Background and objectives:Glucocorticosteroids are widely used in medicine and have shown unchallenged therapeutic potential in several chronic inflammatory and other diseases. They are also widely used in sports medicine for the treatment of conditions such as asthma and acute injuries. In fact, as banned substances, most requests for therapeutic use exemption concern glucocorticosteroids. Nevertheless, their beneficial effect in certain conditions in sports, where inflammation is only a secondary reaction, remains to be validated. This paper aimed to provide a comprehensive review of the literature covering the therapeutic use of glucocorticosteroids since 1977 in conditions ranging from chronic rheumatic illness to peritendinous or intra-articular injection in acute injuries.Methods:Search of the medical literature published between 1977 and 2006 using PubMed. Articles relevant to the question “When and if at all is the use of glucocorticosteroids justified in football?” were selected and analysed.Results and conclusions:The findings clearly point out that, despite the common use of glucocorticosteroids in acute injuries in sports, there is actually limited evidence of the true benefits of such a practice. Physicians must take the possible adverse effects into consideration. In an athlete with clinically verified asthma, inhalational glucocorticosteroids remain first line therapy. Finally, for the purposes of education and prevention of misuse, it should be stressed that a measurable performance enhancing effect of glucocorticoids could not be proved on the basis of the results of the scientific studies to date.

BackgroundPrecompetition screening was implemented for male referees during the 2010 Fédération Internationale de Football Association (FIFA) Word Cup. In contrast, female football referees have been neglected in this respect although they experience similar physical work loads compared to male referees.MethodsThe standardised football-specific Pre-Competition Medical Assessment (PCMA) was performed in 51 referees and assistant referees selected for the 2011 FIFA Women's World Cup.ResultsFamily history for sudden cardiac death (SCD) was positive in four referees (7.8%), but cardiac examinations did not reveal any pathological findings. Training-unrelated ECG changes were identified in three referees (5.9%), all without correlates in echocardiography or clinical examination. Most common echocardiography findings (66.6%, n=34) were asymptomatic tricuspid and mitral regurgitations.ConclusionsDuring the present screening, no elite female referee was identified being at risk for SCD, and no referee had to be excluded from participating in the 2011 FIFA Women's World Cup.

A standardized PCMA including comprehensive orthopedic examination is principally feasible in international elite football. The challenge is to ensure the quality of the physical examinations and to verify their predictive value.

ObjectiveVertigo, dizziness and visual problems are among the main symptoms of a prolong course after concussion. Adequate diagnostic tools are rare. The computerized sensory organization test (SOT) differentiates the sensory integration between somatosensory, vision, vestibular and visual preference. This analysis may help to create an individual rehabilitation program and observe the progress.DesignCase series.SettingRehabilitation center.ParticipantsAmong 31 post-injury tested athletes with a diagnosed concussion 5 male professional players completed a follow-up test by the end of April 2016. Interventions: 5 players performed a post-injury baseline on the computerized dynamic posturograph (Equitest) and repeated the test as follow-up after personalized vestibulo-oculomotor therapy and improvement of symptoms during the rehabilitation process.Outcome measuresOutcome measures were total score (calculated by 6 SOT conditions) and identification of the integrational deficits (calculated by results of sensory analysis). Both values serve to guide and monitor the individual rehabilitation.Main resultsAt post-injury baseline a deficient total score and vestibular impairment was verified in all 5 athletes. After specific individualized vestibulo-oculomotor therapy and a significant reduction of symptoms the follow-up test demonstrated improvement in total score (22% ± 10% SD) to a point where entering intensive training (return to play protocol stage 3) was recommended. Regarding the vestibular system patients improved their score 57% ± 20% SD.ConclusionsThe computerized SOT can be a useful tool to identify specific sensory deficits and to help specify post-injury therapy and observe the individual rehabilitation process regarding the return to play protocol. Further research is required.Competing interestsNone.

ObjectiveBalance problems are a frequent symptom after head trauma including concussion, and the Balance Error Scoring System (BESS) is routinely used as a subjective screening test. Low-cost inertial sensors are an attractive objective alternative to elaborative force plates in objective testing balance in athletes.DesignCase series.SettingTraining area of professional players.Participants310 professional male and female football players from highest league in Switzerland (19/20 (95%) teams).InterventionSubjects were scored on their ability to maintain posture while standing in the six BESS conditions. Errors were counted by a test administrator, while an IPOD worn in a waist belt recorded linear acceleration and rotational velocity.Outcome measuresA variety of measures of stability (e.g., area of 2D surface plot, normalised path length (NPL)) were computed. In order to determine which measure was most sensitive to changes in balance, receiver operating characteristic (ROC) curves were created comparing firm to foam surfaces, and then the area under the ROC was calculated.Main resultsBESS and inertial measures correlated well overall (>0.7). Inertial measurements perform well in easier conditions (ROC area >0.95 for double stance), whereas BESS is insensitive to subtle changes in balance (ROC area=0.5). BESS, however, performs better on difficult conditions (ROC area >0.9 for single stance).ConclusionsAccelerometer assisted balance tests are a useful laboratory test in assessing balance problems. Normative values for athletes should be established.Competing interestsNone.