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At least 595 records · Page 33Linked to original sources
PubMed1997

Rotator cuff pathology in athletes.

The rotator cuff is the primary dynamic stabiliser of the glenohumeral joint and is placed under significant stress during overhead and contact sports. Mechanisms of injury include repetitive microtrauma, usually seen in the athlete involved in overhand sports, and macrotrauma associated with contact sports. Rotator cuff injury and dysfunction in the overhand athlete may be classified based on aetiology as primary impingement, primary tensile overload, and secondary impingement and tensile overload resulting from glenohumeral instability. A thorough history and physical examination are paramount in the evaluation, classification and treatment planning of the athlete with rotator cuff pathology. Imaging studies are a helpful adjunct to the history and physical. Athletes with primary impingement are usually middle aged or older and often have chronic shoulder pain and sometimes weakness associated with overhand sporting activities. Night pain is typical of full thickness rotator cuff tears. Impingement signs are positive and strength of elevation and external rotation are often limited. They usually respond to a nonoperative rehabilitation programme centred on decreasing inflammation, restoring range of motion and strengthening the rotator cuff and scapular stabilisers. Depending on the degree of cuff pathology, acromioplasty, debridement of partial cuff tears, and repair of full thickness tears are usually successful in those who fail a rehabilitation programme. Overhand athletes with cuff pathology secondary to subtle anterior instability are usually young and complain of pain and decreased throwing velocity. Instability may be so subtle that it is only detectable through a positive relocation test on examination. The majority of these athletes do not have a Bankart lesion on magnetic resonance imaging or arthroscopic examination. Arthroscopic examination usually demonstrates anterior capsular laxity (positive 'drive-through' sign), as well as superior-posterior labral and cuff injury typical of internal impingement. If rehabilitation alone is not successful, a capsulolabral repair followed by rehabilitation may allow the athlete to return to their previous level of competition. The athlete with an acute episode of macrotrauma to the shoulder resulting in cuff pathology usually presents with pain, limited active elevation and a positive 'shrug sign'. Arthroscopy and debridement of thickened, inflamed or scarred subacromial bursa with cuff repair or debridement as indicated is usually successful in those who do not respond to a rehabilitation programme.

Arthroscopy↗
PubMed2003

Thermal-assisted capsular shrinkage of the glenohumeral joint in overhead athletes: a 15- to 47-month follow-up.

STUDY DESIGN: Descriptive postoperative follow-up research. OBJECTIVES: The purpose of this investigation was to describe the return-to-competition rate and functional outcome of overhead athletes following arthroscopic thermal-assisted capsular shrinkage (TACS). BACKGROUND: Traditional open procedures to correct instability in overhead athletes, such as capsulolabral repairs and capsular shifts, have produced less-than-favorable results, which have led to the development of TACS. Currently there are no long-term follow-up studies documenting the efficacy of this procedure in groups greater than 31 subjects or for a time period greater than 27 months. METHODS AND MEASURES: Two hundred thirty-one consecutive overhead athletes who due to symptoms of hyperlaxity had previously undergone a TACS procedure from 1997 to 1999 were selected for inclusion in the study. During a 1-month period, 130 of these athletes (mean age +/- SD, 24 +/- 6 years; 113 male, 17 female) were contacted by phone for follow-up at a mean of 29.3 months postoperatively (range, 15.4-46.6 months). Of the 130, 105 participated in baseball (80 pitchers), 14 in softball, 4 in football (quarterbacks), 4 in tennis, and 3 in swimming. Fifty-four (42%) subjects were professional, 49 (38%) collegiate, 16 (12%) high school, and 11 (8%) recreational athletes. One hundred twenty-three of the 130 (95%) underwent 1 or more concomitant procedure(s) at the time of TACS. Most commonly performed were labral debridements (69%), rotator cuff debridements (65%), and superior labral repairs (35%). Subjects who returned to competition were retrospectively evaluated using a modified Athletic Shoulder Outcome Rating Scale to subjectively assess pain, strength and endurance, stability, intensity, and performance. Overall results were based on a 90-point scale with scores of 80 to 90 representing excellent, 60 to 79 good, 40 to 59 fair, and less than 40 poor results. RESULTS: One hundred thirteen out of 130 subjects (87%) returned to competition. Mean (+/-SD) time from surgery to return to competition was 8.4 +/- 4.6 months. Mean outcome score for all subjects was 79/90; 75 (66%) subjects had excellent, 24 (21%) good, 11 (10%) fair, and 3 (3%) poor result. The mean outcome score for males was 80/90 and for females was 70/90. CONCLUSIONS: The majority of overhead athletes (87%) successfully returned to competition following a TACS procedure with good-to-excellent long-term outcomes (88%). Based on the results of this study, TACS of the glenohumeral joint is a viable option for overhead athletes with pathological instability.

Adolescent↗
PubMed2006

Back pain in athletes.

The athlete with back pain presents a clinical challenge. Self-limited symptoms must be distinguished from persistent or recurrent symptoms associated with identifiable pathology. Athletes involved in impact sports appear to have risk factors for specific spinal pathologies that correlate with the loading and repetition demands of specific activities. For example, elite athletes who participate in longer and more intense training have higher incidence rates of degenerative disk disease and spondylolysis than athletes who do not. However, data suggest that the recreational athlete may be protected from lumbar injury with physical conditioning. Treatment of athletes with acute or chronic back pain usually is nonsurgical, and symptoms generally are self-limited. However, a systematic approach to the athlete with back pain, involving a thorough history and physical examination, pertinent imaging, and treatment algorithms designed for specific diagnoses, can facilitate symptomatic improvement and return to play. There are no reliable studies examining the long-term consequences of athletic activity on the lumbar spine.

Athletic Injuries↗
PubMed2000

The role of arthroscopy in the evaluation and treatment of triangular fibrocartilage complex injuries in athletes.

Treating athletes with TFCC injuries can be a difficult but very rewarding undertaking. Each athlete has individual priorities and concerns, ranging from general health and fitness for the recreational athlete to earning or potentially earning a living as a professional athlete. It is crucial for the treating surgeon to understand these issues to offer the appropriate treatment options at the appropriate time. Triangular fibrocartilage complex injuries are quite common in athletes because of the high loads placed on the ulnar side of the wrist, especially with ulnar-neutral and positive variance. The goal of treatment for the competitive athlete with a TFCC lesion is to hasten maximal recovery and return the athlete to participation at the pre-injury level of performance. Early wrist arthroscopy and treatment of TFCC pathology in this population is certainly a real and valuable treatment option. As has been stated, "the TFCC is the new frontier of wrist surgery" and arthroscopy has helped blaze the trail to this frontier. Competitive and recreational athletes alike benefit from arthroscopic treatment of their TFCC injuries.

Arthroscopy↗
PubMed2001

Neuromuscular differences between male and female athletes.

Female athletes who participate in jumping and cutting-type sports have a four- to six-fold higher incidence of serious knee injuries compared with male athletes in the same sports. Many of these injuries involve the anterior cruciate ligament, and occur by non-contact mechanisms. The susceptibility of the female athlete's knee to injury is likely multifactorial, although neuromuscular factors seem to have an important role. Recent studies have identified neuromuscular differences between male and female athletes. Specifically, female athletes have decreased stiffness and decreased potential for dynamic stabilization of the knee joint. Proprioception deficits involving the knee and side-to-side strength and coordination imbalances are more frequent in female athletes. Also, female athletes more commonly demonstrate imbalances in strength, timing of activation, and recruitment patterns of the lower extremity muscles. Based on these findings, neuromuscular training programs have been studied in an effort to correct lower extremity neuromuscular imbalances. Preliminary results from these programs have been encouraging in reducing peak landing imact forces in the knee, correcting strength and proprioception deficits, and ultimately in decreasing the incidence of serious knee injuries in female athletes.

Anterior Cruciate Ligament Injuries↗
PubMed1991

Arthritis and athletics.

The number of people participating in athletics does not equal the number of people with arthritis. There are no data to support the concern that athletic participation will make the onset of arthritic joints more likely. What is clear is that injuries that occur with athletics can increase the incidence of arthritis. If a patient does develop arthritis secondary to athletics, the treatment is not different than that offered for a spontaneously occurring arthritic joint. If an operation is necessary, the best operation depends a good deal on the goals of the patient. Continued athletic participation may be reasonable as long as the athletic activity is not vigorous and does not involve running and jumping or contact. The recommended athletic activities for patients with arthritis and for those having operations for arthritis are swimming, hiking, bicycling, walking, and golfing. The operations recommended for arthritic patients under the age of 30 should be biologic operations such as fusion or osteotomy. In patients aged 30 to 45, the operation should be correlated to lifestyle and desired level of activity. A biologic operation is better for highly active patients. When patients reach the age of 45 or are older, total joint replacement usually is preferable because of the improved clinical functional results and the decreased stress on surrounding joints with arthroplasty. If patients are older than 60 years, total joint replacement is the operation of choice and usually will include a cemented prosthesis. Some surgeons at this time do prefer cementless total-joint replacement for all patients regardless of age. Patients who have arthritis can have a satisfying athletic and exercise routine if they simply apply common sense to the manner in which they conduct their activities.

Adult↗
PubMed1993

The treatment of posterior subluxation in athletes.

Posterior instability in athletes is a diagnostic and therapeutic challenge. Athletes have recurrent posterior subluxations rather than true dislocations, and they have pain rather than instability, which makes the diagnosis difficult. The pathology is usually capsular laxity rather than a true reverse Bankart lesion. There is not one diagnostic test, including computed tomography (CT) arthrogram, magnetic resonance imaging (MRI), or arthroscopy, that will always help with the diagnosis. Most athletes respond to conservative care with an exercise program designed to strengthen the posterior deltoid, the infraspinatus, and the teres minor; but, there is still a select group of athletes that cannot perform their sport after an extensive rehabilitation program. The surgical options for these athletes are varied, and the results in most cases are less than ideal. A posterior capsulorrhaphy was performed to treat this problem. This was initially performed with a staple, but this technique has been abandoned for a suture capsulorrhaphy to avoid staple problems. The 40 athletes treated operatively that had adequate follow-up evaluation reflected a 40% failure rate. Most of the failures were related to ligamentous laxity and unrecognized multidirectional instability not treated at the time of surgery. There may be subtle differences between a patient with posterior subluxation and multidirectional instability; these must be differentiated before operation. Also, the higher the competitive level of athlete, the worse the overall results. The high-level athlete must be informed that even if his or her shoulder is stabilized, the functional results may not allow him or her to continue at the same competitive level.

Adolescent↗
PubMed1996

High-level athlete's impressions of their preparticipation sports examination.

OBJECTIVE: To document the high-level athletes' impressions of their preparticipation examination (PE). EXPERIMENTAL DESIGN: Prospective study by self-reporting questionnaire. SETTING AND PARTICIPANTS: One hundred-fifty French athletes, involved in national or international-level events (PE is obligatory every year in France). Response rate obtained was 71%. Subject population consisted of 107 normal, healthy, elite athletes, ranging in age from 16 to 31 years (mean 22.4 years), included 69 males and 38 females. MEASURES: Knowledge and impression of PE, based upon the athletes' own experience. All of the consulted physician were trained and qualified in sports medicine. RESULTS: Thirty-six percent of the athletes reported having had bad-quality preparticipation sports visit (no significant difference between gender or age). According to them, medical history taking was "poor", and physical examination "restricted to blood pressure measurement" and/or "chest listening" and "not targeted enough on past athletic injuries". Athletes said PE should especially evaluate the cardiovascular system (75% of all citations to the item), the musculoskeletal system (16%) and the lungs (8%), and should involve an electrocardiogram (41%). CONCLUSIONS: Challenges for the future: 1) better educate physician in sport, to improve the preventive aspects of sports medicine 2) physicians should provide information to coaches and athletes concerning the optimal balance between health and physical performance, and therefore to the interest of PE.

Adolescent↗
PubMed1997

Serial sevens: not the most effective test of mental status in high school athletes.

OBJECTIVE: To evaluate the ability of uninjured high school athletes to pass three mental status tests that are commonly used on the sidelines for the evaluation of concussions: the serial sevens test, the serial threes test, and recitation of months of year in reverse order (MOYR). PARTICIPANTS: High school student athletes in grades 9, 10, 11, and 12 having sports preparticipation physical examinations. The initial study tested 522 consecutive athletes. The follow-up study tested 109 consecutive athletes. INTERVENTION: The athletes of the initial group were asked to perform a serial sevens test, followed by a serial threes test, and finally to recite the MOYR. The second group was asked to perform the same tests in a random order. MAIN OUTCOME MEASURES: Participants were given 1-min time limits for each test, with passing defined as either 7 consecutive correct iterations or 11 correct with one mistake. RESULTS: For the initial group, 51.3% successfully performed serial sevens, 78.7% successfully performed serial threes, and 89.5% successfully recited the MOYR. For the second group, 52.7% successfully performed serial sevens, 78.1% successfully performed serial threes, and 88.9% successfully recited the MOYR. The pass rates were significantly different for both groups. The pass rates were similar for both sexes, all grade levels, and all sports in both test groups. Participants, both overall and in all subgroups, failed serial sevens more often than serial threes and MOYR (p < 0.001 for the initial group; p < 0.0001 for the second group). They failed serial threes more often than MOYR (p < 0.001 for the initial group; p < 0.01 for the second group). CONCLUSIONS: The percentage of uninjured high school athletes successfully completing serial sevens is too low to make the test useful for evaluation of concussion; the test lacks specificity. The percentage of athletes passing the MOYR was greatest, perhaps making this a better sideline test than the traditional serial sevens test. However, testing needs to be done in injured athletes before clinical application can be recommended.

Adolescent↗
PubMedDate not supplied

Arrhythmias and sudden cardiac death in elite athletes. American College of Cardiology, 16th Bethesda Conference.

With the recent high visibility deaths of Hank Gathers and Reggie Lewis, two nationally recognized elite basketball players due to cardiovascular disease and arrhythmias, our awareness of the most optimal ways to manage athletes with known arrhythmias has become heightened. In making medical decisions we physicians come to rely in large measure on data, in addition to clinical acumen and experience. Unfortunately, we are at a disadvantage with respect to athletes since previously published data on the natural history and outcome of such individuals with known arrhythmias are sparse. Furthermore, the tragedies of Lewis, Gathers, Pete Maravich and others are also poignant reminders that the denominator of this equation is not defined and that we do not really know precisely how many athletes experience important arrhythmias, nor their relation to sports activity. In the decade since the 16th Bethesda Conference, an American College of Cardiology sponsored consensus panel that developed standards and recommendations for the disqualification from competition of athletes with known cardiovascular disease, little new data have been developed to make objective decisions in these areas (including arrhythmias) much easier. Nevertheless, while such decision-making in athletes involves situations that are relatively rare, the consequences of misjudgement are substantial. Unfortunately, to complicate matters, even if the precise likelihood of sudden death for a given athlete with arrhythmias were known, many (if not most) professional and elite college athletes might still regard any risk as acceptable and withdrawal from formal competition as highly unacceptable from a financial and psychological standpoint. In this review, consideration will be given to the state of our medical knowledge in these areas. Many controversies persist with regard to arrhythmias, most notably for the athlete who has Wolff-Parkinson-White, mitral valve prolapse, myocarditis, or complex ventricular arrhythmias. Finally, consideration will be given to the broader issues of how, ad physicians and members of society, we may deal with these complex issues.

Adult↗
PubMed1991

Muscle strength in male athletes aged 70-81 years and a population sample.

Muscle strength characteristics of different muscle groups were studied in active male strength-trained (ST, n = 14), speed-trained (SP, n = 16), and endurance-trained (EN, n = 67) athletes aged between 70 and 81 years. A population sample of similar age (n = 42) served as a control group. The isometric forces for hand grip, arm flexion, knee extension, trunk extension, and trunk flexion were higher for the athletes than the controls and higher for the ST than EN group. The SP athletes showed higher values in knee extension and trunk flexion than the EN group. When the isometric muscle forces were related to lean body mass, significant differences still existed between the athletes and controls. However, the differences between the ST and EN groups disappeared. The elevation of the body's centre of gravity in the vertical jump was also higher for the athletes than the controls. The SP group performed better in the vertical jump than either the ST or EN group. The results showed that the athletes who trained not only for strength and speed but also for endurance had superior muscle function compared to the average male population of the same age. Although the strength and speed athletes generally showed the highest muscle strength in absolute terms, the endurance athletes also preserved excellent strength characteristics related to body mass.

Aged↗
PubMed1988

Incidence of exercise induced hypoxemia in elite endurance athletes at sea level.

Recent evidence suggests that exercise-induced hypoxemia (EIH) may occur in healthy trained endurance athletes. However, at present, no data exist to describe the regularity of EIH in athletes or non-athletes. Therefore, the purpose of the present investigation was to determine the incidence of EIH during exercise in healthy subjects varying in physical fitness. Subjects (N = 68) performed an incremental cycle ergometer test to volitional fatigue with percent arterial oxyhemoglobin saturation (%SaO2) measured min-by-min. For the purpose of data analysis subjects were divided into three groups according to their level of physical training: 1) untrained (N = 16), 2) moderately trained (N = 27), and 3) elite highly trained endurance athletes (N = 25). EIH was defined as a %SaO2 of less than or equal to 91% during exercise. EIH did not occur in any of the untrained subjects or the moderately trained subjects. However, EIH occurred in 52% of the highly trained endurance athletes tested and was highly reproducible (r = 0.95; P less than 0.05). These findings further confirm the existence of EIH in healthy highly trained endurance athletes and suggests a rather high incidence of EIH in this healthy population. Hence, it is important that the clinician or physiologist performing exercise testing in elite endurance athletes recognize that EIH can and does occur in the elite endurance athlete in the absence of lung disease.

Adult↗
PubMed1991

Athletes' pseudoanaemia.

To characterize the so-called pseudoanaemia of endurance-trained athletes, the plasma volume (PV), red cell volume (RCV) and total blood volume (TBV) of 12 male and 12 female athletes and 5 male and 5 female nonexercising controls were measured using 125I-labelled human serum albumin and 51Cr-labelled erythrocytes. The mean PV of the male athletes (52.8 ml.kg-1) was 37.5% higher than that of the controls (38.4 ml.kg-1), while the 18.1% increase measured in the female runners (51.5 ml.kg-1) over the controls (43.6 ml.kg-1) was a novel observation. Although the RCV was significantly greater (34.7%) in male athletes (32.6 ml.kg-1 vs 24.2 ml.kg-1 in the controls), a similar elevation (3.6%) was not found in the female athletes (25.9 ml.kg-1) compared to the sedentary women (22.8 ml.kg-1). This could have been due to iron-limited erythropoiesis because the RCV of the female athletes defined as clinically anaemic was markedly lower that of the nonanaemic women (P less than 0.05). The elevated plasma protein mass and concentration measured in the athletes partly accounted for their expanded PV. It was concluded that the decreased blood haemoglobin levels reported in the endurance athletes was largely a dilutional effect.

Adult↗
PubMed1994

Arthroscopic treatment of anterior synovitis of the ankle in athletes.

In a retrospective study we analysed the results of arthroscopic treatment of anterior synovitis of the ankle in 35 athletes. Five athletes additionally suffered from anterior osteophytes, and three presented with an anterolateral plica. Their average age was 25 years (SD 8.3), and the follow-up interval was 32.4 months (SD 19.4). Eight patients suffered from additional hyperlaxity of the ankle joint. At the time of follow-up, the patients were examined clinically as well as radiologically. The results were scored according to an ankle index containing the criteria pain, function, athletic activity, walking aids, range of motion and swelling. During surgery a partial synovectomy was performed and removal of anterior osteophytes or anterolateral plica as necessary. The overall score increased non-significantly from 66.2 preoperatively to 78.7 postoperatively (P > 0.05). Comparing the different criteria, the score parameter pain significantly increased after arthroscopy. All other parameters (function, athletic activity, walking aids, range of motion, swelling) showed only slight changes in this patient group. Athletes with a hypermobile joint showed worse results compared with the others. Even after surgery we documented severe restriction concerning athletic activity. Only 9 patients performed their activities at their previous level, 19 had reduced their activity level, and 7 had discontinued their athletic activity. In 6 cases we found temporary iatrogenic neurological damage. Regarding the uncertain clinical outcome and the documented high risk for neurovascular complication, patient selection for arthroscopic partial synovectomy in the athletic population should be extremely carefully performed.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

Ventilatory and heart rate chemosensitivity in track-and-field athletes.

Fifty-four male track-and-field athletes and 18 male non-athletes were examined by isocapnic progressive hypoxia and CO2 rebreathing tests. Ventilatory and heart rate (HR) responses to hypoxia were analysed by a hyperbolic relationship and the ventilatory response to hypercapnia by a linear regression. The results showed that ventilatory sensitivity during hypoxia was significantly attenuated in the long-distance runners and sprinters compared to the non-athletes. Although heart rate sensitivity during hypoxia in none of the athletes showed a significant difference compared to that of the non-athletes, baseline HR in the long-distance runners was significantly lower than that of the non-athletes. None of the athletes showed significant differences in ventilatory sensitivity during hypercapnia compared to the non-athletes.

Adolescent↗
PubMed1998

False-positive defects in technetium-99m sestamibi myocardial single-photon emission tomography in healthy athletes with left ventricular hypertrophy.

Exercise ECG and myocardial single-photon emission tomography (SPET) are fundamental in the non-invasive evaluation of patients suspected of having coronary artery disease (CAD). The purpose of the present study was to investigate the influence of physiological left ventricular hypertrophy (LVH) on myocardial sestamibi SPET in healthy young and old athletes. Eighteen young male elite athletes (ten rowers, five power/weight lifters and three triathletes) and 14 well-trained elderly rowers were studied. All underwent a bicycle test as part of a 2-day sestamibi SPET protocol. Attenuation correction was not performed. The studies were evaluated visually and quantitatively analysed by the CEqual program with its reference files and with a file from a local non-athletic age-matched population. Echocardiographic LVH was an inclusion criterion in the young athletes. Exercise ECG was normal in all subjects. In at least three of the young athletes a reversible defect was observed by visual analysis. On quantitative analysis one-third of the young athletes had "significant" (>10 pixels) defects compared with both the local reference base and the CEqual reference population. Nearly all defects were found in the anterior or inferior wall. The remaining subjects, including all old rowers, had normal SPET findings. Anterior and inferior wall defects are so common in healthy athletes with physiological LVH that the specificity of myocardial SPET, in contrast to exercise ECG, seems to be too low for evaluation of chest pain in this group. The mechanism of anterior and inferior defects may be related to hot spots (papillary muscles?) in the lateral wall. The specificity of SPET is maintained in athletes without LVH.

Adult↗
PubMed2004

Angiotensin-converting enzyme gene polymorphism, left ventricular remodeling, and exercise capacity in strength-trained athletes.

The mechanisms that regulate the development of human physiological cardiac hypertrophy remain poorly understood. The renin-angiotensin system, which is modulated by genetic polymorphism, plays an important role in the regulation of vascular tone and myocardial hypertrophy. Although a few studies have analyzed the association of angiotensin-converting enzyme (ACE) polymorphism and left ventricular (LV) hypertrophy in isotonic exercise-trained subjects who developed eccentric cardiac hypertrophy, there has been no research done in power athletes who developed concentric cardiac hypertrophy. We have hypothesized that ACE genotypic modulation characteristics may affect LV mass in power athletes. This study included 29 elite Caucasian wrestlers (mean age, 22.6 years) and 51 age-matched sedentary subjects. According to the absence or presence of the insertion segment in the polymerase chain reaction (PCR) product, the subjects were classified as homozygous deletion-deletion (DD), insertion-insertion (II), or heterozygous insertion-deletion (ID). The association of LV hypertrophy with ACE gene insertion/deletion (I/D) polymorphism was analyzed. Left ventricular mass and index were determined by echocardiography. Angiotensin-converting enzyme genotyping was performed on peripheral leukocytes using the polymerase chain reaction technique. The study and control group subjects were similar in height and weight. Left ventricular hypertrophy in the athletes was more apparent than in the controls. Angiotensin-converting enzyme genotype II frequency was 17.2% (5) in the athletes, 17.6% (9) in the controls; ID frequency was 51.7% (15) in the athletes, 56.8% (29) in the controls; and the DD frequency was 31% (9) in the athletes and 25.4% (13) in the controls. Left ventricular mass and mass index were found to be higher in genotype DD (126.2 +/- 2.9g/m2) than genotype II (85.5 +/- 4.0g/m2) or genotype ID (110.1 +/- 2.3g/m2) in the athletes (P < 0.001). Furthermore, maximal oxygen consumption in genotype DD was found to be higher than in II and ID. An association was found between ACE gene I/D polymorphism and LV hypertrophy in strength-trained athletes.

Adult↗
PubMed2003

Hormonal responses in athletes: the use of a two bout exercise protocol to detect subtle differences in (over)training status.

In overtrained athletes, several signs and symptoms have been associated with the imbalance between training and recovery. However, reliable diagnostic markers for distinguishing between well-trained, overreached (OR) and overtrained (OT) athletes are lacking. A hallmark feature of overtraining syndrome (OTS) is the inability to sustain intense exercise and recover for the next training or competition session. We therefore devised a test protocol utilizing two bouts of maximal work. With this test protocol we tried to establish a difference in hormonal responses between the training status of T and OR athletes. Seven well-trained cyclists participated in this study and were tested before and after a training camp. We also present the data of one OT motocross athlete who was clinically diagnosed as overtrained. All athletes performed two maximal exercise tests separated by 4 h. Blood was analyzed for cortisol, adrenocorticotrophic hormone (ACTH), growth hormone and prolactin (PRL). Performance decreased by 6% between the first and the second exercise test in the OR group and by 11% in the OT subject. Moreover, during the second exercise test there were more marked differences between the T and OR athletes; in particular, the OT subject did not show an increase in some of the hormonal responses. PRL increased only by 14% in the OT subject's second test and there was a 7% decrease in ACTH. The two exercise approach enables us to detect subtle performance decrements that will not be identified by one exercise trigger. The hormonal responses to the second exercise test were different between the T and OR athletes (the increase in the T group was higher than in the OR that was higher than in the OT). The results of the case presentation of an overtrained athlete provide evidence of an altered and dysfunctional hypothalamic-pituitary axis response to two bouts of maximal exercise. These findings can be used to develop markers for diagnosis of OTS and to begin to address the pathologic mechanism operative in the syndrome, as well as providing an outcome measure to evaluate possible therapeutic regimes.

Adaptation, Physiological↗