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Biomedical subjects

Constance M Lebrun

Publications and source records attributed to Constance M Lebrun.

8 recordsLinked to original sources
PubMed2006

Care of the high school athlete: prevention and treatment of medical emergencies.

An important duty of any sports medicine physician is the care of athletes on the field and at the sidelines. Orthopaedic surgeons, who are trained to treat most musculoskeletal injuries, may not be as well prepared to treat the variety of medical issues and emergencies that are encountered in the "on-the-field" setting. In treating adolescent and high school athletes, advance preparation by the physician is critical for such entities as exercise-induced asthma, anaphylaxis, certain cardiac conditions, seizures, diabetes, and heat illnesses. The initial approach to the athlete who "goes to ground" always remains the same--management of the airway (with cervical spine precautions); establishment and maintenance of breathing and circulation; a limited neurologic examination to assess function; and removal of the athlete from the hazardous environment. Additional treatment is dictated by the specific illness or injury. As is usually the case, prevention is the best form of treatment. Many conditions can be detected at the preparticipation physical examination, which includes a thorough history and focused physical examination. Specific cardiovascular conditions that may be screened for include hypertrophic cardiomyopathy, Marfan syndrome, some congenital coronary artery abnormalities, and electrophysiologic rhythm disturbances. This examination also offers one of the best opportunities to provide information to athletes regarding optimal management of any chronic medical diseases. In preparation for an athletic event, excessive environmental heat and humidity may be addressed with several preventive strategies. Physicians also may be asked to provide counseling and make decisions about return to play for athletes who have had certain infectious diseases, including upper and lower respiratory infections and infectious mononucleosis.

Adolescent↗
PubMed2005

The menstrual cycle and sport performance.

The female sex steroid hormones estrogen and progesterone have potential effects on exercise capacity and performance through numerous mechanisms, such as substrate metabolism, cardiorespiratory function, thermoregulation, psychologic factors, and injuries. Consequently, hormone level changes may theoretically lead to either improved or decreased performance at various times throughout the menstrual cycle. Numerous methodological issues and a paucity of studies have precluded evidence-based conclusions in almost every area of research in this field. In addition, there appears to be a great degree of inter- and intraindividual variability in these hormonal responses. Using oral contraceptives may be advantageous for female athletes who are negatively affected by their menstrual cycle, as they may provide a stable yet controllable hormonal milieu for training and competition.

Anaerobic Threshold↗
PubMed2005

Use of the preparticipation physical examination form to screen for the female athlete triad in Canadian interuniversity sport universities.

OBJECTIVE: The purpose of this study was to survey universities affiliated with Canadian Interuniversity Sport on existing screening protocols for the female athlete triad, and to identify any potential areas for improvement of this system. DESIGN: Surveys were faxed or e-mailed to Canadian Interuniversity Sport-affiliated universities in Canada, and preparticipation physical examination (PPE)/medical history forms from each institution were analyzed. SETTING: The Fowler Kennedy Sports Medicine Clinic at the University of Western Ontario. PARTICIPANTS: In 2000, of the 48 universities, 35 responded (73.0% response rate). In 2002, 39 of 49 universities responded (79.6%). MAIN OUTCOME MEASUREMENTS: Although the majority of institutions surveyed implement a PPE form (80.0% in 2000, 87.2% in 2002), only 70.6% to 75.0% of these institutions actually conduct a follow-up when deemed necessary. However, the number of forms including a specific female section increased from 46.4% in 2000 to 61.8% in 2002. Also encouraging is the percentage of universities attempting to increase awareness of the triad disorders (33.3% in 2002 vs. 14.3% in 2000). It is interesting to note that in over half of the institutions surveyed both years, the athletic therapist or trainer is responsible for analyzing the completed PPE forms. CONCLUSIONS: This study has shown substantial improvement from 2000 to 2002 in the development of the PPE across Canada, even in a relatively short period of 2 years. However, this study also demonstrates the lack of uniformity within Canada of the PPE forms. There remains a need to improve the PPE form to target a section of the form specifically to female athletes, or else cases may be missed. The triad is also not found solely in sports where leanness is associated with better performance. Better efforts need to made to increase awareness of the triad and its risks among female athletes, as well as provide educational opportunities for athletic therapists, who are the first line of intervention in many cases. CLINICAL RELEVANCE: The key to successful prevention and intervention is education. This study demonstrates the need for education for all people directly involved with the athlete, and the need to work together to promote a healthy and realistic body image and increase awareness of the female athlete triad among athletes.

Amenorrhea↗
PubMed2005

Low-dose extracorporeal shock wave therapy for previously untreated lateral epicondylitis.

OBJECTIVE: To determine the effectiveness of low-energy extracorporeal shock wave therapy (ESWT) in the treatment of previously untreated lateral epicondylitis. DESIGN: Randomized double-blind (patient and outcome assessor) controlled trial with power to show a clinically important difference in success rate between groups at the 0.05 level. Block randomization was stratified by unilateral or bilateral epicondylitis. SETTING: Community study at the University of Calgary. PARTICIPANTS: Participants were recruited by poster advertisements in physicians' offices, fitness and sports centers, and postsecondary education institutions, and by e-mail to faculty and staff at those institutions. Inclusion criteria were tenderness over the lateral epicondyle and common extensor origin tendons that worsened with resisted wrist extension and hand grip and with elbow extension, forearm pronation, and wrist palmar flexion; presence of lateral epicondylitis for > or =3 weeks and <1 year; willingness to discontinue bracing; and age > or =18 years. Participants (mean age, 46 years; mean duration of symptoms, 21 weeks; 62% men) were informed that the purpose of the study was to compare 2 different treatment protocols. INTERVENTION: After telephone screening eligible persons were examined by 1 physician. All 60 participants were taught a single forearm extensor stretch (4 repetitions held for 20 seconds, 4 times per day). Persons in the active ESWT were assigned to 3 treatments, 1 per week for 3 weeks. In each session, 2000 pulses of 0.03 to 0.17 mJ/mm2, depending on the participant's pain tolerance, were administered. The sham treatment group was administered the lowest dose buffered by an air pad, on the same schedule. MAIN OUTCOME MEASURES: The main outcome measure was treatment success or failure. Success was defined as > or =50% relief of pain overall from baseline, measured on a 10-cm visual analogue scale, with a maximum pain score of 4.0 cm, and no use of pain medication for lateral epicondylitis for 2 weeks before the 8-week evaluation. Bilaterally affected patients had to fulfill the success criteria for both arms. Change in quality of life and pain-free grip strength were also evaluated. Analysis was by intention to treat, including 4 patients (7%) lost to follow-up. MAIN RESULTS: The proportions of treatment successes in the sham ESWT and the active ESWT were 31% and 39% (P = 0.533). Mean differences pretreatment to posttreatment in median overall pain scores for the more painful elbow were a reduction of 0.9 cm (SD, 0.4; 95% CI, 0.1-1.8) for the sham ESWT group compared with a reduction of 1.5 cm (SD, 0.5; CI, 0.5-2.4) for the active treatment group. Changes in pain-free grip strength and minimal changes for both groups in quality of life did not differ between groups. CONCLUSIONS: Low-dose ESWT did not have a clinically important effect in reducing pain, improving quality of life, or increasing pain-free grip strength in middle-aged patients with previously untreated unilateral or bilateral lateral epicondylitis.

Journal Article↗
PubMed2005

Rowing injuries.

Participation in the sport of rowing has been steadily increasing in recent decades, yet few studies address the specific injuries incurred. This article reviews the most common injuries described in the literature, including musculoskeletal problems in the lower back, ribs, shoulder, wrist and knee. A review of basic rowing physiology and equipment is included, along with a description of the mechanics of the rowing stroke. This information is necessary in order to make an accurate diagnosis and treatment protocol for these injuries, which are mainly chronic in nature. The most frequently injured region is the low back, mainly due to excessive hyperflexion and twisting, and can include specific injuries such as spondylolysis, sacroiliac joint dysfunction and disc herniation. Rib stress fractures account for the most time lost from on-water training and competition. Although theories abound for the mechanism of injury, the exact aetiology of rib stress fractures remains unknown. Other injuries discussed within, which are specific to ribs, include costochondritis, costovertebral joint subluxation and intercostal muscle strains. Shoulder pain is quite common in rowers and can be the result of overuse, poor technique, or tension in the upper body. Injuries concerning the forearm and wrist are also common, and can include exertional compartment syndrome, lateral epicondylitis, deQuervain's and intersection syndrome, and tenosynovitis of the wrist extensors. In the lower body, the major injuries reported include generalised patellofemoral pain due to abnormal patellar tracking, and iliotibial band friction syndrome. Lastly, dermatological issues, such as blisters and abrasions, and miscellaneous issues, such as environmental concerns and the female athlete triad, are also included in this article.Pathophysiology, mechanism of injury, assessment and management strategies are outlined in the text for each injury, with special attention given to ways to correct biomechanical or equipment problems specific to rowing. By gaining an understanding of basic rowing biomechanics and training habits, the physician and/or healthcare provider will be better equipped to treat and prevent injuries in the rowing population.

Athletic Injuries↗