1. Introduction: Skeletal muscle injuries are up to 55% of all sports injuries and causes excessive long term pain and physical disability, Muscles strains and contusions representing more than 90% of all sports related injuries and are the most muscular injuries frequent.

1. Introduction: Skeletal muscle injuries are up to 55% of all sports injuries and causes excessive long term pain and physical disability, Muscles strains and contusions representing more than 90% of all sports related injuries and are the most muscular injuries frequent.

The gym population comprises of everyone from young ones, adolescents, adults to seniors. These groups of folks have different goals for training in gym from trying to keep fit and control body weight to conditioning the body to perform at its highest level in competition therefore it is not uncommon to see professional sports men to workout at the gym at the same time with people doing rehabilitation exercises. (Yigal Pinchas, 2006)

With the increase number of people going to gym, the risk of accident happening in them increased. Gym injuries can range from minor injuries such as small superficial cuts and bruises to severe sprain and strain, crushed body parts and rarely death. Weight room injuries has wake public awareness when a University of Southern California American football player star was injured to his throat and was lucky to survive when his bench press bar slipped from his hand and fell on him. Mr Stafon Johnson received a load of 275 pound nearly 125 kg on his throat and had to undergo multiple neck and throat surgeries. He couldn’t speak for months because of his injuries. Another severe case of injury happened when another American football player nearly got his fingers cheated while training in the weight room ( Josh Staph, 2010). Reed Remington was doing shoulder press with a load of 165 pound (75 kg), when he found out he didn’t have enough strength to push it up from head level, he arched his back to try to lock it out but lost balance while doing so, so he tried to throw the weight bar in the front of his head but ended up having the bar hitting his head while falling down, his right hand got caught between the weight and the apparatus holding the weight which crushed his index finger and ripped it off. After surgery, Reed Remington had to stay at hospital for five days and 3 weeks at home for recovery (Tim Rogers, 2010).

Manual control of loads is describe as the action of lifting, pulling & pushing, moving, decreasing, holding and carrying any objects using the force generated from the human body.

As seen above, weight training injury takes a lot of time and energy to heal up, resulting in temporary impairment and sometimes permanent disabilities if the injury is severe. This affects the income of a working people, his social life and family life and the company currently employing him.

With gym getting more popular these days, more and more people are adopting weight training in their lifestyle. According to a statistic report published in THE NEW YORK CIRCUMSTANCES, weight training injuries are on the raise due to it gaining popularity and trainees dropping their weight where they shouldn’t. From year 1990 to 2007 data collected shows us that nearly one million Americans end up at emergency section in the hospital due to weight lifting injuries and that a yearly increase of 48 percents were noticed in that period. According to The American Journal of Sports Medicine, of the 970,000 people injured, 82 percent were men but this trend is changing, quantity of injuries among women doing weight training is on the rise yearly with 63 percent in the place of men that will be 46 percent. This may be as a result of increase of women adopting gym training in their lifestyle. People between the age 13 to 24 recorded many number of injuries but concern is rising with people between 45 to above as they have recorded the greatest increase of weight training injuries as many of them want to delay or regain the muscle loss due to ageing (Jane E Brody, 2010)

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The most common injures encountered among women were in the region of their feet and legs while in men the majority were the torso and hand. Fractures were mostly reported among women while men suffered more from sprain and strain. All the injuries encountered were by dropping weight on themselves with body parts being crushed or by getting hit by the equipment they are exercising. Loss of balance, overexertion and muscle pull formed 14 percent of injuries which were treated at emergency rooms and 90 percent regarding the injuries happened while using free weight than weight machine (Nicholas Bakalar, 2010)

In Mauritius the average income of workers is about Rs18,247 monthly according to a survey done by the Mauritius Employers’ Federation. (Nilen Kattany, 2011). This have give rise to different gym service facilities offered to Mauritian across the country. They are categories by the number of service they offer, from new sophisticated ergonomic well maintained state of the art weight machine, free weight and coaching system, sauna facility, air conditioned room, good lighting to old out of fashion weight machine from the 1960, Weight machine constructed by owner of the gym by welding iron bars which sometimes isn’t ergonomic for everyone as it isn’t adjustable, bad floors as the owner hasn’t repaired the floor which was damaged by dropping free weight on it which create a risk of slip, trip and falls , no coaching system such as municipal gym multi sport complex where you have the weight machine and free weight but no one to spot you which can induce accidents for example being crushed under a bench press bar, coaching system but with unqualified coach, congested areas where there are too many members training at precisely the same time and you have the risk of being hit by someone training with a weight while moving around and poorly maintained weight machine. Gyms offering good services are quite expensive in Mauritius with a monthly membership fees of Rs1000 to more so most Mauritian (especially teenagers because of the low income) prefer to train in gym offering low to medium services where monthly fees may range from free (Municipal Gym Multisport complex) to Rs 900 making them more exposed to weight training injuries.

To minimise the risk of manual handling injuries in Weight training Gym.

To spot the risk elements contributing to manual handling injuries in weight training exercises.

Identify common weight training exercises which has a significant risk of bodily injuries.

Assess the risk of bodily injuries due to gym environment, individual factors such gender and age

Give recommendation to minimise the accidents.

Manual control of loads is describe as the action of lifting, pulling & pushing, moving, decreasing, holding and carrying any objects whether lively or dead by using the force generated by the human body.

The Occupational safety and health act 2005 points out the legal requirement for health and safety that an company has to abide. Although OSHA 2005 focus mainly on employees, it is the duty of the company to ensure that people other than his employees are not affected by health and safety issues arising during operation of his business

According to section (5)(2) General duties of employers, the company shall, so far as is reasonably practicable, ” provide and keep maintaining a safe working environment”, “provide and keep maintaining any plant or system of work”, “maintain any place of work under his control that is safe and without risks to health”, “ensure that use, handling, of articles is safe and without risks to health” and “provide information, instruction, training and supervision as is necessary to ensure the safety and health at your workplace of his employees”.

Section 10 of OSHA 2005 stressed out the legal obligation of an company to carry out a risk assessment. “Every employer shall, within 30 days of the start of operation of his undertaking, make a suitable and sufficient assessment of any risk to the safety and health to which any employee is exposed whilst he is at work”, “and any risk to the safety and health of any person not in his employment”.

According to this section, every company shall (a) so far so far as is reasonably practicable, avoid the significance of his employees to undertake any manual handling operations at work which involve a risk of bodily injury (b) where it’s not reasonably practicable to avoid the need for his employees to undertake any manual handling operations at your workplace which involve a risk of bodily injury-

take appropriate steps to reduce the risk of bodily injury to those employees arising out of their undertaking any such manual handling operations to the lowest level reasonably practicable.

take appropriate steps to provide any of those employees who are undertaking such manual handling operations with general indications and precise home elevators the weight and nature of each load to be handled.

provide sufficient training in the safe methods or methods of manual lifting and handling to any employee who is required in the normal course of his work regularly to lift, carry or move loads exceeding 18 kilograms for any employee

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Section 84 (3) defines manual control as any transporting or supporting of a load, including the lifting, putting down, pushing, pulling, carrying or moving thereof by hand or by bodily force. This definition reflect exactly the exercises practiced in weight training exercises.

Although these legislation focus mainly on employees, it is the legal duty of the company to ensure the safety and health of any visitors visiting the workplace. By applying these measures to the gym, it will not only affect the health and safety of the employees but also have an impact on the visitors which will decrease the odds of fines and any civil prosecutions due to injuries. According to OSHA 2005, the maximal penalty under this act is RS75,000 and a maximum of 1 year imprisonment.

In this subsection, we will go into detail about the different types of people frequenting the gym, They are divided into different age group and needs to train in gyms. They are namely young ones, adolescents, adults, seniors,

Young ones are described as someone under the age of twelve. Young ones before this age weren’t allowed to workout in gym in the US as there was clearly fear that young ones practicing weight training is vulnerable to injuries such as damaged growth cartilage which would stunt their growth. Research done by Docherty, Wenger, Collis, & Quinney, Hetherington also concluded that weight training at this age was futile as none of their research could demonstrate any adequate escalation in strength and lean muscle mass from test subject doing weight training at this age. Their theory for this result was it was because young ones lack sufficient androgens in their blood at this age (Androgen is the hormone responsible for the development of skeletal muscle mass). Theory about young ones being at more risk of injuries when practicing weight training was confirmed by report published by the US Consumer Product Safety Commission in the year 1987 which found out that of the 8543 weight training related injuries most of them were younger than 14 years old. But recent research done by Faigenbaum, Milliken, Moulton, & Westcott in 2007 discovered that properly designed resistance training exercise ( weight training) for young ones and adolescents increased their muscle strength and decreased the likely hood of injuries and that data from previous research was inaccurate as training exercises use to collect data was for adult. (Aleksandar Ignjatović et Al, 2009). Doing weight training at this age proved to contribute for better posture, improved self confidence, contribute to improve motor abilities and intramuscular coordination. These data proved to be much relevant when we realise that young ones school back pack bags that they carry weights more or less 32 percent of their total body weight so training at gym may help consolidate the weaker muscle group and help them in their daily life. Before starting any exercises, the child should be examined by a physician to determine its physical condition. Training at this age should be strictly supervised, light weight should be use until he or she learn the proper techniques, add weight slowly when 8 to 15 repetition is completed easily and exercises must certanly be design to work all muscle groups and be performed to full extension of joint movement. To gain strength, workout should at least be 20 to 30 minutes long and be done 2 to 3 times weekly with gradual increase of training weight or repetition when strength of muscle improves. Due to skeletal and physical immaturity children should avoid any form of competitive weight training such as bodybuilding, power lifting, weight lifting as they is tempted to lift maximal weight to compete. (PEDIATRICS, 2001; Yigal Pinchas, 2006 )

Adolescent is described as someone between the age of 12 and 17 years old. Physical exercise at this age is vital for achieving the optimum development and growth potential of the body. This is because after these ages, the skeletal system will start to hardened and will be less stimulated by physical exercises and development of the skeletal system will stunt no matter if weight training exercises is used. Strength training at this age can be done with free weights, weight training machine and by using the body own weight. Strength training at this age should be strictly supervised such as frequency of training, types of exercises done, intensity and extent of exercises to ensure strength increase of the adolescent and minimum risk of injuries (Yigal Pinchas, 2006) . At this age, muscle size, strength and power are lost easily after 6 weeks of total rest so maintenance exercises is crucial so as to conserve progress. Adolescent strength training can improve the athletic performance in sports such as American football where strength and size of body matters. Despite theories that strength training helps to reduced or stop sport related muscular skeletal injuries in adolescent scientific research have did not confirm it but recent research suggests that there is a possible reduction in sports-related knee ligament injuries in teenage girls when strength training is combined with plyometric exercises. (Pediatrics, 2008) The National Electronic Injury Surveillance System (NEISS) use by the US Consumer Product Safety Commission has estimated from year 1991 to 1996 that 20 940 to 26 120 injuries happened annually in individual less than 21 years old. Data built-up from NEISS and other studies reported that 40 to 70 percent of the injuries were from muscle strain and most muscle strain occurred in lumbar back area. Before starting any exercises, the adolescent should be examined by a physician to determine its physical condition. Training at this age should be strictly supervised, light weight should be use until he or she learn the proper techniques, add weight slowly when 8 to 15 repetition is completed easily and exercises must certanly be design to work all muscle groups and be performed to full extension of joint movement. To gain strength, workout should at least be 20 to 30 minutes long and be done 2 to 3 times weekly with gradual increase of training weight or repetition when strength of muscle improves. Due to skeletal and physical immaturity adolescent should avoid any form of competitive weight training such as bodybuilding, power lifting, and weight lifting as they is tempted to lift maximal weight to compete (PEDIATRICS, 2001). Most adolescents in Mauritius are influence by western cultures where muscular bodies are seen everywhere in movies or advertisement. More are them are tempted these days to engage in weight training and prefer to go in low services gym as they don’t have enough money, common problem in these gym are they are not supervised and adolescents want rapid results where they lift weight without learning the proper lifting methods and often exaggerate on weight size to gain muscle quickly which all the time lead to serious injuries such as back problems.

All the adult that come to work out in gym do so to keep fit as they have come to accept that exercises is necessary to truly have a sound physical and mental health. At this stage the body is fully developed and ready to accept complex training, increased load, frequencies and extent of exercises (Yigal Pinchas, 2006). With a lot of people working in offices these days and health problem such as overweight and cardiovascular problem at their doorsteps, physical exercise became important these days. According to the Centers for Disease Control and Prevention (CDC) about 600,000 people died of heart problems each year in the US, in Mauritius, concern is rising about heart diseases when diabetic and obesity which always results in heart problem is on the rise (CDC, 2013). Since 1987, Mauritius has recorded an increase of 60 % of diabetic among adult. Nearly half of Mauritian between the age of 25 to 74 is either diabetic or pre-diabetic (Mauritius News Team, 2010). Weight training is one of the solutions to the problem as it can reduce fat by increasing the metabolic rate of the body on short and long term. This is due to the fact that weight training builds lean muscle which metabolise fat in the human body to grow. But weight training can also cause injuries if done carelessly. According to data collected from 100 emergency departments, men were more injured than women from weight training exercises (82.3%). This may be as a result of fact that more men lift weight than women. All the injuries happened due to free weight (90.4%) and most of these injuries happened as soon as the users drop the free weight on themselves or hit themselves by mistakes while using it (65.5%). The upper trunk and lower trunk were the most injured body part on men with 25.3% and 19.7% respectively. The most common diagnostic resulting from these injuries was sprain and strain with 46.1%. Women suffered more from foot injuries and fractures than men. (Zachary Y. Kerr et al, 2010).

At this age where muscle loss and other illness such as osteoporosis and cardiovascular diseases happens gradually with ageing, physical exercise is crucial in order to keep the body fit and away from these illness. At this age working out using weight is a good solution to increase lean muscle mass and reduce fats in the human body while in the same time increase bone density to combat some of the osteoporosis and loss of balance due to weakened muscle. Exercises must certanly be supervise by a qualified instructor as frequency, intensity, range repetition, extent of this exercises and type of exercises is different from those of the other age group. Senior should always consult a doctor before doing any form of exercises due to the fact that most of the time they have orthopaedic issues such as joint problem and cardiac problem and special type of exercises should be designed for them to remove any exercises that can pose a health risk. Senior should go to gym 3 times weekly to gain adequate strength and a rest time of 48 hours between sessions. Exercises should be design so as all muscle groups and joints are trained equally per week, duration of session should be at least 20 minutes but no more than 45 minutes. When progress in strength is seen, repetition or weight should be added in each exercise. But due to orthopaedic and cardiac problem, weight addition could be a problem so other factors like repetition could compensate this problem (Darryn S. Willoughby, 2009). According to statistic, the range injuries among old people is on the rise. All the injuries happen while they used weight training machine. The most common injuries were overexertion and while doing exercises that involve pulling and lifting exercises.

To understand how these different types of injuries occur and how to prevent them, we must understand how the human body work.

The spine is a column comprising of different material namely bones, tendons, ligaments, muscles, cartilages and nerves all assemble together to form an extremely strong yet flexible structure in areas including the neck and lower back.

C:UsersDavidDesktopgymNew folderIllu_vertebral_column.jpg

(Wikipedia, 2006)C:UsersDavidDesktopgymNew folderGray_111_-_Vertebral_column-coloured.png

The lumbar spine is in the lower back area where in actuality the 5 last vertebrae the L1 to L5 bones are found like seen in the picture above. The vertebrae are the 33 bones in the shape of a disc that connects together to form the vertebral column, the vertebra features a hole in the middle where in actuality the spinal cord passes through and so acts as a protection and support. The lumbar spine bears the load of the body and absorbs any stress from movement such as lifting or carrying heavy objects. This is why the vertebra bones are bigger in this area.

Each vertebra sits and is separated by an intervertebral disc and prevents the rubbing of those bones. The intervetebral disc has 2 layers the outer ring called the annulus and the inner ring called nucleus. The annulus is made of fibres bands criss-crossing each other and attaches both the upper and lower vertebrae together. The nucleus, the inner ring is filled with a gel like substance called the nucleus and act as a cushion between both vertebra. The intervetebral disc function like coil spring where in actuality the annulus compress both vertebrae together and the nucleus being and uncompressible liquid push the vertebrae away so a gap between both vertebrae is formed. This gap allows the nucleus being uncompressible to work such as a ball bearing where the vertebrae roll on it and thus making the vertebral column flexible. With age, the intervertebral disc loses progressively the ability to absorb the liquid making the nucleus and so it becomes flatter and brittle resulting in loss of height (Tonya Hines, 2013)

C:UsersDavidDesktopgymNew folderPE-AnatSpine_Figure4b.jpg C:UsersDavidDesktopgymNew folderPE-AnatSpine_Figure4a.jpg

Most of the time, back pain injuries occur due to injuries and degeneration of the intervertebral discs. Degeneration happens due to wear and tear of the intervertebral discs while doing movement such lifting heavy weight, bending over which put stress on the disc. While doing these movements, compression of the intervertebral disc happens and certainly will move the disc toward the spinal cord and surrounding nerve. This displacement results in the compression of the spinal nerve and put strain on nearby ligaments which causes the back pain. Movement where both twisting and bending occurs put more stress on the spine

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Efficacy of growth factors concentration (hGH, IGF-1, FGF-2, PDGF, VEGF) after autologous Platelet-rich plasma injection (PRP) on accelerating healing of proximal hamstring tear for athletes.

Ahmed Gaballah

1- Department of Sports Health Sciences, Damietta University, Damietta, Egypt.

2- Kinesiology and Health Sciences Department, Utah State University, Logan, UT, USA

Abstract

Platelet rich plasma (PRP) become popular biologically method used to accelerate healing in sports medicine and orthopaedic surgery field. PRP is concentrate the human platelets to supra-physiologic levels. It is an autologous producing high level of the platelets concentration centrifuged from the peripheral vein. Then it re-injected under the ultrasound gaudiness during surgery or at a site of injury. METHOD: Seventeen physically active males (age 22.0±0.6) with acute hamstring strain injuries divided to 8 case group and 9 matched controls (age 21.6±2.8) were recruited as research participants. Case group participants were injected with single 3 ml of extracted PRP under ultrasound gaudiness. Nonetheless, Blood samples were collected by venipuncture at standardized time points: before the injection and 24, 48, 72, and 96 hours after for case group and 4wks. and 8wks for both groups. RESULTS: there was clearly somewhat difference between the growth factors results of the case group after 4 weeks compared with the 8 weeks results of the control group. Additionally, equivalent significant results between the two groups after the 8 weeks. Nevertheless, the physical measurements related with hamstring Strain and Knee flexion range of motion between the two groups were not significant after 4 weeks or 8 weeks. CONCLUTION: a single 3-mL injection of autologous PRP combined with a rehabilitation program was effective in time return to play and reducing the severity of pain after a acute grade 2 hamstring injury. Additionally, escalation in circulating concentrations of VEGF, IGF-1, PDGF and FGF-2.

Keywords: Platelet rich plasma (PRP), Human Growth Factors, Hamstring Tear.

1. Introduction:

Skeletal muscle injuries are up to 55% of all sports injuries and causes excessive long term pain and physical disability, Muscles strains and contusions representing more than 90% of all sports related injuries and are the most muscular injuries frequent. [1] [2]  Proximal hamstring tear injuries are common in athletes and frequently end up in prolonged rehabilitation, time missed from play, and a significant risk of re-injury. Reports of acute hamstring strains without avulsion in dancers have suggested recovery times for return-to-play ranging from 30 to 76 weeks [3].

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Platelet rich plasma (PRP) become popular biologically method used to accelerate healing in sports medicine and orthopaedic surgery field. PRP is concentrate the human platelets to supra-physiologic levels. It is an autologous producing high level of the platelets concentration centrifuged from the peripheral vein. Then it re-injected under the ultrasound gaudiness during surgery or at a site of injury [4] [5]. Due to the lack side-effect and the autologous nature of PRP, it offers utilized exponentially over the last few years in sports medicine and orthopaedic. Historically, since the 1950s the platelet-rich plasma (PRP) has been used to dermatological conditions and manage maxillofacial as well [6]. Also, Platelet-derived preparations including PRP were first regulated by WADA under the 2010 Prohibited List because of concerns that the elevated concentrations of growth factors in PRP may confer a unfair advantage to treated athletes. Nonetheless, WADA lifted the ban on PRP last year in recognition of the lack of evidence to support a systemic performance-enhancing effect and to allow further research in the field [7].

Indeed, the blood contains 6% platelets, 1% white blood cells, and 93% red blood cells.  The PRP technique aims to reverse the concentration of the platelet in lieu of red cells to increase the growth factors that more useful in accelerating the healing. [8] However, Platelet rich plasma (PRP) is a centrifuged blood product that contains a supraphysiologic number of platelets. Therefore, the preparation process to product concentrative platelet above the baseline values have started with an autologous extraction of patients` blood, then by plasmapheresis centrifuged to obtain a concentrated suspension of platelets. It then separates the solid and liquid components of the anticoagulated blood after a two-stage of centrifugation process [9]. The initial phase separates the plasma and platelets from the erythrocytes and leucocytes. The second stage concentrates the platelets further into platelet-rich and platelet-poor plasma components [10] [11].

Platelet rich plasma (PRP) contains some biologic factors which have been enhanced the proliferation and collagen secretion of tenocytes. These factors including vascular endothelial growth factor (VEGF), basic fibroblast growth factor (FGF2), and transforming growth factor β (TGF β) [12] [13]. There is an increasing the stimulus response of PDGF and TGF-β in the early stages of tendon and muscles treating after PRP injection resulting in new vessel formation and collagen synthesis. [14]. In addition to decrease oxidative stress that could lead to cell apoptosis, PRP has been promoted tendon and muscles cell growth [15]. This is evidenced and reinforced by release of inflammatory meiators such as COX-1 and2, PGE-2 [16] [17].

Recently, there are various approaches reported the benefits of treating the soft tissue injuries such as muscles tears and tendinosis by injecting platelet rich plasma (PRP). Despite this popularization and increasing use in soft tissue injuries, its efficacy still not clear and remains controversial. It is often previously established that platelets provide regenerative potential by the process of chemo-taxis [18] [19] [20]. The use of PRP in order to accelerate recovery time after muscle injury has become a relatively common practice in sports medicine.