Introduction: Participation in sport among university athletes in Malaysia has progressed right up to Olympic level. However, some of these athletes are prevented from competing due to injuries. Ankle injuries, in particular, are among the common types of injury. Even so, there is still lack of local data and research describing the incidence of ankle injuries. Objectives: To determine peroneus longus muscle activity in different taped ankles and positions among subjects with functional ankle instability (FAI). Methods: Twenty-three subjects with ankle instability (AJFAT score > 26) volunteered to take part in the study. The subjects were tested under three conditions; 1) no tape (NT), 2) Kinesio(r) tape (KT), and 3) rigid tape (RT). The subjects completed two postural stability tests, followed by a sudden inversion perturbation test with EMG, recording throughout the procedures. The EMG data were analyzed, filtered, full-wave rectified and normalized. The data were analyzed by analysis of variance (Independent T-test and ANOVA) to evaluate differences in peak muscle activation (mV) and peroneal latency (ms). Results: Peak muscle activation of the peroneus was activated more in the RT group during both the Static and Dynamic Stability Tests. Apart from that, there were no statistically significant differences. During sudden inversion perturbation, the RT group was the one that was most activated (p=0.001). Peroneal latency was even delayed in KT and RT during the three tests, and shorter in the NT group. There were significant differences during the Dynamic Stability Test, between the NT and KT groups (p=0.001) and between the NT, RT and KT groups (p=0.001). Conclusion: RT tape may enhance the peroneus longus response by maintaining a higher level of muscle activation, especially during dynamic movements and sudden inversion of the ankle, and may selectively benefit individuals with FAI. The KT ankle did not show superior effect to the NT ankle, and demonstrated minimal benefit when used in FAI. Also, its use may be more likely to cause reinjury to the ankle.

Introduction Prolotherapy and other injections, primarily acting on pathways associated with maladaptive tissue repair, are recommended for recalcitrant chronic soft tissue injuries (CSTI). However, selection of injection is challenging due to mixed results. This network meta-analysis (NMA) aimed to compare prolotherapy with other therapies, particularly injections, for CSTI and establish robustness of the results. Methodology Pubmed, Medline, SPORTDiscus and Google scholar were searched from inception to 4th January 2021 for randomised controlled trials (RCTs) involving injection therapies (e.g. blood derivatives, corticosteroid, hyaluronic acid, botulinum toxin) for CSTI. The primary and secondary outcomes were pain and function, respectively, at (or nearest to) 6 months. Effect size (ES) was presented as standardised mean difference with 95% confidence interval (CI). Frequentist random effect NMA was used to generate the overall estimates, subgroup estimates (by region and measurement time point) and sensitivity analyses. Results A total of 91 articles (87 RCTs; 5859 participants) involving upper limb (74%), lower limb (23%) and truncal/hip (3%) injuries were included. At all time points, prolotherapy had no statistically significant pain benefits over other therapies. This observation remained unchanged when tested under various assumptions and with exclusion of studies with high risk of bias. Although prolotherapy did not offer statistically significant functional improvement compared to most therapies, its ES was consistently better than non-injections and corticosteroid injection for both outcomes. At selected time points and for selected injuries, prolotherapy demonstrated potentially better pain improvement over placebo (<4 months: shoulder [ES 0.65; 95% CI 0.00 to 1.30]; 4–8 months: elbow [ES 0.91; 95% CI 0.12 to 1.70]; >8 months: shoulder [ES 2.08; 95% CI 1.49, to 2.68]). Injections generally produced greater ES when combined with non-injection therapy. Conclusion While clinical outcomes were generally comparable across types of injection therapy, prolotherapy may be used preferentially for selected conditions at selected times.

Background: Sudden cardiac arrest and death (SCA/D) remains the leading cause of mortality among athletes. Contemporary standards of identifying normal physiological cardiac adaptations and remodeling from regular athletic training based on certain ECG morphology have been clearly defined by the ‘Seattle Criteria’ in 2012, with an updated ‘International Consensus’ in 2017. In heterogenous Asia, regional SCA/D preponderance data is still lacking. This study aims to report on the detection of potentially dangerous cardiovascular conditions in Malaysian university athletes via pre-participation evaluation.Methods: 176 Malaysian athletes competing in the 18th ASEAN University Games 2016 were requested to attend a centralised pre-participation evaluation (PPE) prior to the games. The PPE included history, physical examination and a resting ECG. Participating sports and the corresponding number of athletes were athletics (40), basketball (26), football (24), silat (16), rugby (14), badminton (14), table tennis (12), shooting (12), fencing (10) and petanque (8).Results: 113 athletes (64.2%) attended and completed the PPE. The highest percentages of athletes screened were from shooting, fencing and petanque (100% respectively), whilst the lowest were from the basketball team (23.1%).  Three abnormal ECGs were identified: a multiple premature ventricular contractions, an atrial tachyarrhythmia and a ventricular pre-excitation. These three athletes were referred for subsequent investigations of which two were allowed to return to play. The latter athlete was diagnosed with Wolff-Parkinson-White syndrome and was advised against competing until definitive management was instituted.  Conclusion: Only a fair number of Malaysian university athletes completed the medical screening, and hence are possibly unaware of the importance of PPE. Despite our small sample size, we picked up three cases requiring further investigation and interventional studies. No screening program provides absolute protection against death. Thus, more evidence-based research and constant update in best practice guidelines are vital to foster safe sports participation and ultimately reduce incidence of SCA/D in the athletic population. Athletes need to be aware and give full cooperation for PPE to ensure timely detection of high risk cardiovascular conditions especially those related to sudden death in sports.

Background: Piriformis Syndrome is a condition in which damage to the piriformis muscle causes pain in buttock and leg. Robinson described the syndrome as having six key characteristics. Before 1934, it was considered that the sciatica can be caused by impingement of sciatic nerve in pelvic, but new diagnostic technology suggests that it can also be caused by distal foraminal entrapment and Piriformis Syndrome. Piriformis syndrome is underrated and mostly neglected by clinician though it can be a cause of low back pain. Objectives: To evaluate the piriformis syndrome in patients complaining of low back pain. Methods: This study was carried out at three different Public Medical Teaching Institutes. Duration of study was 6 months i.e., from March 2018 to August 2018. Sample size of the study was 337 and four different physical tests were performed on patients for diagnosis of Piriformis syndrome. Results: Piriformis Syndrome was diagnosed among 111(32.9%) study participants among which 56 were male and 55 were females. Conclusion: Every third patient of low back pain was diagnosed with Piriformis Syndrome. Male to female ratio of Piriformis Syndrome was 1:3.