Return to play--a personal perspective.
Explore the source record for details and available documents.
Athletic Injuries↗
Biomedical subjects
Peter Brukner
Publications and source records attributed to Peter Brukner.
Screening of athletes for exercise-induced bronchoconstriction.
Exercise-induced bronchoconstriction (EIB) has a high prevalence in elite athletes, particularly endurance athletes, winter athletes and swimmers. Recent studies have shown that a clinical diagnosis of EIB has only a moderate sensitivity and specificity for EIB. This finding in conjunction with a recent ruling by the IOC-medical commission that all athletes competing in initially the 2003 Winter Olympic Games in Salt Lake City, and now the 2004 Summer Olympic Games in Athens require objective evidence of EIB, support the need for bronchial provocation challenge tests in the diagnosis of EIB. The recommended bronchial provocation challenge test is the eucapnic voluntary hyperpnea (EVH) challenge; this challenge test has been shown to have both a high sensitivity and specificity for EIB. Pharmacological challenge tests, such as the methacholine challenge test, have been shown to have only a low sensitivity but high specificity for EIB in elite athletes, and are thus not recommended in the athlete with pure EIB. Exercise challenge tests performed both in the laboratory and field have a high specificity for EIB; however those in the laboratory have only a moderate sensitivity for EIB in elite athletes, whilst those in the field are limited by problems with standardization. The osmotic challenge tests, such as the hypertonic saline and newer inhaled dry powder mannitol challenge have both a high sensitivity and specificity for EIB, and may be used as an alternative to the EVH challenge.
Asthma, Exercise-Induced↗
Screening of athletes: Australian experience.
OBJECTIVE: To present an overview of medical screening of athletes in Australia DATA SOURCES: Data was obtained from Australian sports physicians involved in elite national and professional programs. DATA SYNTHESIS/METHODS: The status in Australia of medical screening and in particular the Pre-participation Examination (PPE) was reviewed. RESULTS: The PPE as practised in North America is not performed in Australia. However medical screening of elite national level and professional athletes is widely practised. A variety of screening methods is used. The medical screening protocol recently developed on behalf of the Australasian College of Sports Physicians (ACSP) is presented. CONCLUSIONS: Medical screening of high performance athletes takes place regularly in Australia. Valuable information may be obtained from this process. The extent of the screening is limited by financial and time constraints. The proposed protocol is a basis for a comprehensive medical screening, but can be adapted depending on the individual and the sport played.
Australia↗
Use of oral corticosteroids in sports medicine.
Explore the source record for details and available documents.
Athletic Injuries↗
Delayed onset of transversus abdominus in long-standing groin pain.
UNLABELLED: Long-standing groin pain is a persistent problem that is commonly difficult to rehabilitate. Theoretical rationale indicates a relationship between the motor control of the pelvis and long-standing groin pain; however, this link has not been investigated. PURPOSE: The current experiment aimed to evaluate motor control of the abdominal muscles in a group of Australian football players with and without long-standing groin pain. METHODS: Ten participants with long-standing groin pain and 12 asymptomatic controls were recruited for the study. Participants were elite or subelite Australian football players. Fine-wire and surface electromyography electrodes were used to record the activity of the selected abdominal and leg muscles during a visual choice reaction-time task (active straight leg raising). RESULTS: When the asymptomatic controls completed the active straight leg raise (ASLR) task, the transversus abdominus contracted in a feed-forward manner. However, when individuals with long-standing groin pain completed the ASLR task, the onset of transversus abdominus was delayed (P < 0.05) compared with the control group. There were no differences between groups for the onset of activity of internal oblique, external oblique, and rectus abdominus (all P > 0.05). CONCLUSIONS: The finding that the onset of transversus abdominus is delayed in individuals with long-standing groin pain is important, as it demonstrates an association between long-standing groin pain and transversus abdominus activation.
Adult↗
Patellar tendinopathy.
Patellar tendinopathy is a common and serious condition in athletes. Although there have been many advances in the understanding of the histopathology, imaging, and surgical outcomes in this condition in the past decade, successful management of athletes with patellar tendinopathy remains a major challenge for both the practitioner and patient. There is a definite need for further prospective studies into etiological factors and randomized controlled trials into treatment choices.
Anti-Inflammatory Agents, Non-Steroidal↗
Hip joint pathology: clinical presentation and correlation between magnetic resonance arthrography, ultrasound, and arthroscopic findings in 25 consecutive cases.
BACKGROUND: The hip joint is becoming increasingly recognized as a source of groin pain and, in the authors' experience, buttock and low back pain. OBJECTIVES: To determine the range of pathologic diagnoses, clinical presentation, and the correlation between magnetic resonance arthrographic, ultrasonographic, and arthroscopic findings in the hip joint. METHODS: We prospectively studied 25 consecutive hip arthroscopies to determine the range of pathologic diagnoses, clinical presentation, and the correlation between magnetic resonance arthrographic, ultrasonographic, and arthroscopic findings. RESULTS: All of the hips arthroscoped had pathology. Back pain and hip pain were the 2 most common presentations. The only consistently positive clinical test result was a restricted and painful hip quadrant compared with the contralateral hip. Of the 17 patients whose flexion, abduction, external rotation (FABER) test results were reported at the time of examination, 15 (88%) were positive, and 2 (12%) negative. Plain radiographs were normal in all patients. All but 1 patient underwent magnetic resonance arthrography. Although specificity of 100% was achieved in our study, the sensitivity was significantly lower, with a relatively high number of false negatives. Hip arthroscopy proved the definitive diagnostic procedure for intraarticular pathology. CONCLUSIONS: Hip pathology, particularly labral pathology, may be more common than has been previously recognized. In those patients with chronic groin and low back pain, a high index of suspicion should be maintained. Clinical signs of a painful, restricted hip quadrant and a positive FABER test result should suggest magnetic resonance arthrography in the first instance, but a negative magnetic resonance image should not preclude hip arthroscopy if there is high clinical suspicion of hip joint pathology.
Adolescent↗
Recommendations for lightning protection in sport.
Lightning is an important cause of weather-related morbidity and mortality and is often underrated. There has been an increase in the proportion of casualties occurring during outdoor sport and recreational activities over recent years. However, in Australia, there is a deficiency in recommendations for lightning safety at sporting events. Organisers of sporting events should have a lightning safety policy that includes a designated weather watcher with the authority to stop or postpone the event, a specific chain of command, and designated safe areas. Suspension and resumption of play should follow the "30/30" rule: play should stop when the flash-to-bang count is 30 seconds, and should not resume until 30 minutes after the last lightning. At events with large crowds, additional time should be allowed for evacuating all people to safe areas.
Guidelines as Topic↗
Evidence-based management of exercise-induced asthma.
Exercise-induced asthma (EIA) is a common, yet often unrecognized condition occurring in both known asthmatics and otherwise healthy individuals. Misdiagnosis, both over- and underdiagnosis, is not uncommon. In order to accurately diagnose EIA, a bronchoprovocation challenge test must be performed; the current recommended test is a eucapnic hyperventilation (EVH) challenge test. Although there are a number of treatment options available, both pharmacologic and nonpharmacologic, in most cases medications are required. A range of medications are currently available to either treat or prevent EIA. It is important that the medications used are individualized to the patients needs and monitored to ensure efficacy.
Administration, Inhalation↗
Long-term outcome of fasciotomy with partial fasciectomy for chronic exertional compartment syndrome of the lower leg.
BACKGROUND: Fasciotomy with partial fasciectomy for compartment syndrome has had good short-term results, but no long-term studies have been performed. HYPOTHESIS: Combining a partial fasciectomy with fasciotomy for compartment syndrome relieves pain and eliminates symptoms in the long term. STUDY DESIGN: Retrospective cohort study. METHODS: A self-administered questionnaire was given to 62 patients at a mean follow-up of 51 months after surgery. RESULTS: Of the 50 patients who underwent a single operation, 60% (30) reported an excellent or good outcome. Average pain and pain-on-running were significantly reduced, although some subjects still reported considerable levels of pain. Fifty-eight percent (36 of 62) were exercising at a lower level than before injury and, of these, 36% (13) cited the return of their compartment syndrome or the development of a different lower leg compartment syndrome as the reason for a reduction in exercise levels. Some subjects indicated early initial improvement followed by subsequent deterioration. CONCLUSION: This surgical technique reduces pain and allows the majority of patients to return to sports; however, patients should be counseled that they may not be able to return to their preinjury level of exercise or remain pain-free.
Adolescent↗