completed a series of questionnaires to assess patient-reported outcomes: 1) Knee Injury and Osteoarthritis Outcomes Score (KOOS), 2) International Knee Documentation Committee (IKDC) score, 3) the Lysholm Knee Scoring Scale, and 4) Tegner Activity Scale.

Results

After two years, participants who used flaxseed oil had 1) better IKDC scores, 2) better KOOS scores for sport and quality of life, 3) higher rates of return to their previous sport level (56 vs. 39%), and 4) less side effects to the knee (e.g. giving in episodes, pain) than the control group. The groups had no differences in KOOS pain or symptoms, Tegner scores, Lysholm scores, or treatment satisfaction.

Viewpoints

Participants who received flaxseed oil supplements had slightly better results than those in the control group. This preliminary study shows that a diet supplemented with flaxseed oil high in α-linolenic acid can improve outcomes after ACL reconstruction. It will be interesting to see if other high-quality research confirms these results with flaxseed oil or another source of α-linolenic acid. One detail not mentioned that could be important is dietary habits beyond flaxseed oil. For example, some participants in the control group may have consumed a diet rich in α-linolenic acid.

Clinical implications

Despite the need for more research, doctors can discuss the small benefits and few risks associated with flaxseed oil supplementation. It is also important to remind athletes to purchase supplements that have been tested to ensure they are getting what they expect in each capsule.

Questions for discussion

Do you recommend these or other nutritional supplements for patients who have undergone ACL reconstruction? If so, what did you suggest and what sources led you to recommend this supplement?

Written by Kyle Harris
Reviewed by Jeffrey Driban

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New artificial intelligence technology being developed by engineers at Brigham Young University could significantly reduce the time and costs that go into film studies for Super Bowl teams (and all NFL and college football teams), while also improving game strategy by using harnessing the power of big data.

BYU professor DJ Lee, master’s student Jacob Newman and Ph.D. students Andrew Sumsion and Shad Torrie use AI to automate the time-consuming process of manually analyzing and annotating game footage. Using deep learning and computer vision, the researchers have developed an algorithm that can consistently locate and label players from game films and determine the formation of the attacking team – a process that can consume the time of an array of video assistants.

“We had a conversation about this and realized: We could probably learn an algorithm to do this,” says Lee, professor of electrical and computer engineering. “So we set up a meeting with BYU Football to learn their process and we immediately knew, yes, we can do this a lot faster.”

Although still in the early stages of research, the team has already achieved over 90% accuracy in detecting and tagging players with their algorithm, along with 85% accuracy in determining formations. They believe the technology can ultimately eliminate the need for the inefficient and tedious practice of manual annotation and analysis of recorded video footage used by NFL and college teams.

Lee and Newman first watched real game footage of BYU’s football team. When they started analyzing it, they realized that they needed some additional angles to properly train their algorithm. So they bought a copy of Madden 2020, which shows the court from above and behind the offense, and manually tagged 1,000 images and videos from the game.

They used that footage to train a deep learning algorithm to locate the players, which is then fed into a Residual Network framework to determine what position the players play. Finally, their neural network uses the location and position information to determine which formation (out of more than 25 formations) the offense is using – from the Pistol Bunch TE to the I Form H Slot Open.

Lee said the algorithm can identify formations with 99.5% accuracy if player location and tag information is correct. The I-formation, where four players line up in front of each other – center, quarterback, fullback and running back – proved to be one of the most challenging formations to identify.

Lee and Newman said the AI ​​system could have applications in other sports as well. In baseball, for example, it could pinpoint players’ positions on the field and identify common patterns to help teams refine how they defend against particular hitters. Or it can be used to locate footballers to help determine more efficient and effective formations.

“Once you have this data, you can do a lot more with it; you can take it to the next level,” Lee said. “Big data can help us know this team’s strategies, or that coach’s tendencies. It can help you know if they’re likely to go for it on 4th Down and 2 or if they’re going to punt. The idea of ​​AI to use for sports is really cool, and if we can give them even a 1% advantage, it’s worth it.”

Financial impact of embedded injury prevention experts in US Army initial entry training

Daniel R. Clifton, D. Alan Nelson, Y. Sammy Choi, Daniel Edgeworth, Donald Shell, Patricia A. Deuster. J Athl train 2022; doi: https://doi.org/10.4085/1062-6050-0353.22

Full text freely available

Take home message

By using athletic trainers and certified strength and conditioning specialists in initial entry-level training for the Army, the Army saved at least three times the cost of contracting these professionals, saving $11 to 20 million annually.

Background

More than 1 in 4 men and women suffer a musculoskeletal injury during initial training for the US military. The U.S. Army began deploying teams of athletic trainers and strength and conditioning specialists in 2010 to address the problem of early-career musculoskeletal discharges. The military could demonstrate the need for these teams if we knew how much money they saved by preventing injuries and treating them quickly.

Study objectives

The author’s purpose was to assess whether built-in injury prevention experts were associated with reduced training costs for soldiers discharged early from service.

Methods

The authors conducted a retrospective analysis of 198,166 active-duty soldiers who began training from January 2014 through May 2017. Soldiers who began training at two locations between April 2015 and November 2015 did not have athletic trainers and strength and conditioning specialists on hand. on site due to a lapse in contracts. The authors categorized these soldiers as not coming into contact with injury prevention experts. All other soldiers were categorized as having been exposed to injury prevention experts. The authors estimate soldier training costs based on average basic and advanced training costs from 2014-2017 for an average of six months of training. To be eligible for discharge from active duty, the discharge had to occur within six months of the start of training and due to a musculoskeletal condition.

Results

A total of 14,094 soldiers had no contact with injury prevention experts. 2.8% of these soldiers were discharged early due to musculoskeletal injuries. Of the 184,072 soldiers exposed to injury prevention experts, 1.0% were discharged early due to musculoskeletal injuries. The authors calculated that the injury prevention experts saved the Army $11 to $20 million per year in lost training costs due to early career discharges (net of contract costs for the experts).

Viewpoints

At a relatively small financial cost (approximately $900,000 per location or $4 million total), the Army reduced the likelihood of early discharge by ~64%. There were also significant savings on lost training costs due to early career medical layoffs. We should also keep in mind that these costs do not include other long-term savings. For example, preventing injuries or treating an injury promptly can reduce the risk of medical discharge later in a person’s life due to chronic pain (e.g., osteoarthritis) or save healthcare costs associated with chronic pain or functional limitations. Furthermore, while the costs help justify hiring these experts, we cannot ignore the other benefits that may accrue, including improved soldier quality of life and function and improved military readiness.

Clinical implications

Clinicians and administrators can use this data to advocate for athletic trainers and strength and conditioning specialists in the military and possibly industrial or performing arts fields to demonstrate a 3 to 5x return on investment.

Written by Mitchell Barnhart
Reviewed by Jeffrey Driban

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50th SMR Post: A Human Performance and Injury Prevention Program for the Army
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Most military service members don’t have to worry about CTE

CTE became national news in the United States in 2007, but it was not until 2016 that the National Institute of Neurological Disorders and Stroke/National Institute of Biomedical Imaging and Bioengineering (NINDS-NIBIB) criteria for the neuropathological diagnosis of CTE were published. and they were refined in 2021. Rare, isolated case studies that reported abnormal findings or used unaccepted diagnostic criteria have been disproportionately emphasized to cast doubt on the link between RHI and CTE.

In a review article in the magazine Acta NeuropathologicaAnn McKee, MD, chief of neuropathology at VA Boston Healthcare System and director of the BU CTE Center, emphasizes that more than 600 CTE cases have now been published in the literature from multiple international research groups. And of the more than 600 cases, 97 percent have confirmed exposure to RHI, mainly through contact and collision sports. CTE has been diagnosed in amateur and professional athletes, including athletes from American, Canadian and Australian football, rugby union, rugby league, soccer, ice hockey, bull riding, wrestling, mixed martial arts and boxing.

Additionally, the study authors revealed that in 82 percent (14 of 17) of alleged CTE cases that occurred without RHI, using current criteria, families were never asked what sports the deceased played.

According to the researchers, despite global efforts to find CTE in the absence of contact sports participation or exposure to RHI, it appears to be exceedingly rare, if it exists at all. “In community brain bank studies, CTE was seen in 0 to 3 percent of cases, and where information is available, positive cases were exposed to brain injury or RHI. In contrast, CTE is the most common diagnosis of neurodegenerative diseases in contact and collision athletes in brain banks around the world. A strong dose-response relationship is perhaps the strongest evidence that RHI causes CTE in athletes,” she added.

“The review presents the timeline for the development of neuropathological criteria for the diagnosis of CTE, begun nearly 100 years ago by pathologist Harrison Martland, who introduced the term ‘punch-drunk’ to describe a neurological condition in low-cost carriers, ” explains McKee. author of the study. The review chronologically describes the multiple studies conducted by independent, international groups examining diverse populations that have found CTE pathology from various sources in individuals with a history of RHI.”

CTE is characterized by a distinctive molecular structural configuration of p-tau fibrils that is different from the changes seen in aging, Alzheimer’s disease, or any other disease caused by tau protein.

Funding for this study was provided by the National Institute of Neurological Disorders and Stroke (U54NS115266; R01NS119651; U01 NS 086659), National Institute on Aging (P30AG13846; U19AG06875; R01AG062348; RF1AG057902; K01AG070326), Department of Veterans Affairs (10 1 BX002466, 101BX004613, BX004349), the Nick and Lynn Buoniconti Foundation, Andlinger Foundation, National Football League (NFL) and World Wrestling Entertainment (WWE) through unrestricted gifts, the Mac Parkman Foundation and the National Operating Committee on Safety for Sports Equipment (NOCSEA).

Effects of cold water immersion compared to other recovery modalities on athletic performance after acute strenuous exercise in physically active participants: a systematic review, meta-analysis and meta-regression.

Moore E, Fuller JT, Bellenger CR, Saunders S, Halson SL, Broatch JR, Buckley JD. Sports Med. December 17, 2022. doi: 10.1007/s40279-022-01800-1. E-publishing prior to printing. PMID: 36527593.

Full text freely available

Take home message

During post-exercise recovery, cold water immersion (CWI) provides similar benefits to other recovery methods, including active recovery.

Background

Cold water immersion (CWI) is one of several methods intended to speed recovery after training and competition. However, it is unclear whether CWI performs better than other commonly used recovery modalities.

Study aim

The researchers conducted a systematic review and meta-analysis to compare CWI with other modalities regarding athletes’ perceptions, physiological changes, and exercise performance outcomes.

Methods

The authors identified 28 articles through a comprehensive literature search for articles that met specific criteria: (1) peer-reviewed randomized controlled trials, (2) included physically active participants, (3) used CWI after acute physical activity, (4) included a other recovery intervention, and (5) outcomes include recovery of exercise performance, muscle strength, or physiological or perceptual markers of recovery. They excluded articles if participants received CWI in combination with another intervention or if participants completed more than one exercise session. The authors extracted data from the included articles: publication information, study methodology, participant information, CWI protocol, comparator recovery protocol, and assessment measures. They then assessed the quality of each study using the SIGN Checklist for Randomized Clinical Trials. During analyses, the authors examined follow-up assessments at 1, 24, 48, and 72 hours after treatment. Alternative treatments typically include active recovery, massage, contrast water therapy, warm water immersion, and cryotherapy.

Results

Overall, the quality of the included studies was low, with only one considered ‘high quality’ and 24 ‘acceptable quality’. Compared to other recovery methods, the authors found that CWI generally had limited or no effect on the perception of recovery and recovery from 1) delayed-onset muscle soreness, 2) strength performance, 3) strength, 4) flexibility, or 5) physiological problems. markers of muscle damage. Water temperature and treatment duration were not related to the outcomes after KWI.

Viewpoints

Cold water immersion is comparable to other recovery modalities, if not slightly better. The exception, however, was aerial cryotherapy, which may outperform CWI, but future studies need to confirm this. Ultimately, CWI is more clinically accessible than air cryotherapy and should be acceptable because it is comparable to other recovery methods. In fact, there was virtually no difference between active recovery and CWI, providing a more practical and easily accessible recovery method for recreationally active people and those without access to CWI. It would have been interesting to know if the results for CWI differed if the person did partial or full body immersion.

Clinical implications

Clinicians should be aware that CWI provides no or minimal improvement in recovery compared to alternative recovery methods. They need to communicate these findings to patients so they can make informed treatment decisions about whether to perform CWI, air cryotherapy, or active recovery.

Questions for discussion

Under what circumstances do you, as a doctor, prefer CWI over other recovery methods? What feedback have you received from your patients?

Written by Kyle Harris
Reviewed by Jeffrey Driban

related posts

Cold water immersion for the prevention and treatment of muscle pain after exercise
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“While I understand the excitement, we must consider how to prevent injuries as athletes adopt this new footwear,” said lead author Adam Tenforde, MD, physician in Mass General Brigham’s Sports Medicine program and medical director of the Spaulding National Running Center. “We hope this current opinion will help better recognize potential medical problems associated with CFP shoes, the appropriate use of this new technology, and how to develop methods to use these shoes safely.”

In their publication, Tenforde and colleagues describe five patient cases, including junior elite track and field athletes in Europe and two athletes in their mid-30s who participated in endurance sports events in North America. All five experienced foot pain after wearing shoes with carbon fiber plates and were later diagnosed with navicular stress injury (BSI).

“Recognizing possible associations with navicular disease in runners with vague metatarsal or ankle pain wearing CFP shoes may be important to identify this high-risk injury,” the authors write.