Surfing has rapidly grown in popularity as the sport made its debut at the Tokyo 2020 Olympic Games. Surfing injuries are becoming more relevant with the globalisation and increasing risks of the sport, but despite this, little is known about surfing injuries or prevention strategies in either the competitive or recreational surfer. We reviewed the literature for the incidence, anatomical distribution, type and underlying mechanism of acute and overuse injuries, and discuss current preventative measures. Four online databases, including MEDLINE, PubMed, EMBASE and Cochrane Library were searched from inception to March 2020. This review finds that skin injuries represent the highest proportion of total injuries. Acute injuries most frequently affect the head, neck and face, followed by the lower limbs. Being struck by one's own board is the most common mechanism of injury. Surfers are injured at a frequency of 0.30–6.60 injuries per 1000 hours of surfing. Most prior studies are limited by small sample sizes, poor data collection methodology and geographical constraints. The scientific literature on surfing injuries under-represents overuse musculoskeletal injuries and the efficacy of prevention strategies for surfing-related overuse musculoskeletal injuries has not been studied. Injuries to the head and neck pose greater risks to a surfer's morbidity and mortality, yet there is no consensus on the management protocol of spinal injuries that occur in open water. Non-contact acute ligament injuries have increased as surfing manoeuvres have become more acrobatic, and overuse musculoskeletal injuries are highly correlated with paddling. Further research is needed to establish preventative measures for both acute and overuse surfing injuries and to ensure the increasing popularity of surfing is met with an improved understanding of sport risks and safety. Specifically, we recommend research be prioritised regarding the efficacy of training programmes to prevent surfing-related overuse musculoskeletal injuries

Compared to conventional road-cycling, little is known about overuse injuries in mountainbiking. The adjustment of the mountainbike seems to be crucial avoiding these syndromes. No other study has prospectively put overuse injuries into correlation with the mountainbike’s adjustment in a competition setting until now. Methods: This prospective field study consisted of two phases using preformed questionnaires to interview volunteering athletes in a race. In phase one overused body regions were identified in mountainbikers. In phase two riders were examined before and after the race for overused body regions which were put into correlation with the bike’s adjustments. The statistical analysis comprised a multivariance analysis. Results: 169 competitors were analyzed of which 87 had after the race. Most injuries inflicted the lower back, the buttocks and the knee. There was a significant correlation between inadequate saddle pedal distance and the incidence of knee pain (p< 0.038), and paraesthetic sensations in the hand (p< 0.023). The inclination of the saddle has also significant impact on the occurrence of pain in the buttocks (p< 0.014)). Symptoms occurred highly statistically in downhill (p< 0.0001) and uphill (p< 0.0007) passages. Conclusion: Overuse injuries are frequently observed in competitive mountain bikers. More than half of the investigated athletes had pain at any body region immediately after the race. The bike’s adjustment has a significant impact in the occurrence of overuse injuries

Summary Statement. ASTM therapy is commonly used to treat Achilles tendinopaty. However, there was no report to evaluate the biomechanical effects, especially the dynamic viscoelasticity. We have shown that ASTM treatment was biomechanically useful for chronic Achilles tendinopathy in an animal model. Introduction. Achilles tendinopathy is a common chronic overuse injury. Because Achilles tendon overuse injury takes place in sports and there has been a general increase in the popularity of sports activities, the number and incidence of Achilles tendon overuse injury has increased. Augmented Soft Tissue Mobilization (ASTM) therapy is a modification of traditional soft tissue mobilization and has been used to treat a variety of musculoskeletal disorders. ASTM therapy is thought to promote collagen fiber realignment and hasten tendon repair. It might also change the biomechanical behavior of the injured tendon, especially the dynamic viscoelasticity. The purpose of this study is to evaluate the effect of ASTM therapy in a rabbit model of Achilles tendinopathy by quantifying dynamic biomechanical properties and histologic features. Patients & Methods. The hind limbs of 12 rabbits were used, and 24 Achilles tendons were injected with collagenase to produce tendon injury. One hind limb of each animal was then randomly allocated to receive ASTM therapy, while the other received no treatment and served as a control. ASTM was performed on the Achilles tendon for 3 minutes on postoperative days 21, 24, 28, 31, 35, and 38. The Achilles tendons were harvested 10 days after the last treatment. Specimens were examined with dynamic viscoelasticity and light microscopy. Results. The mean±SD cross-sectional area for the treated and untreated tendons was 12.30±5.47 mm. 2. and 9.57±8.36 mm. 2. , respectively. The difference between the treated and untreated tendons was statistically significant (P<.01). At all dynamic loading frequencies, the storage modulus in the untreated tendons tended to be higher than that in the treated tendons. At 0.1 Hz and 10 Hz, in the untreated tendons was significantly higher than that in the treated tendons (P=.05). The loss modulus was significantly lower in the treated tendons than in the untreated tendons (P<.05). There was no significant difference in tan δ between the treated and untreated tendons. HE stain showed that the untreated tendon fiber was wavy and kinking and displayed a disordered collagen arrangement. In contrast, the tendon fiber was well aligned in the treated tendons. In the immunohistochemically stained specimens, the type III collagen showed higher color intensity in the untreated tendons than in the treated tendons. Discussion/Conclusion. We have shown that ASTM was a biomechanically useful treatment for chronic Achilles tendinopathy. Biomechanical and histologic data showed the treated Achilles tendons had better biomechanical function and histologic outcomes than the untreated tendons

The fibrocartilaginous enthesis displays a complex interface between two mechanically dissimilar tissues, namely tendon and bone. This graded transition zone consists of parallel collagen type I fibres arising from the tendon and inserting into bone across zones of fibrocartilage with aligned collagen type I and collagen type II fibres and mineralised fibrocartilage. Due the high stress concentrations arising at the interface, entheses are prone to traumatic and chronic overuse injuries such as rotator cuff and anterior cruciate ligament (ACL) tears. Treatment strategies range from surgical reattachment for complete tears and conservative treatments (physiotherapy, anti-inflammatory drugs) in chronic inflammatory conditions. Generally, the native tissue architecture is not re-established and mechanically inferior scar tissue is formed. Current interfacial tissue engineering approaches pose scaffold-associated drawbacks and limitations, such as foreign body response. Using a thermo-responsive electrospun scaffold that provides architectural signals similar to native tissues and can be removed prior to implantation, we aim to develop an ECM-rich, cell-based implant for tendon-enthesis regeneration. Alcian blue staining revealed highest sGAG deposition in cell (human adipose derived stem cells) sheets grown on random electrospun fibres and lowest sGAG deposition in collagen type I sponges. Cells did not show an equal distribution throughout the collagen type II scaffolds but tended to form localised aggregates. Thermo-responsive electrospun fibres with random and aligned fibre orientation provided an adequate three-dimensional environment for chondrogenic differentiation of multilayer hADSC-sheets shown by high ECM-production, especially high sGAG deposition. Chondrogenic cell sheets showed increased expression of SOX9, COL2A1, COL1A1, COMP and ACAN after 7 days of chondrogenic induction when compared to pellet culture. Anisotropic fibres enabled the generation of aligned chondrogenic cell sheets, shown by cell and collagen fibre alignment. Thermoresponsive electrospun fibres showed high chondro-inductivity due to their three-dimensionality and therefore pose a promising tool for the generation of scaffold-free multilayer constructs for tendon-enthesis repair within short culture periods. Aligned chondrogenic cell sheets mimic the zonal orientation of the native enthesis as the fibrocartilaginous zone exhibits high collagen alignment

Introduction. Golf is a recommended form of physical activity for older adults. However, clinicians have no evidence-based research regarding the demands on the hips of older adults during golf. The purpose of our in vivoobservational study was to quantify the hip biomechanics of older adult golfers. Methods. Seventeen healthy older male golfers(62.2±8.8 years, handicap 8.7±4.9) free from orthopaedic injuries and surgeries volunteered for participation in this IRB-approved study. A 10-camera motion capture system recorded kinematics, and two force plates collected kinetic data. Participants performed eight shots using their own driver. Data processing was performed in Visual3D. The overall range of excursion and three-dimensional net joint moments normalized to body weight for the lead and trail hips were extracted. Results. Kinematics (mean excursion and range) of lead and trail hips in all three planes during a golf swing are presented in Table 1. The trail leg experiences higher excursion in the sagittal plane, while the lead leg has more frontal plane movement. Average maximum net joint moments of the lead and trail hips were 1.2 ± 0.2 and 1.7 ± 0.3 Nm/kg, respectively. Conclusion. Our study is the first to quantify the kinematics and kinetics of the hip joint in healthy older male golfers. While the golf swing is often considered to be a predominant transverse plane motion, our results indicate considerable excursion at the hip joints in all three planes. Furthermore, the trail leg experiences 40% greater loading than the lead leg throughout the swing, suggesting that the trail leg may have a larger impact on golf performance while also leaving it more susceptible to overuse injury. For clinicians with patients who experience osteoarthritis of the hip or who have recently undergone hip surgery, this study may provide novel insight into the demands of golf on the hips. For any tables or figures, please contact the authors directly

Most cases of tendinopathy are believed to be overuse injuries rather than the result of a chronic event. The investigation of the fatigue properties of tendon is therefore of critical importance. This work considered the cyclic stress-relaxation and creep behaviour of two contrasting bovine tendon types – the largely postional digital extensor and the more energy storing deep digital flexor tendon. Fascicles were cyclically loaded (1Hz), to 1800 cycles of stress relaxation or to failure in creep, stopping some tests at 300, 900 or 1200 cycles to perform quasi-static failure tests or confocal imaging using a highly concentrated Acridine Orange solution. Creep tests were cycled to 60% of the ultimate tensile strength (UTS), while for stress relaxation, cyclic deformation to the strain associated with 60% UTS was used. Flexor tendon fascicles were found to exhibit reduced stress relaxation at all time points compared to the extensor fascicles and also showed an increase in the mean cycles to failure during creep testing. Evidence of fatigue damage was clear in the confocal images with breakdown of the collagen fibre alignment evident from 300 cycles; however it appears that some damage could occur without effect on the UTS of the fascicle. Despite what appears to be superior fatigue resistance in the flexor tendon fascicles, the matrix damage, certainly at early time points, appeared visually to be as severe as that observed with the extensor tendon fascicles

Purpose of study. To study the effect of different shoes and orthotics have on patellar tendon tensile forces. Patellar tendinopathy is an overuse injury that affects tennis players and in high impact sports like basketball, volleyball and running has an incidence of 20%. The tensile forces in the patellar tendon can be reliably measured with an intratendinously placed fibre optic tube and wireless transmission device allows for dynamic testing. The biggest strain differentials have been confirmed in jumps from 30cm height. Tennis is played on 3 major different court surfaces and there is a variety of commercially designed tennis shoes on the market. Materials and methods. 6 male tennis players, ages 18–49 were enrolled for this study. A fibre optic cannula was placed in the middle of the proximal pole of patella tendon from lateral to medial direction in the dominant knee. The patellar tendon tensile forces deform the fibre optic cannula in turn modulating the light signal passing through the optic cannula. The drag in the fibre optic sensor signal was used to measure the tensile forces in the patellar tendon. MLTS 700 goniometer were utilized to measure and record the amount of flexion with each jump to standardize results for different shoes and orthotics. Results. The results of patellar tendon tensile forces measurements for different players, different shoes and orthotics showed no trend or statistical difference for any particular shoe or orthotic. Conclusions. Fibre optic measurements of the effect of different shoes on patellar tendon tensile forces did not show a distinct advantage for any shoe above another. 1 DISCLOSURE

Autologous cell therapy using stem cells and progenitor cells is considered to be a popular approach in regenerative medicine for the repair and regeneration of tissue and organs. In orthopaedic practice, autologous cell therapy has become a major focus, particularly, as a feasible treatment for tendon injury. Tendons are dense connective tissue that bridge bone to muscle and transmit forces between muscle and bone to maintain mechanical movement. Tendons are poorly vascularised and have very little capacity to self-regenerate. Degeneration of tendon is often caused by injury. The pathogenesis of tendon injury, commonly known as tendinosis, is not an inflammatory condition but is secondary to degenerative changes, including disruption of the collagen matrix, calcification, vascularisation and adipogenesis. The aetiology of tendinosis is considered to be multifactorial and the pathogenesis is still unclear. Intrinsic factors such as a lack of blood and nutrition supply and extrinsic factors such as acute trauma and overuse injury caused by repetitive strain, have been implicated as contributors to the pathogenesis of tendinosis. More recent studies suggest that programmed tendon cell death (tenocyte apoptosis) may play a major role in the development of tendinosis. Such cellular abnormalities may influence the capacity of tendon to maintain its integrity. Traditional treatments such as anti-inflammatory drugs, steroid injections and physiotherapy are aimed at symptom relief and do not address the underlying pathological changes of degeneration. Here, we propose that autologous cell therapy may be an innovative and promising treatment for tendon injury. We will present evidence that suggest that autologous tendon cell therapy may be feasible to repair and regenerate tendon. We will also present data summarising the preclinical evaluation of autologous tendon cell therapy in animal models and the safety and tolerability of autologous tendon cell therapy in humans in studies, which are currently conducted at the Centre for Orthopaedic Research at the University of Western Australia

It is suggested that there is a link between overuse injuries and the type of arch of the foot, and that the use of appropriate running shoes may reduce running injuries substantially. However, to select the correct shoe, a runner needs knowledge of the anatomy and biomechanics of his/her foot. Five orthopaedic surgeons and experienced orthopaedic technicians examined the feet of 92 runners of mean age 35.4 years (12 to 63), mean height 176 cm (154 to 195) and mean body weight 70.38 kg (45 to 95). Weight-bearing podograms were used to define deformities of the feet further. A questionnaire ascertained what runners knew about their arch heights and the biomechanics of running. Of 43 volunteers with normal arches, 25 correctly assessed their feet, but only 18 of 47 runners with a flatfoot deformity identified their deformity. Two runners with a cavus foot identified it correctly. Only four of 38 runners who diagnosed themselves as pronators were found to be, and four runners who self-diagnosed non-pronation were classified as pronators. Three runners who could not classify themselves were diagnosed as pronators. This study demonstrates the poor knowledge of foot deformities in the running community

Introduction. Chronic Achilles tendinopathy is a common overuse injury. There are several modalities of treatment, reflecting difficulties in its management. In particular, due to the well-recognised morbidity associated with surgical decompression, treatment has steered towards a less invasive route. Dry needling has been efficacious in managing other tendinopathies. This study therefore assessed dry needling and percutaneous hydrostatic decompression of the Achilles tendon as a novel treatment for this condition. Methods. Twenty-two patients with 27 sonographically-confirmed chronic Achilles tendinopathy were prospectively enrolled. All were symptomatic for >6 months and have failed alternative conservative treatments. Ultrasound-guided dry needling of neovascular areas and paratenon hydrostatic decompression was performed by a dedicated musculoskeletal radiologist on a 6-weekly basis until symptomatic resolution or no improvement was evident. Sonographic assessment of the tendon's thickness and neovascularity was undertaken. Following treatment, a standardized physiotherapy regime was adopted. At baseline and 6 weeks post-final procedure, visual analogue scores (VAS) at rest and during activity were obtained. Telephonic interviews were carried out 12 and 24 months post-treatment. Results. 24 tendons (in 19 patients) were successfully treated - 1 patient had spontaneous symptomatic resolution and 2 progressed to surgical intervention. The mean number of treatment sessions was 2. There was no significant change in neovascularity or tendon thickness after treatment. Therapeutic intervention led to a significant improvement in VAS at rest (42 v 18.4, p=0.0005) and during activity (74 v 33.7, p< 0.0001). At 12 months, 77% of patients were >80% satisfied with their outcome of the procedure, with 85% of patients able to return to their sporting interests. At 24 months, 90% of patients were >80% satisfied with their outcome, with nearly half having complete symptomatic resolution. Conclusion. Dry needling and percutaneous paratenon decompression under ultrasound guidance shows promise as an alternative treatment for this chronic condition

It is suggested that there is a link between arch type of the foot and overuse injuries. The use of individual selected running shoes can reduce running injuries substantially. To select the correct shoe the runner needs to have appropriate knowledge of his own foot anatomy and biomechanics. A questionnaire was used to investigate the knowledge of the runner about his arch height and biomechanics of running. Clinical examination was performed by 5 orthopaedic surgeons and experienced orthopaedic technicians. Weight-bearing podograms were used to further define the deformity. We examined 92 volunteers with a mean age of 35.4 (12–63) years, a mean size of 176 cm (154–195) with a mean body weight of 70.38 kg (45–95). Eighteen out of 47 runners with a flatfoot deformity identified their deformity correctly. Twenty five out of 43 volunteers with a normal arch were correct in assessing their foot. Two runners with a cavus foot were correct in identifying their foot. Only 4 out of 38 runners that diagnosed themselves as being pronators have been found to be pronators. Four runners with a self-diagnosed non-pro-nating foot were classified as being pronators. Three runners that could not classify themselves were diagnosed as pronators. This study demonstrates the poor knowledge of foot deformities in the running community

Introduction and Aims: The possible deleterious effects of long distance running remain controversial. The repetitive loading could potentially predispose to the subsequent development of osteoarthritis. The purpose of this study is to investigate whether external impact loading in marathon runners creates internal stresses on bone and cartilage that are demonstrable on MR images. Method: Six recreational, two semi-professional runners and seven beginners underwent magnetic resonance (MR) imaging of the hip and knee before and after a marathon run using coronal body phased-arrayed coil and the following pulse sequences: a coronal T1 weighted spin echo sequence and STIR sequences. To be included in the study, the runners had to successfully finish a previous race in less than 4.5 hours. The following exclusion included surgery for overuse injuries in the prior 48 months, and symptoms of overuse in the six months preceding the race. Results: The pre- and post-run scans failed to demonstrate marrow oedema, periosteal stress reactions or joint effusions in seven runners. One patient who underwent a reconstruction of his anterior cruciate ligament 18 months ago demonstrated a small effusion in the reconstructed knee before and after the race. Six of the beginners demonstrated minimal effusions in the hip and knee joints. However no bone oedema was seen in any of the beginners. Conclusions: Our results suggest that the high impact forces in long distance running are well tolerated and subsequently not demonstrated on MR images in experienced runners. Beginners do compensate the impact stresses to a certain extend and it is postulated that long distance runners undergo a natural selection process

Paratenonitis describes inflammation of the paratenon and commonly presents as an overuse injury. The paratenon is the connective tissue sheath that surrounds tendons - including tendo Achilles, and serves to minimise friction with the outer layer of the tendon, the epitenon. Whilst this conjunction allows the tendon to glide smoothly on muscular contraction, the presentation of paratenonitis typically follows periods of frequent, repetitive musculoskeletal movements; hence, paratenonitis commonly afflicts the elite and, albeit to a lesser extent, amateur athlete. The extent to which friction at the epitenon-paratenon juncture contributes to this tendinopathy remains unclear, and this study is therefore concerned with the coefficient of friction and the lubrication regime. By using a specially designed and validated apparatus, the in vivo paratenon-epitenon conjunction was approximated using bovine flexor tendon paratenon and a glass disc; this is being an equivalent experimental set-up to that used in other studies exploring soft tissue contacts. Bovine synovial fluid was used to lubricate the conjunction at 37 deg C, and the frictional characteristics were analysed over a range of sliding speeds and loads. The coefficient of friction was found to generally lie between 0.1 – 0.01. This range suggests that a system of mixed lubrication applies - where the synovial fluid is causing partial separation of the two surfaces. However, when the data is plotted in the form of a Stribeck curve, the trend suggests that boundary lubrication prevails - where lubrication is determined by surface-bound proteins. The coefficient of friction at the epitenon-paratenon interface appears to be approximately one order of magnitude greater than that typically reported within the healthy synovial joint. Additionally, the synovial joint is thought to exhibit some fluid film lubrication (i.e. total surface separation), whereas the epitenon-paratenon lubrication regime appears to vary only between the inferior mixed and boundary systems - depending on the specific biomechanical conditions. This data would suggest that the coefficient of friction at the epitenon-paratenon interface is relatively high and thus is potentially significant in the incidence of paratenonitis. Such a hypothesis could be of particular interest to sports-medicine and orthopaedic specialists

Low back pain is not a frequent complaint in adolescents and usually is a self-limited affliction without signs or significant findings in pertinent imaging studies. Adolescent athletes are in an increased risk of overuse injuries to the spine due to their relative ligamentous laxity and lack of proper technique in their chosen sport. This is a prospective study of adolescent athletes referred to the spine clinic due to low back pain and significant findings on physical examination and/or the imaging studies. Between 01.08.1998 and 31.03.2001 we have treated 7 athletes, 2 girls and 5 boys, average age 15.67 years (range 13–17). Sports involved were golf in 2, body building in 1, volleyball in 1, handball in 1, track and field in 1, and ballet in 1. Five were eventually diagnosed with L5 pars defects (2 unilateral and 3 with bilateral lesions); L2 spondylolysis was diagnosed in 1 and L5-S1 central disc protrusion in 1. All complained of pain located to the lower back, the patient with disc protrusion complained of pain radiating to her lower extremities. Plain films were diagnostic in 1 patient only with a unilateral L5 pars defect. Technetium bone scan showed increased uptake at the level of the lesion in all 6 patients with spondylolysis and was normal in the patient with L5-S1 disc protrusion. CT scans were performed in 4 patients and were diagnostic 2, MRI was performed in 2 patients and was diagnostic in both. The six patients with spondylolysis were treated by analgesics, rest for 3 months and then gradual supervised return to sports with modification of the swing in both golfers, decrease of training volume in the body builder and limiting the track and field athlete to running only. Both volleyball and handball players withdrew from athletic activities. The volleyball player with L5-S1 herniation refused surgical treatment. The evaluation of adolescent athletes with low back pain longer than few weeks, should be by bone scan first and CT and/or MRI later. MRI should be preferred to limit radiation exposure. After proper rest and supervised training they can safely resume their athletic interests

Introduction: Stress fractures comprise a major problem in female police or army recruits. The incidence of stress fractures is reported ranging from 3 to 10 fold when compared to male recruits taking the same training program. This study consisted of an intervention program aiming at reducing combat gear weight and locating the gear as close as possible to the body center of gravity. Material and Methods: In a prospective study we followed up two companies of female recruits of the Israel Border Police. Both companies were followed for the four months of basic training using a basic data questionnaire inclusive of previous physical activity habits, previous acute and overuse injuries, menstrual history and previous smoking habits. An injury questionnaire was filled on commencement of the course and every two weeks thereafter. The clinical records of medic and doctor visits, as well as the personal medical file, were revised. Roentgenological and scintigraphic imaging were performed during the course, when clinical suspicion of a stress fracture arose. The first company of 71 fighters used the standard combat gear amounting to 12.5 kg. The second company of 64 fighters used combat equipment weighing 9.4 kg, held in a combat girdle close to the body center of gravity, inclusive of a shorter personal combat riffle and personal combat vest. Results: There was no difference in the number of clinic visits between the two companies. Complaints suggesting stress fractures were recorded in the first company from the 3. rd. to the 8. th. week of training and in the second from the 1. st. to 3. rd. week. The percentage of fighters sent for Scintigraphy because of clinical suspicion of stress fractures was 22.5% in the first company and 6.25% in the second. The percentage of fighters in whom stress fractures were located by Scintigraphy was 15.5% in the first company and 4.7% in the second. The number of stress fractures in average per fighter was 0.45 fractures in the first company and 0.27 fractures in the second. When calculating only “dangerous” stress fractures (long bones and navicular) there were noted 0.34 fractures per fighter in the first company and 0.20 in the second. Total average training days lost for reason of stress fractures was 2.21 per fighter in the first company and 1.08 in the second. Conclusions: Reducing the weight of the fighting gear and securing it closer to the body center of gravity may have a positive effect in reducing the incidence of stress fractures in female recruits of fighting units during the intense basic training program

Background: Foot injuries represent a small but important proportion of injuries to professional rugby union players. There are no detailed epidemiological studies regarding these injuries. Purpose: The aim of this study was to describe the epidemiology of foot injuries sustained by a cohort of professional rugby union players and identify areas that may be targeted for injury prevention in the future. Study design: Descriptive epidemiological study. Methods: Medical personnel prospectively recorded injuries in professional, premiership rugby union players in England over 4 seasons. Injuries to the foot were identified and the time away from training and playing was reported. Results: A total of 147-foot injuries were sustained resulting in 3,542 days of absence in total. Acute events accounted for 73% of all foot injuries, with chronic, mostly overuse conditions, accounting for 25% (undiagnosed 2%). Chronic conditions led to proportionately more time away from training and playing (p< 0.001). Specifically, stress fractures in the foot accounted for 8% of the total foot injuries but 22% of the absence. Navicular stress fractures had the longest recovery time with the mean return to training and match play of 188 days. Conclusions: In collision sports, such as rugby, injury is inevitable, but clinicians should always be seeking ways to minimise their occurrence and impact. This study revealed significant morbidity associated with chronic and overuse foot injuries in these professional athletes. With greater attention paid to risk factors, some of these injuries, and importantly, recurrent injuries may be avoided

Aims

The use of biologics in the treatment of musculoskeletal injuries in Olympic and professional athletes appears to be increasing. There are no studies which currently map the extent, range, and nature of existing literature concerning the use and efficacy of such therapies in this arena. The objective of this scoping review is to map the available evidence regarding the use of biologics in the treatment of musculoskeletal injuries in Olympic and professional sport.

Objectives

The objective of this study was to quantify the relative movement between the articular surfaces in the tibiotalar and subtalar joints during normal walking in asymptomatic individuals.