Innovative approaches beyond periprocedural hydration for preventing contrast-induced acute kidney injury

Contrast-induced acute kidney injury(CI-AKI)is a major concern in clinical practice,particularly among high-risk patients with preexisting renal and cardiovascular conditions.Although periprocedural hydration has long been the primary approach for CI-AKI prevention,recent advancements have led to the development of novel approaches such as RenalGuard and contrast removal systems.This editorial explores these emerging approaches and highlights their potential for enhancing CI-AKI prevention.By incorporating the latest evidence into clinical practice,health-care professionals can more effectively maintain renal function and improve outcomes for patients undergoing contrast-enhanced procedures.

Physical exercises for preventing injuries among adult male football players:A systematic review

Background:Football is the most practised sport in the world and is associated with the risk of injuries in the players.Some studies have been published that identify injury prevention programs,but there is no review of the full body of evidence on injury prevention programs for use by football coaches.The aim of this article was to carry out a systematic review of published studies on injury prevention programs for adult male footballers,identify points of common understanding and establish recommendations that should be considered in the design of injury prevention strategies.Methods:PubMed and EMBASE databases were used to identify relevant published articles using the following keywords:"soccer"AND"injury"AND"prevention".Results:A total of 2512 studies were identified initially,but only 11 studies met the inclusion criteria,and their outcomes are presented.Results revealed that injury prevention programs in football have focused on strength training,proprioceptive training,multicomponent programs(balance,core stability,and functional strength and mobility),and warm-up programs.Conclusion:Based on results from the studies analyzed,football players can lower the incidence of match and training injuries by participating in dynamic warm-up programs that include preventive exercises before games or during training sessions,and by adding strength,balance,and mobility training to the training sessions.

Anterior cruciate ligament injuries in soccer:Loading mechanisms,risk factors,and prevention programs

Anterior cruciate ligament （ACL） injuries are common in soccer. Understanding ACL loading mechanisms and risk factors for ACL injury is critical for designing effective prevention programs. The purpose of this review is to summarize the relevant literature on ACL loading mechanisms, ACL injury risk factors, and current ACL injury prevention programs for soccer players. Literature has shown that tibial anterior translation due to shear force at the proximal end of tibia is the primary ACL loading mechanism. No evidence has been found showing that knee valgus moment is the primary ACL loading mechanism. ACL loading mechanisms are largely ignored in previous studies on risk factors for ACL injury. Identified risk factors have little connections to ACL loading mechanisms. The results of studies on ACL injury prevention programs for soccer players are inconsistent. Current ACL injury prevention programs for soccer players are clinically ineffective due to low compliance. Future studies are urgently needed to identify risk factors for ACL injury in soccer that are connected to ACL loading mechanisms and have cause-and-effect relationships with injury rate, and to develop new prevention programs to improve compliance.

A Mesh Meta-Analysis of the Effectiveness of Different Warm-Up Exercises to Prevent Knee Injuries in Young Child Soccer Players

Objective: A mesh Meta-analysis was used to evaluate the effectiveness of four warm-up exercises to prevent knee injuries in juvenile soccer players. Method: They are a randomized controlled trial (RCT) on FIFA 11+ integrated warm-up, FIFA 11+ Kids integrated warm-up, and neuromuscular training (NMT) warm-up for the prevention of knee joint in juvenile soccer players by a computer search of CNKI, CBMdisc, WanFangdata, Pubmed, Web of science, and SPORTDicus database. The search period was from the establishment of each database to February 2022. Two investigators screened the literature, extracted data, and assessed risk bias for the included studies according to the pre-defined inclusion and exclusion criteria, and finally analyzed the data using Stata 14.0 software and OpenBUGS software. Results: A total of 10 RCT studies with 17,143 subjects, spanning the age range of 7 to 19 years, were included. The results of the reticulated Meta-analysis showed that all three warm-up modalities were effective in reducing the incidence of knee injuries in junior soccer players compared to conventional warm-up, with the optimality in descending order of FIFA 11+ Kids comprehensive warm-up (SUCRA = 85.3), neuromuscular training warm-up (SUCRA = 66.7), and FIFA 11+ combined warm-up (SUCRA = 44). Conclusion: The FIFA 11+ Kids comprehensive warm-up is the most effective warm-up exercise for the prevention of knee injuries in junior and child soccer players, but the above findings need further validation due to the quantity and quality of the literature and the quality of the evidence.

Review on Development of Pressure Injury Prevention Fabric

Pressure injury is a common postoperative complication of wheelchair users. It has a high incidence rate and can induce sepsis and even death. The fabrics that touch patients’ skin directly have a profound impact on their skin surfaces. This review summarizes the research in the last five years on the relationship between pressure injuries and fabrics. Following the preferred reporting items for systematic reviews and meta-analyses(PRISMA) statement, a systematic literature search is conducted in nine databases, including SCI(Web of Science), IEEE, ASTM, Taylor & Francis, ProQuest, Wiley, SpringerLink, PubMed and SAGE. The research objects, experimental equipment and survey results are investigated in this review, in which twenty-four different textiles and seven different test methodologies are involved. The test methodologies include five kinds of performance tests and two kinds of observational studies. Two studies showed that the particular fabric was helpful to reduce the pressure on the skin surface, and twelve studies revealed that the multi-layer fabric with good air permeability, heat dissipation and moisture dissipation was helpful to prevent pressure injury. This review confirms the correlation between the fabric properties and the occurrence of postoperative pressure injury in wheelchair users. Further experiments are needed to reasonably integrate the fabric characteristics of pressure injury prevention into the mass-produced pressure injury prevention clothes for wheelchair users.

The Use of Far Infrared Treatment Prior to Exercise in Horses: An mfBIA and Acoustic Myography Three Case Study

Background: Acute effects of Far Infrared (FIR) treatment in horses are unknown, especially short periods of 30 minutes, as is any effect on such muscle parameters as warm-up balance, overall exercise balance and laterality asymmetries. Aim: This study examines three equine cases in detail to measure any effects of a short period of FIR treatment. Methods: Multi-frequency bioimpedance (mfBIA) and acoustic myography (AMG), non-invasive techniques, were applied pre- and post-treatment with FIR to the back (T5-L4/5) and for m.Longissimus dorsi and m.Gluteus medius was recorded during a 15-minute warm-up regimen. mfBIA parameters included extracellular resistance (Re), centre frequency (fc), membrane capacitance (Mc), intracellular resistance (Ri) and phase angle (PA) which indicates level of training and health status. Results: FIR treatment responses for mfBIA parameters were found to be horse-specific and different, whilst in terms of AMG, FIR treatment for 30 minutes had a beneficial effect on overall balance in all three horses (5 out of 6 muscles), and a beneficial effect on the AMG parameter ST (force symmetry) in all three horses (6 out of 6 muscles). An overall improvement for combined balance and ST values for both muscles and all three horses of 86% was noted with FIR treatment, compared to 56% without. Conclusions: This preliminary study of FIR treatment in three horses, has been found to result in an overall improvement in combined balance and ST values for both muscles. FIR has potential as a promising treatment to reduce the risk of warm-up-related injuries in athletic horses.

A systematic review of running-related musculoskeletal injuries in runners

Objective:Running-related musculoskeletal injuries(RRMIs),especially stemming from overuse,frequently occur in runners.This study aimed to systematically review the literature and determine the incidence and prevalence proportion of RRMIs by anatomic location and specific pathology.Methods:An electronic database search with no date beginning restrictions was performed in SPORTDiscus,PubMed,and MEDLINE up to June 2020.Prospective studies were used to find the anatomic location and the incidence proportion of each RRMI,whereas retrospective or cross-sectional studies were used to find the prevalence proportion of each RRMI.A separate analysis for ultramarathon runners was performed.Results:The overall injury incidence and prevalence were 40.2%±18.8%and 44.6%±18.4%(mean±SD),respectively.The knee,ankle,and lower leg accounted for the highest proportion of injury incidence,whereas the knee,lower leg,and foot/toes had the highest proportion of injury prevalence.Achilles tendinopathy(10.3%),medial tibial stress syndrome(9.4%),patellofemoral pain syndrome(6.3%),plantar fasciitis(6.1%),and ankle sprains(5.8%)accounted for the highest proportion of injury incidence,whereas patellofemoral pain syndrome(16.7%),medial tibial stress syndrome(9.1%),plantar fasciitis(7.9%),iliotibial band syndrome(7.9%),and Achilles tendinopathy(6.6%)had the highest proportion of injury prevalence.The ankle(34.5%),knee(28.1%),and lower leg(12.9%)were the 3 most frequently injured sites among ultramarathoners.Conclusion:The injury incidence proportions by anatomic location between ultramarathoners and non-ultramarathoners were not significantly different(p=0.798).The pathologies with the highest incidence proportion of injuries were anterior compartment tendinopathy(19.4%),patellofemoral pain syndrome(15.8%),and Achilles tendinopathy(13.7%).The interpretation of epidemiological data in RRMIs is limited due to several methodological issues encountered.

Prevention and protection against cerebral ischemic injury using acupuncture

Cardiovascular disease is the leading cause of death worldwide.Stroke is the second leading cause of death above the age of 60 years and the leading cause of acquired disability in adults.The main type of stroke is ischemic stroke（80%）and it is subclassified as thrombotic or embolic in nature.

Research in prevention and rehabilitation of hamstring muscle strain injury

Hamstring muscle strain injury is the most common and prevalent injury in sports involving high-speed running,such as American football,Australian football,English rugby,soccer,track and field,and cricket.1Hamstring muscle strain injury also has a high recurrence rate of up to 48%.2The average practice and game time loss due to hamstring injury is between17 and 60 days,contingent on the grade of injury.2Severe hamstring muscle strain injuries,and associated recurrent inju-

Discuss Basketball Injury Prevention and Self- Protection Methods

Basketball has always been loved by the majority of high school students, especially after compulsory education improved school basketball venues and facilities to make basketball an unprecedented development, because basketball is a very physical confrontational sport, so the student damage occurring in the course of basketball movement is the more common case, which affects not only the physical development of middle school students, but also affects the popularity of basketball in this project. How to do active in basketball injury prevention, learning first aid knowledge after injury, will be beneficial in the school＇ s basketball further popularization and development.

A lateral ankle sprain during a lateral backward step in badminton:A case report of a televised injury incident

Background:This study presents a kinematic analysis of an acute lateral ankle sprain incurred during a televised badminton match.The kinematics of this injury were compared to those of 19 previously reported cases in the published literature.Methods:Four camera views of an acute lateral ankle sprain incurred during a televised badminton match were synchronized and rendered in3-dimensional animation software.A badminton court with known dimensions was built in a virtual environment,and a skeletal model scaled to the inj ured athlete’s height was used for skeletal matching.The ankle joint angle and angular velocity profiles of this acute injury were compared to the summarized findings from 19 previously reported cases in the published literature.Results:At foot strike,the ankle joint was 2° everted,33° plantarflexed,and 18° internally rotated.Maximum inversion of 114° and internal rotation of 69° was achieved at 0.24 s and 0.20 s after foot strike,respectively.After the foot strike,the ankle joint moved from an initial position of plantarflexion to dorsiflexion-from 33° plantarflexion to 53° dorsiflexion(range=86°).Maximum inversion,dorsiflexion,and internal rotation angular velocity were 1262°/s,961°/s,and 677°/s,respectively,at 0.12 s after foot strike.Conclusion:A forefoot landing posture with a plantarflexed and internally rotated ankle joint configuration could incite an acute lateral ankle sprain injury in badminton.Prevention of lateral ankle sprains in badminton should focus on the control and stability of the ankle joint angle during forefoot landings,especially when the athletes perform a combined lateral and backward step.

Effects of the FIFA 11+program on performance,biomechanical measures,and physiological responses:A systematic review

Background:The side effects of the FIFA 11+program on performance have not been generally reviewed.The objective of this study was to synthesize the literature on the effects of the 11+on players’performance.Methods:Five online databases(PubMed,Scopus,ScienceDirect,Springer,and Google Scholar)were searched(from April 2006 to March 2022)using predefined keywords and sub-keywords.The potential references were primarily recorded through Endnote and imported to Covidence.Out of the 123 references screened by 2 blinded researchers through the software,59 full texts were assessed for eligibility,33 of which were ultimately included.The quality of the studies and the risk of bias were then assessed.Study ID,title,place,aim,design,start/end dates,population description,study criteria,statistical analysis,and outcomes were extracted.Results:Studies were conducted on male and female players aged 10-32 years old.The quality of the studies was moderate to high,and except for unclear bias for blinding outcome assessment,the risk of bias for all domains was low.Long-term application of the 11+improved most biomechanical measures and physiological responses except for lower extremity stability,ankle evertors time latency,ankle dorsiflexion,and proprioception.Conversely,the 11+showed acute negative effects on physical performance compared to dynamic warm-ups and non-significant effects on technical abilities.Conclusion:Mid-to-long-term implementation of the 11+improved the maj ority of biomechanical and a couple of physical measure s but showed no effects on technical skills.Precaution must be observed for using the 11+before competitions,as it could acutely decrease physical/technical performance.Given the contradictory nature of the literature,further studies should evaluate the short-to-mid-term effects of the 11+.Further studies are required to address ankle responses to the 11+intervention.

Pharmacological Action and Molecular Mechanism of Glaucocalyxin B

Glaucocalyxin B(GLB)not only has many pharmacological actions such as anti-Parkinson's disease,preventing neuron injury,anti-neuritis and anti-rheumatoid arthritis,but also has good anti-tumor activity,especially with obvious therapeutic effect on cervical cancer,gastric cancer and breast cancer.In this paper,the pharmacological action and molecular mechanism of GLB are reviewed,in order to provide a theoretical basis for the development and clinical application of GLB.

What are the ten new commandments in severe polytrauma management？

This review aims to provide a concise overview of the trauma management evolution in the past decade. 1） Trauma care priorities have incorporated staff protection against infection and early decision making in addition to the conventional ABCDE. 2） Five stratified levels for DAM have replaced the non-specific conventional Plans A ＆ B. 3） CT scanning can be the tunnel to death for the hemodynamically unstable patient. 4） DPL has virtually been replaced by the FAST USG. 5） Direct whole-body MDCT provides rapid imaging diagnosis ＆ expedites the definitive treatment but carries high radiation hazards. 6） The dynamic shock assessment by fluid resuscitation response provides more outcome-specific evaluation than the static blood volume loss model. 7） DCR comprising of permissive hypotension, hemostatic resuscitation ＆ DCS aims to overcome the lethal triad of trauma. Early transfusion of blood components of FFP ＆ platelet concentrates improves the outcome in massive blood transfusion. 8） DCS aims to rectify the deranged physiology and not to fully restore the damaged anatomy. 9） A pre-defined protocol for major pelvic fracture can be life-saving and the novel Pre-PPP （pre-peritoneal pelvic packing） may further reduce mortality coupled with the necessary TCAE. 10） Injury prevention is equally important if not more than the trauma resuscitation ＆ operation.

Effects of flexibility and strength training on peak hamstring musculotendinous strains during sprinting

Background:Hamstring injury is one of the most common injuries in sports involving sprinting.Hamstring flexibility and strength are often considered to be modifiable risk factors in hamstring injury.Understanding the effects of hamstring flexibility or strength training on the biomechanics of the hamstring muscles during sprinting could assist in improving prevention strategies and rehabilitation related to these injuries.The purpose of this study was to determine the effects of altering hamstring flexibility or strength on peak hamstring musculotendinous strain during sprinting.Methods:A total of 20 male college students(aged 18-24 years)participated and were randomly assigned to either a flexibility intervention group or a strength intervention group.Each participant executed exercise training 3 times a week for 8 weeks.Flexibility,sprinting,and isokinetic strength testing were performed before and after the 2 interventions.Paired t tests were performed to determine hamstring flexibility or strength intervention effects on optimal hamstring musculotendinous lengths and peak hamstring musculotendinous strains during sprinting.Results:Participants in the flexibility intervention group significantly increased the optimal musculotendinous lengths of the semimembranosus and biceps long head(p<0.026)and decreased peak musculotendinous strains in all 3 bi-articulate hamstring muscles(p<0.004).Participants in the strength-intervention group significantly increased the optimal musculotendinous lengths of all 3 hamstring muscles(p<0.041)and significantly decreased their peak musculotendinous strain during sprinting(p<0.017).Conclusion:Increasing hamstring flexibility or strength through exercise training may assist in reducing the risk of hamstring injury during sprinting for recreational male athletes.

Biomechanical characteristics of an anterior cruciate ligament injury in javelin throwing

Purpose： The purpose of this study was to understand the mechanism of an anterior cruciate ligament （ACL） injury in javelin throwing and javelin throwing techniques relevant to this ACL injury. Methods： The patient in this study was an elite female javelin thrower who completed the first three trials and sustained a non-contact ACL injury on her left knee in the fourth trial of javelin throwing during a recent track and field meet. Three-dimensional kinematic data were collected in the injury and non-injury trials. The kinematic data of 52 male and 54 female elite javelin throwers were obtained from a javelin throwing biomechanical database. Results： The patient had greater forward center of mass velocity and less vertical center of mass velocity after the first 25% of the delivery phase in the injury trial compared to non-injury trials. The patient had less left knee flexion angle and angular velocity but similar left knee valgus and internal rotation angles during the first 21% of the delivery phase in the injury trial compared to non-injury trials. The video images showed an obvious tibia anterior translation at the 30% of the delivery phase in the injury trial. The left knee flexion angle and angular velocity at the time of the left foot landing and the maximal left knee flexion angle during the delivery phase were not significantly correlated to the official distance for 52 male and 54 female elite javelin throwers. Conclusion： The ACL injury in this study occurred during the first 30% of the delivery phase, most likely during the first 25% of the delivery phase. A stiff landing of the left leg with a small knee flexion angle was the primary contributor to this injury. Javelin throwers may have a soft left leg landing with a flexed knee, which may help them prevent ACL injuries without compromising performance.

A comparison of lower limb stiffness and mechanical muscle function in ACL-reconstructed,elite,and adolescent alpine ski racers/ski cross athletes

Purpose： The aim of this study was to compare mechanical muscle function in the eccentric/concentric phases of vertical bilateral jumping in anterior cruciate ligament-reconstructed （ACLR）, elite （ELITE）, and adolescent （ADOL） alpine ski racers and ski cross athletes. Methods： Alpine ski racers/ski crossers （ACLR： n = 12, age = 26.7 ± 3.8 years; ELITE： n = 12, age = 23.9 ± 3.0 years; ADOL： n = 12, age = 17.8 ± 0.7 years; females： n = 6 per group, males： n = 6 per group） performed 5 maximal countermovement jumps （CMJs） and 5 squat jumps. The ground reaction forces for each limb were analyzed using dual force plate recording to obtain body center of mass （BCM） velocity, displacement, and power. The eccentric deceleration （ECC） and concentric phases were determined from BCM velocity. CMJ net concentric and ECC impulses were calculated （body mass normalized） along with the peak and mean BCM power and maximal vertical jump height. CMJ lower limb stiffness （LLS） was determined by the slope of the ground reaction forces vs. the BCM displacement curve over the ECC phase. Concentric and ECC asymmetry indices were calculated for each leg, and the left vs. right LLS was compared. Outcome measures （reported as mean ± SD） calculated as a 5-jump mean were normalized to body mass and compared using an analysis of variance. Results： No between-group differences were found for peak and mean power or jump heights. There were no group differences for LLS or net concentric phase impulse, but the net ECC impulse was lower in the ADOL group compared with ELITE skiers （ADOL： 1.33 ± 0.32 Ns/kg; ELITE： 1.59 ± 0.16 Ns/kg; p 〈 0.05）. Although no group differences were found for ECC asymmetry indices, a group × limb interaction was found for LLS （p 〈 0.01）, which was systematically higher in the right vs. the left limb of ADOL skiers （right： 54.1 ± 17.9 N/m/kg; left： 48.7 ± 15.7 N/m/kg;p 〈 0.01）. Conclusion： ADOL skiers demonstrated decreased ECC impulse and systematic right limb dominance in LLS compared with ACLR and ELITE skiers. The implication of these findings for injury and performance are unknown, but further investigation into these potential relationships is warranted.2018 Published by Elsevier B.V. on behalf of Shanghai University of Sport. This is an open access article under the CC BY-NC-ND license. （http：//creativecommons.org/licenses/by-nc-nd/4.0/）.

Experts’ perspectives on the application of public-private partnership policy in prevention of road traffic injuries

Purpose: Successful application experiences on public-private partnership (PPP) in different countries, suggest that PPP could be an option in road traffic injury (RTI) prevention. The present study aims at investigating the applicability of PPP policy in RTI prevention in Iran based on the experts’ perspectives.Methods: This is a qualitative study with grounded theory approach which has been conducted in Tabriz University of Medical Sciences, Iran in 2018. The participants were 22 experts in the field of RTIs selected using purposive sampling method. Data were collected by semi-structured interviews and analyzed with content-analysis method.Results: The results were classified under 5 main themes (applicability, scopes and services, challenges, advantages, and strategies) for applying PPP policy and 37 sub-themes. Due to the prevalence of RTIs, the present challenges in public sector, existence of qualified private sector, and successful experiences in other areas, there are opportunities for private sector partnership in prevention of RTIs. Private sector could participate in different scopes and services regarding RTI prevention, including road construction and maintenance, maintenance and provision of vehicles safety and public education. The main challenges including legislation issues, ambiguities in collaboration, political and organizational unsustain-ability, government’s financial hardship and lack of experienced experts in the field of RTI. However, there are significant advantages including high efficiency in program implementation, covering the weaknesses of public sector, effective and efficient management on application of PPP in RTI prevention. The strategies include identifying and prioritizing the assignable activities, identifying the qualified private sector, developing PPP policies and legal frameworks, creating a common language between public and private parties, trying to meet the expectations of the private sector by public sector, developing a comprehensive and sound contract, and cultivating public culture to accept private sector in the field of RTI prevention.Conclusion: This study sought to determine whether PPP could be used as strategy to reduce the burden of RTIs in Iran. But it requires a lot of preliminary studies to provide the context and conditions for applying this policy.

Attitudes towards child restrains and seat belts usage in the learned population of Karachi,Pakistan

BACKGROUND:Motor vehicles crashes(MVCs) are the leading cause of injury related morbidity and mortality in developed countries. Recent evidence proves that properly used child seat belts can dramatically reduce the risk of severe and life-threatening injury from MVCs. There are rarities of thought and inspiration regarding the use of child seat belts in our society and region,therefore we lack of data regarding factors and paucity of usage of child seat belts in motor vehicles. This study aimed to assess the knowledge and attitudes of child seat belt usage among the educated population in Karachi,Pakistan.METHODS:Altogether 304 employees were investigated. They were employees of Aga Khan University who were using their cars and having children younger than 10 years old. A cross sectional observational study was designed,and a 36-item questionnaire in English was used to collect data on participants' demographic details,designation,educational level,economic status,validity of driving license,number of children and cars,availability of adult seat belts and child seat belts along with their functionality,awareness,knowledge and attitude toward its use,and reason of not using these devices. SPSS version 20 for Windows was used to analyze the data and the Chi-square test was used.RESULTS:Totally 290 participants were recruited with a response rate of 72%(212). Of 212 participants,126(59%) were male. 154(72.6%) participants had valid driver licenses,and 154(72.6%) had adult seat belts in their vehicles. Only 32(15%) reported regular use of adult seat belts. Although 168(79.2%) participants had some knowledge about child restrains(CRs),only 65(22%) had CRs in their cars. Eighty-two(38.7%) participants got the knowledge about CRs and seat belts from media. Mothers were more concerned about the use of CRs than fathers. Only 14(6.6%) parents were found to use both adult and child seat belts all the time. Of the 157 parents who did not us use CRs,42 considered unnecessary,35 lacked relevant knowledge. But 15 parents used CR against their children's wills.CONCLUSIONS:The pattern of CR usage among the employees at Aga Khan University,Karachi is dictated by the unavailability of CR,followed by ignorance,inconvenience,and nonacceptance by their children. The important issue of CR has consistently been ignored over the years and it has never gained enough popularity in Pakistan.

“When you’re down, stay down”:A lesson for all competitive alpine skiers supported by an ACL rupture measured in vivo

Background:During an experiment,a ski racer equipped with various measurement devices suffered an anterior cruciate ligament(ACL)rupture in his right knee.The aim of this study was to describe the underlying injury mechanism from a functional perspective.Methods:Eight giant slalom turns(i.e.,4 left turns),followed by 1 left turn at which the ACL injury occurred,were recorded by 2 video cameras,electromyography of 4 relevant muscle groups,inertial measurement units to measure knee and hip angles,and pressure insoles to determine ground reaction forces.Results:Due to a loss of balance,the ski racer began to slide sideways at the apex of a left turn.During sliding,his right(outside)leg was actively abducted upward without touching the ground.The ski racer then attempted to stand up again by dropping his leg back towards the snow surface.The end of this dropping was accompanied by a decrease in electromyographic activity in the knee stabilizing muscles.Once the inside edge of the outer ski caught the snow surface,a rapidly increasing peak force,knee flexion,and an aggressive sudden activation of the vastus medialis muscle were observed,while biceps femoris and rectus femoris further decreased their activation levels.This likely resulted in excessive anterior translation of the tibia relative to the femur,causing damage to the ACL.Conclusion:Our example emphasizes that ski racers should not get up until they stop sliding.Remember:“When you’re down,stay down.”