DOCSLIB.ORG

The Use of Platelet-Rich-Plasma (PRP)

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
The Use of Platelet-Rich-Plasma (PRP) Review article The use of platelet-rich plasma to augment conservative and surgical treatment of hip and pelvic disorders Matthew J. Kraeutler 1 KEY WORDS: hamstring tendinopathy, hip osteoarthritis, Tigran Garabekyan 2 osteitis pubis, microfracture, platelet-rich plasma. Omer Mei-Dan 3 1 University of Colorado School of Medicine, Introduction Department of Orthopedics, Aurora, USA 2 Platelet-rich plasma (PRP) has gained popularity within Southern California Hip Institute, North Hollywood, the last decade among the orthopaedic community as a CA, USA 3 treatment modality to enhance tissue healing. The term Hip Preservation/ Sports Medicine/Orthopedics platelet-rich plasma may be applied to any fraction of University of Colorado autologous blood that contains a higher concentration of platelets than baseline 1. Thus, this term is non-spe - Corresponding author: cific and factors such as the concentration of platelets Omer Mei-Dan and leukocytes as well as centrifugation methods have Hip Preservation/Sports Medicine/Orthopedics differed between studies. DeLong et al. 2 developed the University of Colorado PAW classification system to aid in comparing different 12631 East 17th Avenue protocols of PRP preparation. This classification system Mail Stop B202, Room L15-4505 is based on the absolute number of platelets (P), the Aurora, Colorado 80045 (USA) method of platelet activation (A), and the presence/ab - E-mail: [email protected] sence of white cells (W). Recently, PRP has been utilized for numerous muscu - loskeletal indications such as rotator cuff repair 3,4 , Summary patellar tendinopathy 5, knee osteoarthritis 6, lateral epi - condylitis 7, osteochondral lesions of the talus 8, and Background: In recent years, platelet-rich plasma many other orthopaedic conditions. PRP induces mus - (PRP) has gained popularity within the orthopaedic culoskeletal healing through a number of effects. As a community as a treatment modality to enhance tis - treatment modality for tendon healing, PRP enhances sue healing. 9 the mobilization of circulation-derived cells . This may Purpose: This review aims to concisely present the include inflammatory cells that secrete cytokines and current indications for PRP injections in the treat - growth factors as well as fibroblast-like cells that syn - ment of hip and pelvic pathologies and to describe thesize matrix. Compared to serum, PRP has been some novel applications for PRP which have not shown to significantly increase the deposition of a colla - yet been reported in the literature. gen-rich extracellular matrix 10 , with higher collagen I 11 Methods : We reviewed the literature on the non-op - content compared to placebo . Interestingly, PRP- erative and operative indications for PRP in the treated tendon tears have actually been shown to con - treatment of hip and pelvic pathologies. tain fewer blood vessels compared to placebo 11 , possi - Conclusions: With regard to hip and pelvic patholo - bly indicating a more physiological healing process. gies, PRP injections are used most commonly as a Once PRP enhances the early phase of regeneration, non-operative intervention, and have been de - mechanical stimulation is required to promote orga - scribed in the literature to treat osteoarthritis of the nized collagen synthesis and remodeling during new 12 hip joint as well as tendinopathy of the hamstrings, tendon development . adductor longus, and gluteus medius. In contrast, With muscle strains or contusions, the hematoma that most of the surgical applications of PRP for the hip originates contains approximately 94% red blood cells, 13 are novel, with few reported studies in the litera - 4% platelets, and <1% leukocytes . Compared to ture. Because of the increasing awareness of PRP’s whole blood, PRP contains higher concentrations of beneficial effects on musculoskeletal healing and certain growth factors, in particular platelet-derived b thus the growing number of indications for its use, growth factor (PDGF) and transforming growth factor- b 14 this review also describes some novel applications (TGF- ) . Thus, PRP is theorized to replace the for PRP, including osteitis pubis, post-microfrac - hematoma with a high concentration of platelets and ture of the hip, tears of the rectus femoris, and growth factors to promote healing. Furthermore, PRP avulsion of the sartorius muscle. has been shown to promote angiogenesis through acti - Level of evidence: V. vation of PRP-releasate (PRP-r) 15 . In comparison to 410 Muscles, Ligaments and Tendons Journal 2016;6 (3):409-419 The use of platelet-rich plasma to augment conservative and surgical treatment of hip and pelvic disorders tendon and muscle healing, little is known on the mech - trate are activated with calcium chloride and/or autolo - anisms of PRP in promoting healing of articular carti - gous or bovine thrombin. These additions are used to lage, though this likely involves multiple biological initiate the clotting cascade, the release of growth fac - processes including apoptosis, extracellular matrix syn - tors from the platelets, and the formation of a fibrin 16 20 thesis, angiogenesis, and inflammation . Because of scaffold . Autologous thrombin has been shown to the increasing awareness of PRP’s beneficial effects on have a lower clot strength compared to bovine thrombin musculoskeletal healing and thus the growing number or calcium chloride, with bovine thrombin having the 21 of indications for its use, we present a review of the quickest clot initiation time . In an equine model, calci - current indications for platelet-rich plasma injections to um chloride activation of PRP has been shown to result augment the conservative and surgical treatment of hip in greater release of platelet-derived growth factor com - 22 and pelvic pathologies and describe some novel appli - pared to autologous or bovine thrombin . Calcium cations for PRP which have not yet been described in chloride also provides the advantage of not using the literature. Although several studies have described bovine or other non-autologous materials. the use of PRP for some of these pathologies, other in - Therapeutic doses of PRP require 2.5-5 times the dications for PRP discussed in this review have not baseline concentration of platelets 23,24 , though higher been published previously. As such, these indications concentrations than this have an inhibitory effect on 25 are not yet evidence-based. This article submits to the healing . The white blood cell concentration may also 17 ethical standards of the journal . be controlled, with leukocyte-rich PRP (L-PRP) and leukocyte-poor PRP (P-PRP) both being used in the lit - erature. For production of L-PRP, the entire layer of the Decision-making buffy coat and few RBCs are transferred to an empty sterile tube, while the upper layer and only the superfi - After performing an appropriate patient history and cial buffy coat are transferred for production of P- 19 physical examination, advanced imaging is typically ob - PRP . Plasma rich in growth factors (PRGF) is a term tained to better characterize the suspected pathology. used to describe a leukocyte-poor PRP which is sepa - With muscle or tendon tears, magnetic resonance rated manually (direct visualization using a fine pipette) imaging (MRI) or ultrasound (US) should be used to de - from the lower fraction of the plasma containing the termine the exact location and extent of the injury. De - highest concentration of platelets and growth factors, pending on the pathology, PRP may be used as a con - avoiding the thin WBC layer. PRGF techniques have servative treatment measure or as adjunctive treatment been shown to produce lower concentrations of growth during surgery. When used as a conservative treatment factors compared to standard PRP kits by 3-4 fold 26 option, PRP may be applicable for tendinopathic which, according to many studies, may serve as the op - changes or partial tendon tears in which the tendon timal ratio for tissue healing. 1 ends are not retracted . When a tendon or muscle is injured, healing proceeds The cost of platelet-rich plasma treatment is certainly a through three processes: inflammation/degeneration, 1 factor in the decision-making process. Insurance com - regeneration, and fibrosis . Although L-PRP has been panies still do not recognize PRP as standard of care, shown to contain the highest levels of growth factors and thus PRP must be paid by patients out of pocket. It and cytokines 27 , it induces catabolic effects and a sig - has been estimated recently that the cost of PRP is nificantly greater acute inflammatory response and thus 18 27-30 $500 to $1,500 per application . It is important to have may actually prolong the healing process . Thus, the an open discussion regarding the cost of PRP injec - inclusion of white cells defeats the purpose of PRP. On tions, given that it may be prohibitively expensive for the other hand, P-PRP induces mainly anabolic some patients. changes, and while this is generally a beneficial out - come, it could also result in scar tissue formation due to 27,30 these anabolic effects . Still, no randomized or Preparation and application techniques prospective clinical studies have been performed to compare outcomes between leukocyte-rich versus A sample of whole blood is collected in a sodium citrate leukocyte-poor PRP. tube in order to delay clotting of the blood sample. Once the whole blood sample is collected, centrifuga - tion allows separation of the sample into its component Non-operative applications cells and serum. Either one or two centrifugation steps may be used depending on the final product desired. A Platelet-rich plasma injections are used most commonly “soft” spin separates the whole blood sample into three as an adjunct to conservative treatment. In cases of layers: an upper layer consisting mainly of plasma and chronic tendinopathy or osteoarthritis, PRP is typically platelets, a very thin middle layer known as the “buffy indicated when first-line treatment (physical therapy, coat” that is highly concentrated in WBCs, and a bot - rest) fails. For professional athletes, in-season PRP 19 tom layer consisting mainly of red blood cells (RBCs) .
Load more

Recommended publications
  • MUSCULOSKELETAL MRI Temporomandibular Joints (TMJ) Temporomandibular Joints (TMJ) MRI - W/O Contrast
    MUSCULOSKELETAL MRI Temporomandibular Joints (TMJ) Temporomandibular joints (TMJ) MRI - W/O Contrast . CPT Code 70336 • Arthritis • TMJ disc abnormality • Osteonecrosis (AVN) Temporomandibular joints (TMJ) MRI - W and W/O Contrast . CPT Code 70336 • Arthritis/Synovitis • Mass/Tumor Chest Chest Wall/Rib, Sternum, Bilateral Pectoralis Muscles, Bilateral Clavicles MRI - W/O Contrast . CPT Code 71550 • Rib fracture, costochondral cartilage injury • Muscle, tendon or nerve injury Chest Wall/Rib, Sternum, Bilateral Pectoralis Muscles, Bilateral Clavicles MRI - W and W/O Contrast . CPT Code 71552 • Mass/Tumor • Infection Upper Extremity (Non-Joint) Scapula MRI - W/O Contrast . CPT Code 73218 • Fracture • Muscle, tendon or nerve injury Scapula MRI - W and W/O Contrast . CPT code 73220 • Mass/Tumor • Infection Humerus, Arm MRI - W/O Contrast . CPT Code 73218 • Fracture • Muscle, tendon or nerve injury Humerus, Arm MRI - W and W/O Contrast . CPT Code 73220 • Mass/Tumor • Infection Forearm MRI - W/O Contrast . CPT Code 73218 • Fracture • Muscle, tendon or nerve injury Forearm MRI - W and W/O Contrast . CPT Code 73220 • Mass/Tumor • Infection Hand MRI - W/O Contrast. CPT Code 73218 • Fracture • Muscle, tendon or nerve injury Hand MRI - W and W/O Contrast . CPT Code 73220 • Mass/Tumor • Infection • Tenosynovitis Finger(s) MRI - W/O Contrast. CPT Code 73218 • Fracture • Muscle, tendon or nerve injury Finger(s) MRI - W and W/O Contrast . CPT Code 73220 • Mass/Tumor • Infection • Tenosynovitis Upper Extremity (Joint) Shoulder MRI - W/O Contrast. CPT Code 73221 • Muscle, tendon (rotator cuff) or nerve injury • Fracture • Osteoarthritis Shoulder MRI - W Contrast (Arthrogram only; no IV contrast) . CPT Code 73222 • Labral (SLAP) tear • Rotator cuff tear Shoulder MRI - W and W/O Contrast .
    [Show full text]
  • Eastern Athletic Trainers' Association Annual Meeting & Clinical Symposium Cd Subject Index
    EASTERN ATHLETIC TRAINERS’ ASSOCIATION ANNUAL MEETING & CLINICAL SYMPOSIUM CD SUBJECT INDEX 11/18/06 A ACI Questioning Skills (abstract)- 2006 ACL Injuries in Females-2004 ACL Surgery Workshop-2006 Acute Trauma With Recurrent Shoulder Instability (abstract)- 2006 Adherence To Rehabilitation- Research To Reality Presentation 2006 Alternatives to NSAIDS- 2006 An Infrapatellar Fat Pad Tear In A High School Athlete (abstract)- 2007 An Outcomes Analysis Of A Sports Medicine Approach To Prevent And Manage Work-Related Low Back Pain (abstract)- 2007 Anatomical and Biomechanical Assessments of Medial Tibial Stress Syndrome (abstract)- 2006 Anatomical Evaluation of Tibial Nerve (abstract)- 2006 Ankle Anatomy- 2004 Ankle- Chronic Dysfunction Test (abstract)- 2004 Ankle Injury- Return to Play Criteria- 2004 Ankle Research Update-2004 Ankle-Talar Dome Injury (abstract)- 2004 Anterior Cruciate Ligament Injury Of The Knee With Secondary Development Of A Deep Vein Thrombosis In An Intercollegiate Female Volleyball Player (abstract)- 2007 Aquatic Plyometric Training Program (abstract)- 2006 Aquatic Therapy- 2004 Asthma- 2004 Athletic Training Students’ Perception of Their Retention in Undergrad AT Programs (abstract)-04 Athletic Training Students’ Use Of Time During Clinical Education Experiences: A Case Study Approach Using Time Profiles (abstract) – 2005 Athletic Pubalgia And Adductor Tendon Avulsion Repair In A Collegiate Football Player (abstract)- 2007 Auscultation Skills- 2004 Automated External Defibrillators- 2004 Avulsion Fracture Of Lesser
    [Show full text]
  • Preventing Athletic Pubalgia and Chronic Groin Pain in the Soccer Player Layout 1
    ERFORMANCE P SOCCER CONDITIONING A NEWSLETTER DEDICATED TO IMPROVING SOCCER PLAYERS www.performancecondition.com/soccer Preventing Athletic Pubalgia and Chronic Groin Pain in the Soccer Player Chet North The Many Causes of Groin Pain There can be pain in the hip area because of the many different structures there. You have glands that fight off infection plus muscles and tendons located in your upper thighs under the crease of your thigh and abdomen. There is a lot going on in this area. Adding to the situation in highly competitive soccer, even the articulating surface of the hips can cause some pain. With all this it's really hard to differentiate what the pain might be. Is it an articulating surface? Tendonitis? Rupture of a muscle or tendon? Or is it a situation where a tendon separated from part of a bone? There are many causes of pain in this very mobile area. As a coach, to call it pubalgia in the training room or on the soccer field is hard to do. It might be a strain or tendonitis of an adductor, which pulls the hip in. It might be a hip flexor, which brings the hip forward. It might be a pubalgia-type injury where you have strain of the abdominal wall and structures of the lower abdominal area; however, it's hard to determine. It's vague, and that's why you want to have a doctor look at these symptoms early on. A lot of the injuries we think are just muscle strains can be much more than that.
    [Show full text]
  • Printable Notes
    12/9/2013 Diagnosis and Treatment of Hip Pain in the Athlete History Was there an injury? Pain Duration Location Type Better/Worse Severity Subjective Jonathan M. Fallon, D.O., M.S. assessment Shoulder Surgery and Operative Sports Medicine Sports www.hamportho.com Hip and Groin Pain Location, Location , Location 1. Inguinal Region • Diagnosis difficult and 2. Peri-Trochanteric confusing Compartment • Extensive rehabilitation • Significant risk for time loss 3. Mid-line/abdominal Structures • 5‐9% of sports injuries 3 • Literature extensive but often contradictory 1 • Consider: 2 – Bone – Soft tissue – Intra‐articular pathology Differential Diagnosis Orthopaedic Etiology Non‐Orthopaedic Etiology Adductor strain Inguinal hernia Rectus femoris strain Femoral hernia Physical Examination Iliopsoas strain Peritoneal hernia Rectus abdominus strain Testicular neoplasm Gait Muscle contusion Ureteral colic Avulsion fracture Prostatitis Abdominal Exam Gracilis syndrome Epididymitis Spine Exam Athletic hernia Urethritis/UTI Osteitis pubis Hydrocele/varicocele Knee Exam Hip DJD Ovarian cyst SCFE PID Limb Lengths AVN Endometriosis Stress fracture Colorectal neoplasm Labral tear IBD Lumbar radiculopathy Diverticulitis Ilioinguinal neuropathy Obturator neuropathy Bony/soft tissue neoplasm Seronegative spondyloarthropathy 1 12/9/2013 Physical Examination • Point of maximal tenderness Athletic Pubalgia – Psoas, troch, pub sym, adductor – Gilmore’s groin (Gilmore • C sign • ROM 1992) • Thomas Test: flexion contracture – Sportsman’s hernia • McCarthy Test: labral pathology (Malycha 1992) • Impingement Test – Incipient hernia 3 • Clicking: psoas vs labrum • Resisted SLR: intra‐articular – Hockey Groin Syndrome – • Ober: IT band Slapshot Gut • FABER: SI joint – Ashby’s inguinal ligament • Heel Strike: Femoral neck • Log Roll: intra‐articular enthesopathy • Single leg stance –Trendel. Location, Location , Location Athletic Pubalgia - Natural History 1.
    [Show full text]
  • MEDICAL JOURNAL (USPS 464-820), a Monthly Publication, Is MICHAEL K
    RHODE ISLAND M EDICAL J OURNAL SPECIAL SECTION SPORTS MEDICINE GUEST EDITOR: RAZIB KHAUND, MD OCTOBER 2016 VOLUME 99 • NUMBER 10 ISSN 2327-2228 Your records are secure. Until they’re not. Data theft can happen to anyone, anytime. A misplaced mobile device can compromise your personal or patient records. RIMS-IBC can get you the cyber liability insurance you need to protect yourself and your patients. Call us. 401-272-1050 IN COOPERATION WITH RIMS-IBC 405 PROMENADE STREET, SUITE B, PROVIDENCE RI 02908-4811 MEDICAL PROFESSIONAL/CYBER LIABILITY PROPERTY/CASUALTY LIFE/HEALTH/DISABILITY RHODE ISLAND M EDICAL J OURNAL 18 Collaboration and Collegiality: The Fuel For Growth in Sports Medicine RAZIB KHAUND, MD GUEST EDITOR R. Khaund, MD 19 Preparticipation Physical Exams: The Rhode Island Perspective, A Call for Standardization PETER K. KRIZ, MD,FAAP, FACSM AILIS CLYNE, MD, MPH, FAAP SARA R. FORD, MD, FAAP On the cover P. Kriz, MD A. Clyne, MD S. Ford, MD Photos: CDC, Public Health Image 23 Current Concepts in Library/Amanda Mills Sports-related Concussion http://phil.cdc.gov/phil/home.asp JEFFREY P. FEDEN, MD J. Feden, MD 27 Diagnosis and Management of Meniscal Injury JACOB BABU, MD, MHA ROBERT M. SHALVOY, MD STEVE B. BEHRENS, MD J. Babu, MD R. Shalvoy, MD S. Behrens, MD 31 Understanding Athletic Pubalgia: A Review BRIAN COHEN, MD DOMINIC KLEINHENZ, MD JONATHAN SCHILLER, MD RAMIN TABADDOR, MD B. Cohen, MD D. Kleinhenz, MD J. Schiller, MD R. Tabaddor, MD RHODE ISLAND M EDICAL J OURNAL 8 COMMENTARY The Not-So-Near Death of Autopsies in the U.S.
    [Show full text]
  • Sports Hernia / Athletic Pubalgia / Core Muscle Injury
    DEPARTMENT OF ORTHOPEDIC SURGERY SPORTS MEDICINE Marc R. Safran, MD Professor, Orthopaedic Surgery Chief, Division of Sports Medicine SPORTS HERNIA / ATHLETIC PUBALGIA / CORE MUSCLE INJURY DESCRIPTION This is an ill defined injury to the groin, involving the lower abdominal muscles and/inner thigh muscles, where they attach to the front of the pelvis. It generally is an overuse type injury, in that it does not involve a single acute episode. These muscles attach to the front of the pelvis on either side of the symphysis pubis joint. The symphysis pubis joint joins the two of the main bones of the pelvis. The symphysis pubis joint is made up of the pubic bones (portion of the pelvis), cartilage, a joint capsule and joint fluid. As there has recently been an association with femoroacetabular impingement (FAI) of the hip, there is some thought that limited hip rotation seen with FAI puts excessive stress on the pubic symphysis. The motion at the pubic symphysis is limited by the bony morphology, cartilage disc and ligaments of the pubis. The lower abdominal muscles and adductor muscles of the thigh may contract to limit motion at the pubic symphysis and get overloaded, as they are not biomechanically oriented to efficiently limit that motion, and may be injured as a result. Some other doctors think that there is a posterior wall weakness, though not true hernia, that is the cause of the pain. FREQUENT SIGNS AND SYMPTOMS Pain, discomfort or ache, tenderness and swelling at the front of the pelvis at the pubic symphysis. The pain may extend to the groin, inner thigh and/or lower belly Symptoms usually start slowly and insidiously following the activity, and progress to affect the whole activity, becoming constant pain.
    [Show full text]
  • The “Sports Hernia”
    The “Sports Hernia” Russell Steves M.Ed, ATC, PT Princeton University Why Should I Care? • You may run into it – An athlete with groin pain not getting better • You may read about it – An athlete may read about it • It’s a difficult diagnosis to get right Why Is It Tough to Get Right? • Broad area for symptoms • Many possible diagnoses • Unfamiliar anatomy • Interchangeable names for “sports hernias” Today’s Purpose • Explain the different pathologies that are described as “sports hernias” • Teach clinicians how to identify sports hernias in their athletes • Describe the effective treatments for sports hernias –Surgery Where does it hurt? Many Causes of Groin Pain Groin Pain Pathologies • Musculo-tendinous Injury – Hip flexors – Hip adductors – Abdominals –Enthesopathy • Adductor longus • Rectus abdominus Groin Pain Pathologies • Hip joint pathology –Sprain – Arthritis •OA •DJD – Acetabular labral tear – Femoral head/neck AVN Groin Pain Pathologies • Stress fractures – Pubic rami – Femoral head/neck • Avulsion fractures – AIIS/ASIS – Lesser trochanter – Pubic symphysis Groin Pain Pathologies • Iliopectineal bursitis • Osteitis pubis • Pelvic girdle dysfunction • Lumbar spine pathology – Facet joint injury – Disk protrusion – Spondylolysis/spondylolisthesis Groin Pain Pathologies • Nerve entrapment – Ilioinguinal – Genitofemoral – Obturator • Prostatitis • Varicocele testis • Osteomyelitis at pubic symphysis Groin Pain Pathologies • “Sports hernias” – Gilmore’s groin – Athletic Pubalgia – Symphysis syndrome – Hockey groin syndrome –Hernia
    [Show full text]
  • Athletic Pubalgia
    NEWSLETTER OF THE AMERICAN ORTHOPAEDIC SOCIETY FOR SPORTS MEDICINE FALL 2016 UPDATE TEAM PHYSICIAN XS AND OS What’s with the cups? STOP Sports Injuries Research Grants and Awards ATHLETIC PUBALGIA www.sportsmed.org AOSSM Corporate Partners AOSSM gratefully acknowledges the following companies for their generous 2015 – 2016 support of our mission! Platinum Elite $100,000 and above Silver $35,000 – $69,999 Bronze up to $34,999 The Aircast Foundation Ferring Pharmaceuticals Tissue Regenix Breg Flexion Therapeutics Orthopedics Topical Gear Bioventus Modernizing Medicine All rights reserved. American Orthopaedic Society for Sports Medicine. Copyright © 2016 Daiichi Sankyo, Inc. Orteq Sports Medicine Vericel www.sportsmed.org AOSSM_2016_Thank_sponsor_v1_print.indd 1 6/10/16 5:11 PM CO-EDITORS EDITOR C. David Geier, Jr., MD EDITOR Grant L. Jones, MD MANAGING EDITOR Lisa Weisenberger TEAM PUBLICATIONS COMMITTEE PHYSICIAN’S C. David Geier, Jr., MD, Chair CORNER 3 Jonathan F. Dickens, MD Lee H. Diehl, MD Alexander Golant, MD Grant L. Jones, MD Michael S. Khazzam, MD Michael J. Leddy, III, MD Alexander K. Meininger, MD Arun J. Ramappa, MD Athletic Seth L. Sherman, MD Christopher J. Tucker, MD BOARD OF DIRECTORS Pubalgia PRESIDENT Annunziato Amendola, MD PRESIDENT-ELECT CHARLES A. Bush-Joseph, MD Groin Pain in Athletes VICE PRESIDENT Neal ElAttrach, MD SECRETARY Rick D. Wilkerson, DO TREASURER Andrew J. Cosgarea, MD UNDER 45 MEMBER-AT-LARGE Joseph H. Guettler, MD UNDER 45 MEMBER-AT-LARGE Robin Vereek West, MD OVER 45 MEMBER-AT-LARGE Jeffery Dugas, MD PAST PRESIDENT Robert A. Arciero, MD PAST PRESIDENT Allen F. Anderson EX OFFICIO COUNCIL OF DELEGATES Christopher C.
    [Show full text]
  • MRI of Athletic Pubalgia
    MRI of Athletic Pubalgia Christopher Beaulieu, M.D., Ph.D. Stanford University Medical Center Groin Pain Hip joint Arthritis Femoracetabular impingement (FAI) Osseous stress injuries AVN Tendinopathy or tear $0<4>09/49:?=49I,88,>4:9:<-?<=4>4= SCFE Inguinal or femoral hernia (traditional) “Sports or sportsman’s hernia” “Sports Hernia” Originally, described as a weakness in the abdominal wall without true herniation of bowel. “incipient hernia” Later, a variety of predominantly musculotendinous disorders about the pubis recognized and lumped under this term, having nothing to do with hernia whatsoever A somewhat better term the syndrome of groin pain in athletes is athletic pubalgia Athletic Pubalgia Groin pain in an individual that cannot be attributed to hip joint or hip tendon pathology, often in competitive athletes May be acute, but is more often chronic Encompasses osseous, myotendinous, as well as abdominal wall disorders Current terminology in fashion is “core (muscle) injury” Etiology Sports with rapid change in direction and twisting or kicking American football Soccer Rugby Australian rules football Hockey Trail running (?) Anatomic Structures Involved Bones - pubic symphysis Tendons and muscles Rectus abdominis Adductors, long and short Inguinal ligament and abdominal wall muscles Modified from Falvey et al. Br J Sports Med 2016;50:423-430 Injury Patterns Osteitis pubis - bone marrow edema Rectus-adductor “pubic plate” injury Adductor longus tendinopathy/tear Short adductor tendinopathy/tear Muscle tear Pubic bone marrow edema, Osteitis Pubis Radiographic Signs Primary (symphyseal) cleft Normal physiologic cleft between pubic bones, closed superiorly and inferiorly by cartilage and ligaments Secondary cleft Fluid extending from the primary cleft and tracking parallel to the inferior margin of inferior pubic rams.
    [Show full text]
  • Effectiveness of Active Rehabilitation Program on Sports Hernia: Randomized Control Trial Walid Ahmed Abouelnaga, Phd, PT, Nancy Hassan Aboelnour, Phd, PT
    Original Article Ann Rehabil Med 2019;43(3):305-313 pISSN: 2234-0645 • eISSN: 2234-0653 https://doi.org/10.5535/arm.2019.43.3.305 Annals of Rehabilitation Medicine Effectiveness of Active Rehabilitation Program on Sports Hernia: Randomized Control Trial Walid Ahmed Abouelnaga, PhD, PT, Nancy Hassan Aboelnour, PhD, PT Physical Therapy Department for Surgery, Faculty of Physical Therapy, Cairo University, Giza, Egypt Objective To determine whether an active rehabilitation program that involves repetitive effortful muscle con- tractions, including core stability, balancing exercises, progressive resistance exercises, and running activities, after a sports hernia, is effective. Methods Forty soccer players with sports hernias were randomly divided into two equal groups: group A (active rehabilitation program) and group B (conventional treatment). The methods of assessment included a visual analog scale (VAS) and hip internal and external range of motion assessments. Group A received conventional treatment (heat, massage, transcutaneous electrical nerve stimulation, and mobilization) plus an active re- habilitation program, while group B received only conventional treatment. Three treatment sessions were given each week for 2 months. Evaluations were performed pre- and post-treatment. Results A decrease in VAS was seen in both groups at the end of treatment, 80.25% in group A and 41.93% in group B. The difference between the two groups was statistically significant (p=0.0001), whereas there were no statistical differences in internal and external rotation between the groups at the end of treatment (p>0.05). After treatment, an improvement in outcome measures of group A compared to group B (p=0.01) was seen.
    [Show full text]
  • WINTER 2019 and Muscle Soreness Jeff Fleming, DO Athletes of All Levels Use Techniques to Reduce Muscle Soreness and Recover Faster
    SportsMedToday.com YOUR COMPREHENSIVE SPORTS MEDICINE RESOURCE FOR ATHLETES, COACHES AND PARENTS The Truth about Post-Exercise Recovery WINTER 2019 and Muscle Soreness Jeff Fleming, DO Athletes of all levels use techniques to reduce muscle soreness and recover faster. At the professional level, it’s common to hear of elite athletes spending thousands of dollars per year on post-game recovery. From hyperbaric oxygen chambers to personal massage therapists, top-notch athletes seem to have limitless recovery resources at their disposal. But do all these expensive therapies and extravagant techniques make a difference? The short answer is – probably not. In reality, the recovery process is less about a single recovery method and more about your overall approach to fitness and attention to detail. immersion, massage and heat wraps occurs. You should begin the recovery It’s difficult to imagine how amateurs reduce muscle soreness following process immediately after your workout could care for their bodies the same way exercise, but there is still a lot of debate. has concluded. Most research is in professional athletes do, but they can! In The most effective way to combat agreement that recovery techniques are this article, we will look at post-exercise soreness is to continue light activity and most effective if done within the first two recovery principles and shed light on use whichever recovery strategy you like hours after exercise. how you can recover just like the pros, best. for a fraction of the cost. True or False? True or False? Muscle soreness is harmless. True or False? Stretching reduces muscle soreness.
    [Show full text]
  • Prevention & Care of Soccer Injuries
    SPORTS TIP PREVENTION & CARE OF SOCCER INJURIES occer is one of the most exciting sports in the world. Although soccer provides an enjoyable form of aerobic exercise and helps develop strength, Sbalance, agility, coordination, and a sense of teamwork, players must be aware of the injury risk due to the physical nature and fast pace of play. Injury Prevention In 2016, US Youth Soccer implemented a heading policy to reduce concussion and neck injuries in skeletally immature athletes. Players 10 and younger are prohibited from heading the ball in both practice and competition. Children ages 11–12 are permitted to head up to 25 times per week in practice or competition. When players reach age 13 there are no heading restrictions. Introduction of heading in practice should include the instruction of proper technique and safe play habits when challenging for a ball in the air. When possible, begin heading drills with a lightweight ball until technique is mastered. Due to the demanding nature of soccer, it is important for an athlete to be physically well rounded by maintaining flexibility, balance, agility, endurance, speed, and strength standards appropriate for their level of play. Injury prevention programs are designed to address these factors and decrease the incidence of injury, particularly in the lower extremity. Warm Up To prevent musculoskeletal injuries common in soccer, a thorough warm-up of at least 10 minutes should be performed including movement and stretching. Start with jogging to increase overall body temperature and blood flow to the muscles. Next, loosen joints and muscles with large, controlled dynamic movements such as walking lunges, hip swings, trunk rotation, and arm circles.
    [Show full text]