[Injuries among physically active people].
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Dancers present problems that develop slowly and require a specialized approach for diagnosis and treatment. Five hundred dancers were evaluated at the author's clinic over a nine-year period. They were treated for their particular complaint and were also observed to determine other possible conditions associated with spine, hip, knee, ankle, and foot. Most of the problems occurring in dancers develop subtly over a period of time rather than through a single traumatic episode. Considerable time often elapsed before a diagnosis was made because complaints of pain were suppressed. Techniques of bone scanning and computerized tomographic (CT) scanning are now used as daily tools in diagnosis and treatment. Foot and ankle problems were most commonly observed. Poor dance technique and lack of self-discipline were often responsible for exacerbation of otherwise mild symptoms from overuse syndromes. A working knowledge of dance and the artistic personality is important in the diagnosis and treatment of dancers' injuries.
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With long-established traditions in both sports medicine and trauma in Sweden, investigations are in progress on prevention, diagnosis, treatment, and rehabilitation, with special emphasis on soft-tissue injuries. The following subjects are of current interest: injuries to the ankle ligaments, compartment syndromes, knee ligament and meniscus injuries, thigh and groin muscle injuries, shoulder dislocation, lateral epicondylitis, and rupture of the ulnar collateral ligament of the thumb. Skiing injuries and the prevention of trauma in soccer players represent important unsolved problems.
Microangiopathies were the earliest and most frequent complications of diabetes mellitus; however, their pathogenetic mechanisms are still obscure. Electron microscopic study of the capillaries of the gastrocnemius was conducted in 11 patients with diabetes mellitus at the state of decompensation and in 8--of clinical compensation; blood aldosterone level and the plasma renin activity were determined by the radio-immunological method. A marked thickening of the capillary basal membrane (the most marked sign of microvascular affection) was revealed in all the patients under study; there was also an increase in the aldosterone level and renin activity. The mentioned changes were to the greatest degree (statistically significant values) expressed in the patients at the state of decompensation. Analysis of the data obtained revealed a direct correlative relationship of these changes.
There is a distinct difference between ballet injuries and sports injuries in general, and the sports medicine physician needs to study the technique of dance and the specific injuries that it may produce in order to treat dancers effectively. In Australia, which is typical of other countries where ballet is performed, ballet injuries include strained lumbar muscles, sprained ankle, Achilles tendinitis, clicking hip, jumper's knee, chondromalacia, stress fractures, patellar subluxation, and other knee and tendon problems.
The management of 14 patients with combined orthopaedic and vascular injury of the lower limb have been reviewed. Six of the 14 limbs were amputated, 5 have a residual functional defect and 3 were restored to normal function. Delay in diagnosis and failure to treat the consequences of soft tissue injury and ischaemia were mainly responsible for the poor results. The results of internal fixation were poor and the possible use of external fixation has been discussed. The importance of a sound technique for vascular repair with post reconstruction on-table arteriography has also been discussed.
When assessing injuries to the lower extremity, they can best be discussed if divided into two groups: (1) vehicular or crushing injuries; and (2) nonvehicular, torsion, or overuse injuries. Vehicular injuries require speedy, accurate assessment as they are often complex and frequently involve other systems. The patient is initially stabilized, then assessment of orthopedic problems is begun. The nurse's role is an assistive one. If the patient is admitted to the hospital, orthopedic care involves prevention of complications, reduction of pain, and assisting the patient in daily activities. Nonvehicular injuries are more chronic in nature. The patient may have unsuccessfully ignored the problem, tried home remedies, or attempted to work with it. At this point, they are seen in the physician's office, hoping for a cure. After diagnosis, proper instruction for a rehabilitation program is begun. Treatment for a sprain, strain, or overuse syndrome can often be done at home. An active program should be encouraged and the patient should be taught why the problem occurred initially and how it can be prevented in the future.
Middle-aged persons who start physical training have a relatively high incidence of injuries. Most of these injuries are minor, but they often represent an important cause for dropout from training. This article reviews the most common injuries among beginners, with special reference to those arising during running. Most of these are "overuse" or stress injuries. The most important therapeutic principles for both acute injuries and stress injuries are outlined. Finally the most significant preventive measures against injury are discussed.
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