Patellofemoral joint loads in ACL reconstructed elite athletes during running at time of return to sport

Background: Patellofemoral joint pain and degeneration is common in patients who undergo ACL reconstruction (ACLR). The presence of patellofemoral joint pain significantly impacts on the ability to continue to participate in sport and may even have a bearing on participation in activities of daily living. What is currently unclear is the mechanisms behind this process, previous research has identified altered patellofemoral joint loading in individuals with patellofemoral joint pain when running. It is unclear if this process is occurring following ACLR. Hypothesis/Purpose: To assess the patellofemoral joint stresses during running in ACLR knees and compare the findings to non-injured knee and matched control knees. Study Design: Cohort study Methods: Thirty four elite sports practitioners who had undergone ACLR and thirty four age and sex matched controls participated in the study. The participants had their running gait assessed using 3D motion capture, and knee loads and forces calculated using inverse dynamics. Results: There was a significance difference in knee extensor moment, knee flexion angles, patellofemoral contact force (around 23% greater), and patellofemoral contact pressure (around 27% greater) between the ACLR and non-injured limb (p≤0.04) and the ACLR and control limb (p≤0.04), with no significant difference between the non-injured and control limbs (p≥0.44). Conclusion: Significantly greater levels of patellofemoral joint stress and load were found in the ACLR knee compared to the non-injured and control knees. Clinical Relevance: Altered levels of patellofemoral stress in the ACLR knee during running may predispose these individuals to patellofemoral joint pain

Does the Powers™ strap influence the lower limb biomechanics during running?

Previous research has reported a prevalence of running related injuries in 25.9% to 72% of all runners. A greater hip internal rotation and adduction during the stance phase in running has been associated with many running related injuries, such as patellofemoral pain. Researchers in the USA designed a treatment device 'the PowersTM strap' to facilitate an external rotation of the femur and to thereby control abnormal hip and knee motion during leisure and sport activities. However, to date no literature exists to demonstrate whether the PowersTM strap is able to reduce hip internal rotation during running. 22 healthy participants, 11 males and 11 females (age: 27.45 ±4.43 years, height: 1.73 ± 0.06m, mass: 66.77 ±9.24kg) were asked to run on a 22m track under two conditions: without and with the PowersTM strap. Threedimensional motion analysis was conducted using ten Qualisys OQUS 7 cameras (Qualisys AB, Sweden) and force data was captured with three AMTI force plates (BP600900, Advanced Mechanical Technology, Inc.USA). Paired sample t-tests were performed at the 95% confidence interval on all lower limb kinematic and kinetic data. The PowersTM strap significantly reduced hip and knee internal rotation throughout the stance phase of running. These results showed that the PowersTM strap has the potential to influence hip motion during running related activities, in doing so this might be beneficial for patients with lower limb injuries. Future research should investigate the influence of the PowersTM strap in subjects who suffer from running related injuries, such as patellofemoral pain

The influence of an off the shelf lateral wedge orthotic on knee loading during running

Knee injuries are prevalent in sports and associated with degenerative changes to the joint (Silverwood et al.,2015). High external knee adduction moments (EKAMs), knee adduction angular impulses (KAAIs) and knee flexion moments (KFMs) have been associated with increased cartilage deterioration (Chehab, Favre, Erhart-Hledik, & Andriacchi, 2014). Lateral wedge insoles (LWIs) have demonstrated reductions in biomechanical loading (EKAM, KAAI) associated with osteoarthritis progression during walking in individuals with osteoarthritis (OA; Jones, Chapman, Forsythe, Parkes, & Felson, 2014). Younger individuals who sustain a knee injury during sport are likely to return to physical activity following treatment (Kim, Nagao, Kamata, Maeda, & Nozawa, 2013). With increased risk of developing knee OA, identifying preventative measures to delay the progression of OA during dynamic tasks such as running is required

Dietary Intakes of Elite 14 - 19 Year Old English Academy Rugby Players During a Pre-Season Training Period.

Good nutrition is essential for the physical development of adolescent athletes, however data on dietary intakes of adolescent rugby players are lacking. This study quantified and evaluated dietary intake in 87 elite male English academy rugby league (RL) and rugby union (RU) players by age (under-16 (U16) and under-19 (U19) years old) and code (RL and RU). Relationships of intakes with body mass and composition (sum of 8 skinfolds) were also investigated. Using 4-day diet and physical activity diaries, dietary intake was compared to adolescent sports nutrition recommendations and the UK national food guide. Dietary intake did not differ by code, whereas U19s consumed greater energy (3366 ± 658 vs. 2995 ± 774 kcal.day-1), protein (207 ± 49 vs. 150 ± 53 g.day-1) and fluid (4221 ± 1323 vs. 3137 ± 1015 ml.day-1) than U16s. U19s consumed a better quality diet than U16s (greater intakes of fruit and vegetables; 4.4 ± 1.9 vs. 2.8 ± 1.5 servings.day-1; non-dairy proteins; 3.9 ± 1.1 vs. 2.9 ± 1.1 servings.day-1) and less fats and sugars (2.0 ± 1. vs. 93.6 ± 2.1 servings.day-1). Protein intake vs. body mass was moderate (r = 0.46, p < 0.001), and other relationships were weak. The findings of this study suggest adolescent rugby players consume adequate dietary intakes in relation to current guidelines for energy, macronutrient and fluid intake. Players should improve the quality of their diet by replacing intakes from the fats and sugars food group with healthier choices, while maintaining current energy, and macronutrient intakes

Braking characteristics during cutting and pivoting in female soccer players

Biomechanical studies into changing direction focus on final contact (FC), whilst limited research has examined penultimate contact (PEN). The aim of this study was to explore the kinematic and kinetic differences between PEN and FC of cutting and pivoting in 22 female soccer players (mean ± SD; age: 21 ± 3.1 years, height: 1.68 ± 0.07 m, mass: 58.9 ± 7.3 kg). Furthermore, the study investigated whether horizontal force-time characteristics during PEN were related to peak knee abduction moments during FC. Three dimensional motion analyses of cutting and pivoting on the right leg were performed using Qualysis ‘Pro-reflex’ infrared cameras (240Hz). Ground reaction forces (GRF) were collected from two AMTI force platforms (1200Hz) to examine PEN and FC. Both manoeuvres involved significantly (P < 0.05) greater knee joint flexion angles, peak horizontal GRF, but lower average horizontal GRF during PEN compared to FC. Average horizontal GRF during PEN (R = -0.569, R2 = 32%, P = 0.006) and average horizontal GRF ratio (R = 0.466, R2 = 22%, P = 0.029) were significantly related to peak knee abduction moments during the FC of cutting and pivoting, respectively. The results indicate PEN during pre-planned changing direction helps reduce loading on the turning leg where there is greater risk of injuries to knee ligaments

The impact of conditionality on the welfare rights of EU migrants in the UK

This paper highlights and explores how conditionality operating at three levels (the EU supra-national level, the UK national level and in migrants’ mundane ‘street level’ encounters with social security administrators), come together to restrict and have a negative impact on the social rights of EU migrants living in the UK. Presenting analysis of new data generated in repeat qualitative interviews with 49 EU migrants resident in the UK, the paper makes an original contribution to understanding how the conditionality inherent in macro level EU and UK policy has seriously detrimental effects on the everyday lives of individual EU migrants

Housing works : assessing the impact of housing association employment support

Social housing providers in the UK have a long history of delivering support to their residents beyond housing, including providing employment related assistance. A small but growing area of research investigates the role of employment support outside the mainstream welfare system. However, little is known about the support provided, the impact it has on individuals’ prospects in the labour market, and related outcomes for housing providers, the taxpayer and wider society. As increasing numbers of people are expected to engage in work search and other work preparation activities in exchange for continued receipt of welfare benefits, the impact of housing provider employment support needs to be better understood. The membership of Give us a Chance (GUAC) have, as housing associations, been involved in a range of initiatives to improve the employment and life chance outcomes of their residents, including working with employment support organisations and the voluntary and community sector. However, there is considerable variation in the way that housing association employment support is currently provided, and a wide range of tools and measures are used to show the value of these initiatives, from specific organisational measures through to more generic approaches, such as the Housing Associations’ Charitable Trust (HACT) measures and the New Economy Cost Benefit Analysis (CBA) model. Hence, it is often difficult to compare the value of projects based on different approaches and measured using different tools. This research had two key aims: to contribute to an understanding of what helps people to move closer to, enter or sustain employment and to demonstrate the value of housing association investment in employment related support for residents. The project had the following linked objectives: 1. Provide a review of housing association employment related support activity; 2. Undertake a review of the impact measures currently used for employment related support across the social housing sector; and 3. Provide an understanding of ‘what works’ in terms of employment related support and the measures used among GUAC members

Welfare conditionality and disabled people in the UK: claimants' perspectives

In order to fully understand the impact of the extension of conditionality in the UK to include people with impairments, it is vital to give voice to those with direct experience of the welfare system. The case studies that follow are taken from interviews carried out as part of a project called Welfare Conditionality: Sanctions, Support and Behaviour Change. This is a major five-year programme of research running from 2013-2018, funded under the Economic and Social Research Council’s Centres and Large Grants Scheme (ESRC grant ES/K002163/2)

Activation of Cells Containing Estrogen Receptor Alpha or Somatostatin in the Medial Preoptic Area, Arcuate Nucleus, and Ventromedial Nucleus of Intact Ewes During the Follicular Phase, and Alteration after Lipopolysaccharide

Cells in the medial preoptic area (mPOA), arcuate nucleus (ARC), and ventromedial nucleus (VMN) that possess estrogen receptor alpha (ER alpha) mediate estradiol feedback to regulate endocrine and behavioral events during the estrous cycle. A percentage of ER alpha cells located in the ARC and VMN express somatostatin (SST) and are activated in response to estradiol. The aims of the present study were to investigate the location of c-Fos, a marker for activation, in cells containing ER alpha or SST at various times during the follicular phase and to determine whether lipopolysaccharide (LPS) administration, which leads to disruption of the luteinizing hormone (LH) surge, is accompanied by altered ER alpha and/or SST activation patterns. Follicular phases were synchronized with progesterone vaginal pessaries, and control animals were killed at 0, 16, 31, and 40 h (n = 4–6/group) after progesterone withdrawal (PW [time 0]). At 28 h, other animals received LPS (100 ng/kg) and were subsequently killed at 31 h or 40 h (n = 5/group). Hypothalamic sections were immunostained for c-Fos and ER alpha or SST. LH surges occurred only in control ewes with onset at 36.7 ± 1.3 h after PW; these animals had a marked increase in the percentage of ER alpha cells that colocalized c-Fos (%ER alpha/c-Fos) in the ARC and mPOA from 31 h after PW and throughout the LH surge. In the VMN, %ER alpha/c-Fos was higher in animals that expressed sexual behavior than in those that did not. SST cell activation in the ARC and VMN was greater during the LH surge than in other stages in the follicular phase. At 31 or 40 h after PW (i.e., 3 or 12 h after treatment, respectively), LPS decreased %ER alpha/c-Fos in the ARC and the mPOA, but there was no change in the VMN compared to that in controls. The %SST/c-Fos increased in the VMN at 31 h after PW (i.e., 3 h after LPS) with no change in the ARC compared to controls. These results indicate that there is a distinct temporal pattern of ER alpha cell activation in the hypothalamus during the follicular phase, which begins in the ARC and mPOA at least 6–7 h before the LH surge onset and extends to the VMN after the onset of sexual behavior and LH surge. Furthermore, during the surge, some of these ER alpha-activated cells may be SST-secreting cells. This pattern is markedly altered by LPS administered during the late follicular phase, indicating that the disruptive effects of this stressor are mediated by suppressing ER alpha cell activation at the level of the mPOA and ARC and enhancing SST cell activation in the VMN, leading to the attenuation of the LH surge

Work, welfare and wellbeing? The impacts of welfare conditionality on people with mental health impairments in the UK

The personal, economic and social costs of mental ill-health are increasingly acknowledged by many governments and international organisations. Simultaneously, in high income nations the reach of welfare conditionality has extended to encompass many people with mental health impairments as part of on-going welfare reforms. This is particularly the case in the UK where, especially since the introduction of Employment and Support Allowance (ESA) in 2008, the rights and responsibilities of disabled people have been subject to contestation and redefinition. Following a review of the emergent international evidence on mental health and welfare conditionality, this paper explores two specific issues. First, the impacts of the application of welfare conditionality on benefit claimants with mental health impairments. Second, the effectiveness of welfare conditionality in supporting people with experience of mental ill health into paid work. In considering these questions this paper presents original analysis of data generated in qualitative longitudinal interviews with 207 UK social security benefit recipients with experience of a range of mental health issues. The evidence suggests that welfare conditionality is largely ineffective in moving people with mental health impairments into, or closer to, paid work. Indeed, in many cases it triggers negative health outcomes that make future employment less likely. It is concluded that the application of conditionality for people with mental health issues is inappropriate and should cease