Abstract Disclosure: Á.D. Árnason: None. B.B. Sigurdsson: None. E. Cook: None. M. Þorsteinsdóttir: None. S. Wallerstedt: None. H.A. Sigurjonsdottir: None. Background: The diagnosis of liquorice induced hypertension (LIH) has been confirmed by measuring the urinary ratio of free cortisol/cortisone by gas chromatography. The aim of this study was to evaluate if analysis of this ratio in serum (QS) is as sensitive and selective compared to analysis of the urinary ratio (QU) using mass spectrometry (LC-MS/MS) and if the analysis of serum GA (glycyrrhetinic acid) correlates to the ratio of QS in order to diagnose LIH. Methods: We included 125 individuals, 117 normotensive (NT) and 8 hypertensive (HT). Mean age was 31.6 years for the whole group (W), 31.1 years for NT, 39 years for HT, 31.1 years for men (n=72) and 32.2 years for women (n=53). The study was prospective and double blind, participants consuming 150 mg of capsuled GA daily for 2 weeks (n= 62) or placebo (n=63). Highly selective and sensitive validated inhouse LC-MS/MS method, able to measure both serum and urine samples, was used to quantify free cortisol and cortisone. An additional validated in-house method was used to quantify serum 18β-GA. Mean values with standard deviation of QS, QU and serum GA was obtained for W and the subgroups. The mean difference (mdiff) in QS, QU and serum GA before and after GA intake (or placebo) was evaluated with Wilcoxon test and correlation by Spearman correlation test. Results: For W the mdiff for QS was 0.936 (±3.19, p<0.001) and for QU it was 0.214 (±0.493, p<0.001), QS and QU correlated (p<0.001, rho=0,605). For NT the mdiff for QS was 0.877 (±3.22, p<0.001) and for QU it was 0.203 (±0.498, p<0.001), Qs and QU correlated (p<0.001 and rho=0.610). For HT the mdiff for QS and QU was not significant. For men the mdiff for QS was 1.30 (±2.85, p<0.001) and for QU it was 0.241 (±0.474, p<0.001), QS and QU correlated (p<0.001, rho=0.635). For women the mdiff of QS was 0.446 (±3.58, p=0.00816) and for QU it was 0.176 (±0.520, p=0.0360), Qs and QU correlated (p<0.001, rho=0.477).The mdiff for GA for W was 6.78x105 (±1.04x106, p<0.001), for the NT the mdiff in GA was 6.50x105 (±1.00x106, p<0.001), for HT it was not significant. For men it was 7.18x105 (±9.15x105, p<0.001) and for women it was 6.24x105(±1.19x106, p=0.0140). There was a positive linear relationship between the mdiff of QS and GA and QU and GA, for all groups (p<0,05). Conclusions: We conclude that the new inhouse LC-MS/MS method is a sensitive and reliable method to evaluate Qs, Qu and serum GA. Further, this new inhouse method is a reliable method to diagnose LIH. Presentation: Friday, June 16, 2023

Introduction Few studies have used electromyography (EMG) to assess hamstrings function after anterior cruciate ligament reconstruction (ACLR). The purpose of this study was to identify inter-limb differences in muscle activity of the semitendinosus (ST) and the long head of the biceps femoris (BFLH) after ACLR while accounting for the muscles' mass, as measured with ultrasound. Materials and Methods Twenty athletes (age 18–28) who had undergone ACLR with a graft harvested from ST partook in the study. Electrodes were placed over the midbelly of ST and BFLH bilaterally. Peak muscle activity was measured during three good trials of a single leg jump and normalized to the signal obtained during a maximal voluntary isometric contraction. Ultrasound was used to measure muscle mass. Processing was conducted in Visual 3D, while mixed model statistical analysis was performed with Jamovi. Results Peak activation of BFLH was higher than ST across both sides (p<0.001) and activation of both muscles was generally higher on the injured vs. uninjured side (p<0.001). Muscle mass of ST on the injured side was negatively correlated with muscle activity, while the correlation was positive on the uninjured side (interaction; p<0.001). No correlation was found between muscle mass and BFLH muscle activation (n.s.). Conclusion The use of ST for ACLR not only has a significant effect on the muscle's mass but also influences muscle contraction levels of the injured limb. Prospective intervention studies are needed to determine whether specific post-surgical intervention may positively influence long-term muscle mass and activation, and lower limb function.

INTRODUCTION: In the first half of the 20th century, Icelandic doctors and teachers began documenting the health of school children, believing that physical measurements were important to monitoring physical development. The measurements could also be used for comparison in other areas and for reasearch. At the Reginonal Archives of Skagafjordur, rare data about the physique of children in Saudarkrokur in 1912??? 1953, measured by Jon Th. Bjornsson, is preserved. MATERIAL AND METHODS: Height, weight, grip strenght, thorax expansion and tidal volume were measured twice in 2018???2019 on 7???15-year-old children in elementary schools in Saudarkrokur and Varmahlid. These measurements were compared with similar measurements from 1912???1953. RESULTS: Children in 2018???2019 at ages 7???15 years were significantly taller, heavier, with greater thorax expansion and tidal volume than their peers in 1912???1953 (p<0,001???0,037). Children in 2018???2019 at ages 7???14 years had significantly higher body mass index than their peers in 1912???1953 (p<0,001???0,027). If adjusted for height and weight in thorax expansion and tidal volume measurements, similar results were found. Children in 2018???2019 had significantly less grip strength than their peers in 1912???1953 at ages 7 and 9???12-years when adjusted for height and weight (p<0,001???0,025). There was significant development in the physique of children over the years 1912???1953 in most measurements and age groups (p<0,001???0,040). CONCLUSIONS: A significant increase in measured factors in 2018???2019 compared to 1912???1953 can possibly be attributed to improved quality of life.

In this prospective cohort study, the aim was to examine any association between pre-season training load and overuse problems (OP) in low back, knee, and shoulder in Icelandic elite male handball players. A total of 139 players participated, answering the OSTRC overuse questionnaire weekly during a 6-week period. The training volume and intensity were registered by the coaches. The average weekly OP prevalence for shoulder was 40% (95% CI 36% to 44%), for knee 33% (95% CI 28% to 38%), and for low back 31% (95% CI 26% to 36%). Substantial overuse problems (SOP) were 14% (95% CI 11% to 17%) for shoulder, 11% (95% CI 10% to 12%) for knee, and 6% (95% CI 4% to 8%) for low back. The knee was most susceptible for OP with weekly number of training and training hours associated with OP and SOP. For individual training factors, running (OP; OR = 1.30, SOP; OR = 1.59), and shooting practice (OP; OR = 1.82, SOP; OR = 3.22) had the highest associations for knee problems. Jumping was associated with OP in low back (OR = 4.55). Handball players are most susceptible for OP in knees during their pre-season. Every week, 30% participated with (SOP), affecting their performance and participation.

Many handball studies have reported injuries that cause absence from participation. In this prospective cohort study on elite Icelandic male players, the aim was to examine the prevalence of overuse problems in low back, knee, and shoulder. Sixteen Icelandic teams were invited. Thirteen teams agreed to participate. The OSTRC overuse questionnaire was distributed every second week during 32-week period. In addition, the 9+ Screening Test was performed on 130 players. In total, 229 players participated with a weekly average response rate of 72%. The average weekly prevalence for shoulder was 28% (95% CI 25% to 31%), for knee 33% (95% CI 30% to 36%), and for low back 32% (95% CI 29% to 35%). Substantial problems were 10% (95% CI 9% to 11%) in shoulder and knee and 11% (95%CI 10% to 12%) in low back. Only 1% (95% CI 1% to 2%) of the overuse problems caused time loss from participation. In total, 61% of the players played with at least one overuse problem and 25% with one affecting their performance. There was no association between the 9+ Screening Test score and overuse problems among Icelandic male handball players.

Objective: To examine the incidence, type, location, and severity of injuries in Icelandic elite male handball players and compare across factors like physical characteristics and playing position. Design: Prospective cohort study. Setting: The latter part of the preseason and the competitive season of Icelandic male handball. Participants: Eleven handball teams (185 players) from the 2 highest divisions in Iceland participated in the study. Six teams (109 players) completed the study. Variables Measured: Injuries were recorded by the players under supervision from their team physiotherapists or coaches. Coaches recorded training exposure, and match exposure was obtained from the Icelandic and European Handball Federations. The players directly recorded potential risk factors, such as age, height, weight, previous injuries, and player position. Main Outcome Measures: Injury incidence and injury location and number of injury days. Results: Recorded time-loss injuries were 86, of which 53 (62%) were acute and 33 (38%) were due to overuse. The incidence of acute injuries was 15.0 injuries/1000 hours during games and 1.1 injuries/1000 hours during training sessions. No significant difference was found in injury incidence between teams, but number of injury days did differ between teams ( P = 0.0006). Acute injuries were most common in knees (26%), ankles (19%), and feet/toes (17%), but overuse injuries occurred in low back/pelvic region (39%), shoulders (21%), and knees (21%). Previous knee injuries were the only potential risk factor found for knee injury. Conclusions: The results indicate a higher rate of overuse injuries in low back/pelvic region and shoulders than in comparable studies.

Background: Eccentric exercises are the only conservative treatment that has shown good clinical results in studies of Achilles tendinopathy (AT), but success rates vary, indicating the need for alternative treatments. Soft tissue treatments are widely used for AT, but strong scientific evidence is lacking to support those treatments. Purpose/Hypotheses: This study aimed to determine whether pressure massage to the calf muscles is a useful treatment for AT and to compare this treatment versus an eccentric exercise protocol. Our first hypothesis was that pressure massage treatment is equivalent or superior to eccentric exercises with regard to pain reduction time (ie, pain would be reduced more quickly with pressure massage). The second hypothesis was that pressure massage is equivalent or superior to eccentric exercises with regard to function of the calf muscles. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 60 patients with AT were randomized into 3 groups: group 1 underwent an eccentric exercise protocol, group 2 underwent pressure massage, and group 3 underwent pressure massage and the eccentric exercise protocol. Patients were evaluated with the Icelandic version of the Victorian Institute of Sports Assessment–Achilles questionnaire (VISA-A-IS), an algometer to test the pressure pain threshold (PPT) of the Achilles tendon, tests for ankle range of motion (ROM), and real-time ultrasonographic (US) scanning of tendon thickness and degree of neovascularization. Measurements for VISA-A-IS, PPT, and ROM were taken at 0, 4, 8, 12, and 24 weeks. US scan measurements were taken at 0, 12, and 24 weeks. Mixed-model analysis of variance was used for statistical analysis. Results: All groups improved when evaluated with VISA-A-IS scores (P < .0001). The pressure massage group improved significantly more than the eccentric exercise group at week 4, which was the only between-group difference. Ankle ROM increased significantly over time (ROM bent knee P = .006 and ROM straight knee P = .034), but no significant difference was found between groups. No significant difference was found in evaluations of PPT or US scan measurements. Conclusion: Pressure massage is a useful treatment for Achilles tendinopathy. Compared with eccentric exercise treatment, pressure massage gives similar results. Combining the treatments did not improve the outcome.

Objectives: To test 9 + screening batteries intra-rater reliability, to provide indicative data of elite handball players, and to analyze difference between age, playing positions and level of play. Design: Descriptive study. Setting: Icelandic elite male handball players. Participants: 182 elite male handball players. Main outcome measures: Nine + screening battery. Results: Reliability test; Intra-class correlation for the total score was 0.95. The correlation of each of the test factors varied from 0.63 to 0.91. The mean total score was 22.3 +/- 2.9 (95%Cl 16.7-28.1), with no difference in total score comparing players age or level of play. Goalkeepers displayed a higher total score than other players (F-3,F-151 = 5.75, p = 0.001). Junior players had a lower score than senior players in tests measuring abdominal strength and core stability; Test 5; vertical bar(2)(3, 182)= 41.5, p <0.0001, Test 6; vertical bar(2)(3, 182) = 55.7, p <0.0001, Test 7; vertical bar(2)(3, 182) = 11.8, p < 0.005, but higher scores in tests measuring trunk and shoulder mobility Test 8; vertical bar(2)(3, 182) =18.2, p < 0.0001, Test 9; vertical bar(2)(3, 182) = 22.2, p = 0.006. Conclusions: The 9+ intra-rater reliability was acceptable for the total score and individual tests. Age-related differences were provided in many individual tests. (C) 2019 Elsevier Ltd. All rights reserved.

BACKGROUND:Studies show a high cumulative prevalence of musculoskeletal disorders among musicians. Increased emphasis is needed on studying the effectiveness of education and prevention courses in music schools.OBJECTIVES:To investigate the effects on music students of an education and prevention course on body awareness and their attitude toward health and prevention.METHODS:23 music students participated in this prospective descriptive comparative study, with 13 students taking the course and serving as a prevention education group (PG) and 10 students serving as a comparison group (CG). The course met once weekly for 2 semesters and included lectures and practical sessions. Before and after the course, participants answered a questionnaire about their level of physical activity, warm-up exercises prior to musical performance, health-promoting activities, and subjective body awareness during musical performance and during activities of daily living (ADL).RESULTS:Over the 9-month study period, the PG group increased, and the CG lessened, the amount of warm-up prior to music performance, showing a significant group difference after the course (p=0.036). Significant interactions were seen for subjective body awareness scores (between groups over time) during practice (p=0.026) and during ADLs (p=0.004), as the PG group had greater positive change over time. No group differences were found in students' subjective rating of body awareness during live performance.CONCLUSIONS:Participation in a prevention and education course may be beneficial for music students due to improved subjective body awareness and attitude toward prevention strategies.

Norraena raðherranefndin um felags- og heilbrigðismal (MR-S) akvað 2017 að lata fara fram stefnumotandi uttekt a norraenu samstarfi i felagsmalum. Markmiðið var að þroa og efla norraent samstarf i fel ...

Background: Female athletes have a higher rate of anterior cruciate ligament (ACL) injury than males from adolescence and into maturity, which is suggested to result from sex-specific changes in dynamic movement patterns with maturation. Few studies have studied movement strategies and response to fatigue in children. Purpose: To evaluate the effect of fatigue on biomechanical variables associated with increased risk for ACL injury during a drop-jump (DJ) performance in children. Study Design: Controlled laboratory study. Methods: A total of 116 children (mean age, 10.4 years) were recruited from local sports clubs and performed 5 repetitions of a DJ task before and after a fatigue protocol. Kinematic and kinetic data from initial contact (IC) to the first peak vertical ground reaction force (vGRF) were analyzed for both limbs, including limb and fatigue as within-subject factors for analyses between boys and girls. Pearson correlation coefficients were calculated to identify associations between variables of interest. Results: Girls demonstrated greater peak vGRF values than boys (by 8.1%; P < .05), there were greater peak vGRF values for the right limb than the left (by 6.2%; P < .001), and fatigue led to slightly greater values ( P < .05). Although weak, the correlation between peak vGRF values and knee flexion excursion was stronger for girls ( r = –0.20) than boys ( r = –0.08) ( P < .006). Fatigue resulted in greater knee flexion angles at IC and less excursion during landing, more so for girls (by 6.1° vs 1.4°; interaction, P < .001), although the knee flexion moment was generally lowered by fatigue ( P < .001). Limb asymmetry in knee flexion moments was more pronounced for boys than for girls (interaction, P < .05), contrary to that seen in frontal plane knee moments, where asymmetry was much greater in girls than boys (interaction, P < .001). Conclusion: Even as young athletes, girls and boys seem to adopt dissimilar movement strategies and are differently affected by fatigue. Clinical Relevance: Injury prevention programs should be considered at an earlier age in an effort to lower the risk of ACL injury in athletes.

Background The majority of studies in handball register only time loss injuries. From previous studies and our experience working with handball players we know that playing with overuse problems are common and such symptoms can affect their performance. Objective To register the prevalence of overuse problems in low back, knee and dominant shoulder among Icelandic male handball players using questionnaire designed by OSTRC in Oslo, Norway. Design Prospective cohort study. Players from the two highest division in Iceland were invited. Setting Icelandic elite male handball players. Patients (or Participants) Out of 14 elite male handball teams invited, totally 229 players from 13 teams participated. The first questionnaire was answered by 206 players; 137 answered the final one. Interventions (or Assessment of Risk Factors) The questionnaire was distributed sixteen times to players via e-mail, every second week from September 25th 2012 to April 22nd 2013. Main Outcome Measurements The prevalence of overuse problems (every problems registered) and substantial problems (problems affecting performance or participation) were calculated for knee, low back and dominant shoulder. This was done for each questionnaire by dividing the number of players that reported problems (overuse or substantial overuse) by the total number of respondents. Results The response ratio was 71.5%. During the research period 91% of participants reported overuse problems and 61% reported substantial overuse problems. The average prevalence of overuse problems was 34% (31–37 95% CI), varying from 21–47%, highest during the pre-season period (September 25th to October 8th). The average prevalence of substantial overuse problems was 12% (10–14 95% CI), varying from 6–15% over the research period. Conclusions Substantial overuse problems are constantly affecting many players during the season. High prevalence in the first two questionnaires raises speculations about the training methods during the pre-season.

Background: The department of physical therapy at the University of Iceland is introducing a 5 years master's degree program to replace 4 years baccalaureate degree program to prepare students for practice.

Background: The department of physical therapy at the University of Iceland is introducing a 5 years entry-level Master's degree program (MS) to replace 4 years baccalaureate degree program (BS) to prepare students for practice.

Most research studies investigating the prevalence of musculoskeletal disorders affecting musicians and music students have focused on classical music, while less is known about their prevalence in other music genres. The purpose of this study was to document cumulative and point prevalence of playing-related musculoskeletal disorders (PRMD) among music students in Iceland and, specifically, to identify differences between those studying classical vs rhythmic music. We hypothesized that students of classical music would report more frequent and more severe musculoskeletal disorders than students involved in rhythmic music, as classical instruments and composition typically require more demanding, sustained postures during practice and performance. A total of 74 students from two classical music schools (schools A and B) and 1 rhythmic school (school C) participated in the study by answering a questionnaire assessing PRMDs. The results showed that 62% of participants had, at some point in their musical career, suffered a PRMD. The cumulative prevalence was highest in music school A (71.4%) and lowest in music school C (38.9%). A statistically significant difference was identified between the cumulative prevalence of PRMD from schools A and B combined compared to music school C (p=0.019). Over 40% of participants reported a "current PRMD," and a significant difference was identified between the three schools (p=0.011), with the highest point prevalence being registered in music school A (66.6%) and the lowest in music school C (22.2%). The prevalence of PRMDs among Icelandic music students was high. The difference found between students who play classical vs rhythmic music may be explained by different demands of the instruments and composition on playing posture.

Background One of many risk factors for ACL injury may involve neuromuscular activation patterns of muscles in the lower extremities. These have been studied for some muscles in pre- and post-pubescent female and male athletes. Although m.gluteus medius (GM) activity may be important during dynamic activities, its activation patterns have not been extensively studied. Objective To identify gender differences in neuromuscular activation of GM in young athletes. Design Cross-sectional controlled laboratory trial. Setting Measurements took place in the Research Centre of Movement Science at the University of Iceland. Participants 11–12 years old football and handball players were recruited from local sports clubs, 9 boys and 36 girls. Risk factor assessment Surface electrodes were used to collect EMG activity from GM during two dynamic tasks (drop-jumps (DJ) and cutting maneuvers (CM)), before and after a fatigue protocol. Main outcome measurements Timing of peak muscle activation and activation levels at initial contact (IC), normalized to peak activation, were analyzed pre- and post-fatigue between genders for each task. Results Girls demonstrated greater activation at IC than boys (P=.02) and peak activation occurred earlier in girls than boys (P<.01) during the DJ. Moreover, GM activation levels at IC were overall significantly greater after a fatigue protocol than before (P<.01) and peaked earlier (P<.01). During CM the only significant finding was a main effect of fatigue for activation levels at IC (P<.01). Conclusions Gender differences in activation patterns of GM were identified during DJ in young athletes. This may, in part, reflect different kinematic strategies during this dynamic task or gender biased training. As girls go into puberty earlier than boys, this may have influenced movement patterns of some of the female participants. Further investigation into GM activation in relation to lower extremity kinematics within the context of injury prevention is warranted.

Background Injuries are common in handball, but little is known about their risk factors. One potential screening test to identify player at risk is the Nine Test Screening Battery (NTSB). Objective To test the intra-rater reliability of the NTSB and compare the results from NTSB between subgroups in the cohort. Design Test-retest design used for the intra-rater reliability test of NTSB. Experimental design used for testing senior and national team players. Setting Icelandic male handball players. Participants A total of 50 junior players from 5 clubs participated in the intra-rater reliability test. Also, 115 seniorplayers from 13 of 16 teams in the two highest divisions in Iceland and 26 Icelandic national team players (8 playing abroad), participated. Main outcome of measurement Intra-rater reliability of NTSB. Difference in NTSB scores between subgroups. Results There was a strong intra-rater correlation between the test-retest sessions, ICC: 0.95 T1: 21.6±3.5 (95% CI: 20.7–22.6), T2: 22.0±3.4 (95% CI: 21.0–22.9). The retest had significantly higher total score than the first test (P=.041), indicating some learning effect. No difference was found in total score of NTSB between teams, level of play or different age and height groups. However, goalkeepers had higher total score than other players (P=.001). Observing NTSB separately, junior players had significantly less core stability than senior and national team players (tests 5-7, P≤.006) and more mobility in trunk and shoulders (tests 8-9, P<.001). National team players were stronger in abdominal muscles (test 5, P=.003) and more flexible in active hip flexion (test 4, P=.03) than senior players in division 1 and 2. Conclusions NTSB seems to be reliable in test-retest, but some learning effect was noticed. Junior players showed less core stability and more trunk and shoulder mobility than senior players.

Background After puberty female athletes are in 2–7 times higher risk of tearing the anterior cruciate ligament as compared to males. Objective To compare following factors between 15 and 18 years boys and girls participating in soccer: 1) Vertical jump height. 2) Jump- and landing technique in drop jump. 3) EMG activity around the knee during jumping and landing. Design Observational, cross-sectional study. Setting National youth soccer teams in Iceland. Participants 20 boys and 17 girls, 15–18 years, from three soccer teams and also participating in Icelandic national youth soccer teams were invited to participate. Of these, 10 boys and 10 girls accepted participation and showed up for testing. Main outcome measurement (1) Jump height in counter movement jumps. (2) Degree of knee valgus during drop jumps. (3) EMG onset latency for five different muscles in each thigh during drop jumps. Results Boys jumped significantly higher than girls in countermovement jump (30.3±2.6 cm vs 22.6±3.8 cm, p<0.001). In the drop jump, girls had significantly increased knee valgus compared to boys in three of five test points: when toes touch the floor (165.1±4.0° vs 168.7±4.1°, p=0.05), at 25% of the height from lowest position (163.3±6.4° vs 169.2±9.0°, p=0.013) and at toe off, when jumping up again (162.5±4.2° vs 167.2±4.4°, p=0.01). No difference was found for the lowest position or for 25% of the height from the lowest position to toe off. No gender difference was found for onset latencies of the leg muscles, except for right biceps femoris, where girls activated this muscle earlier before landing than boys (−0.31±0.39 vs −0.12±0.13, p<0.001). Conclusion Boys jumped higher than girls. Girls had more knee valgus during landing, at 25% from the lowest position on the way down and, during toe off. No gender differences were found for muscle onset latencies except for one thigh muscle.