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Comparison of stretching with ice, stretching with heat, or stretching alone on hamstring flexibility.

OBJECTIVE: To investigate the efficacy of stretching with ice for increasing hamstring flexibility. DESIGN AND SETTING: Supine hamstring flexibility was measured before and after subjects accomplished a 20-minute hamstring stretching routine. Two groups of eight subjects accomplished the routine using one of two modalities. A control group (n = 8) accomplished the routine without a modality. The measurements were compared. SUBJECTS: Twenty-four male collegiate baseball players. MEASUREMENTS: Heat or ice applied to the hamstring. RESULTS: We found differences in the responses among subject groups. Supine hamstring flexibility after stretching with ice was greater than both stretching with heat and stretching alone. Scores after stretching with heat and stretching alone were not different. CONCLUSIONS: The results of our investigation suggest that the application of ice may provide enhanced short-term improvements in hamstring flexibility over heat or stretching alone. Further research is necessary to investigate the possible mechanisms for these improvements and to determine whether similar results can be obtained with other muscle groups.

Journal Article↗

[Three cases of spontaneous pneumomediastinum].

We encountered 3 male patients with spontaneous pneumomediastinum. The patients were a 16-year old and a 17-year old and a 24-year old. Predisposing episodes for the development of spontaneous pneumomediastinum could be identified in all 3 patients: throwing a ball during a baseball game in 1, lifting a heavy load during work in 2. However, they were healthy and suddenly developed symptoms in the absence of any underlying disease. The presenting complaint was chest pain in all 3 patients. Chest X-ray films and chest CT images revealed pneumomediastinum. A diagnosis of spontaneous pneumomediastinum was made based on chest X-ray films and chest CT images. After conservative treatment, all 3 patients recovered.

Adolescent↗

Importance of the autonomic nervous system in an experimental model of commotio cordis.

BACKGROUND: Young athletes may die suddenly when they are struck in the chest (commotio cordis). Proposed mechanisms of sudden death in commotio cordis include hypervagatonia and activation of the sympathetic nervous system. In an experimental model of commotio cordis, the importance of the sympathetic and parasympathetic nervous system in the initiation of ventricular fibrillation was evaluated. MATERIAL/METHODS: Juvenile swine weighing between 8 and 12 kg were anesthetized with ketamine and isoflurane and placed prone in a sling. Twenty animals were randomized to pretreatment with placebo or sympathetic and parasympathetic blockade. Chest blows were guided by echocardiography to the center of the left ventricle and animals received 1-3 strikes with a regulation baseball propelled at 30 mph and timed to impact 10-30 ms prior to the peak of the T-wave. RESULTS: With 17 impacts in 10 autonomically blocked animals, 6 episodes of ventricular fibrillation were seen; with 15 impacts in 10 control animals, ventricular fibrillation occurred 6 times. There was also no significant difference between the groups in occurrence of nonsustained polymorphic ventricular tachycardia or ST elevation. Transient complete heart block was less commonly seen in animals treated with autonomic blockade, although this did not achieve statistical significance. CONCLUSIONS: In this experimental model of commotio cordis, autonomic blockade did not affect the frequency of sudden cardiac death, polymorphic ventricular tachycardia or ST segment elevation. Thus, vagotonic and sympathetic surges likely do not contribute to the syndrome of sudden death due to chest blows in young people and athletes.

Animals↗

Arteriopathy in the high-performance athlete.

Pain occurs frequently in high-performance athletes and is most often due to musculoskeletal injury or strain. However, athletes who participate in sports that require highly frequent, repetitive limb motion can also experience pain from an underlying arteriopathy, which causes exercise-induced ischemia. We reviewed the clinical records and follow-up care of 3 high-performance athletes (mean age, 29.3 yr; range, 16-47 yr) who were admitted consecutively to our institution from January 2002 through May 2003, each with a diagnosis of limb ischemia due to arteriopathy. The study group comprised 3 males: 2 active in competitive baseball (ages, 16 and 19 yr) and a cyclist (age, 47 yr). Provocative testing and radiologic evaluation established the diagnoses. Treatment goals included targeted resection of compressive structures, arterial reconstruction to eliminate stenosis and possible emboli, and improvement of distal perfusion. Our successful reconstructive techniques included thoracic outlet decompression and interpositional bypass of the subclavian artery in the 16-year-old patient, pectoralis muscle and tendon decompression to relieve compression of the axillary artery in the 19-year-old, and patch angioplasty for endofibrosis affecting the external iliac artery in the 47-year-old. Each patient was asymptomatic on follow-up and had resumed participation in competitive athletics. The recognition and anatomic definition of an arteriopathy that produces exercise-induced ischemia enables the application of precise therapy that can produce a symptom-free outcome and the ability to resume competitive athletics.

Adolescent↗

The nature, causes, and visual outcome of ocular trauma requiring posterior segment surgery at a county hospital.

Fifty consecutive, severe ocular trauma cases with posterior segment involvement underwent vitreoretinal surgery over a 14-month period at a county hospital. Forty-five (90%) of the patients were boys and men, and the mean age was 27 years. The injuries were the result of assaults in 37 cases (74%), industrial accidents in six (12%), accidents involving children at play in six (12%), and child abuse in one (2%). Twenty-five (50%) of the injuries were inflicted by firearms, by knives or sharp objects in ten (20%), by baseball bats in two (4%), by broken glass in two (4%), and unknown in 11 (22%). Twenty-six (52%) were penetrating injuries, of which eight were double perforations. There were ten (20%) intraorbital foreign bodies and three (6%) intraocular foreign bodies. Forty-three (86%) of the cases had initial visual acuities of 20/400 or worse. After a minimum of six months' follow-up, 48.8% improved two or more lines visually, and 69.4% were anatomic successes. Unlike other ocular-trauma studies, where industrial accidents and sports-related injuries were the most common causes of the trauma, assaults with firearms were the most common cause of ocular trauma at this county hospital. The visual and anatomic surgical results, however, were similar to those of other ocular-trauma studies.

Adolescent↗

Prevention of sports-related eye injury.

Sports-related eye injury is an important cause of vision loss. Many eye injuries can be prevented through the supervision of play, the enforcement of game rules and the use of eye protective devices. State-of-the-art eye protective devices incorporate highly impact-resistant optical material, usually polycarbonate lenses, in a sturdy frame. Protective devices are available for use in racquet sports, baseball, basketball, football, ice hockey and other sports.

Adolescent↗

Sports injuries and adolescent athletes.

A one-year study was undertaken investigating adolescent sports injury experiences at a major sports clinic in the state of Delaware. A total of 619 athletes sustained 870 injuries, for an overall injury rate of 1.4 injuries per athlete. The largest number of injuries was recorded in football (40.2 percent), followed by boys' soccer, wrestling, baseball and girls' basketball. Severity of injury was measured by the number of days lost per injury. Cheerleading had the highest average days lost per injury (28.8), followed by girls' basketball, wrestling, boys' cross-country and girls' tennis. Inflammation, fractures and dislocations comprised 50.6 percent of all the injuries, while 50.5 percent of the injuries were located in the knee, thigh, and shoulder. Twenty-seven of the 870 injuries required surgery.

Adolescent↗

Diagnosis and management of sports-related injuries to the face.

The face is often the most exposed part of the body during athletic competition. This article concentrates on sports-related injuries to the zygoma and periorbital area, the maxilla, the nose, and the external ear. Discussions of the management of soft-tissue injuries and the diagnosis and treatment of underlying disruption of bone and cartilage are presented. A new piece of protective athletic equipment for the prevention of facial injuries to baseball players is introduced.

Athletic Injuries↗

Femoral shaft stress fractures in athletes.

Stress fractures of the femoral shaft in athletes occur most commonly in the proximal third of the femur. They can, however, also be found in the mid- or distal third. Conservative treatment is highly successful in healing these fractures without complications. Athletes can usually return to activity in 8 to 14 weeks. Recognition of the symptoms characteristic of these fractures (vague thigh pain, diffuse tenderness, no trauma) will assist early diagnosis. Early definitive diagnosis can be made by radionuclide scanning or later, by plain radiography, if symptoms have been present for a sufficient period. Diagnosis is not limited to novice runners since runners with significant mileage, or baseball or basketball players, can develop femoral shaft stress fractures.

Adolescent↗

Paradoxic aciduria in bovine metabolic alkalosis.

Cows with metabolic alkalosis secondary to abomasal displacement and other abomasal disorders were often found to excrete acidic urine. This paradoxic aciduria contradictsthe classical view that the pH of the urine may be used to estimate the acid-base status of the body. Data from bovine clinical patients with metabolic alkalosis, serum electrolyte changes, and paradoxic aciduria suggested that the balance of sodium potassium, and chloride in the body places limits on the kidneys' ability to regulate the acid-basebalance.

Abomasum↗

Fracture of the hook of the hamate.

We removed the fracture fragment from fifty-nine patients who had an isolated fracture of the hook of the hamate. Preoperatively, all had complained of pain and tenderness on the ulnar side of the palm or on the dorsal ulnar aspect of the wrist. Most fractures were thought to have occurred while the patient was swinging a racquet, golf club, or baseball bat. Some fractures were caused by striking the palm on a solid object, by falling on the palm, or by a crush injury to the hand. Most of the fractures were diagnosed conclusively on a carpal tunnel roentgenogram or on a special oblique roentgenogram of the wrist supinated. We now believe that computed axial tomography is the best imaging technique for demonstrating this fracture. Except for two patients who had a crush injury, all of the patients returned to their regular occupational and athletic pursuits. There were no surgical complications.

Adult↗

[Secondary ligament instabilities in the area of the elbow joint].

Secondary capsular or ligamentous injuries around the elbow joint, which are generally a rare finding, can give rise to medial, lateral, anterior, and posterior instability. Medial instability is especially bothersome during sporting activities, such as javelin throwing and baseball, and requires tightening or replacement of the ulnar collateral ligament. On the lateral side it is particularly the subluxation of the head of the radius that makes surgical tightening of the annular ligament essential. Anterior instability, which would cause the joint to dislocate anteriorly, is extremely rare and does not lead to secondary problems. Posterolateral, chronically recurrent, dislocation of the elbow joint, however, is intolerable for the patient, and many operative stabilizing procedures have been performed, mostly in isolated patients, in attempts at correction. The current method of choice consists in tightening of the dorsoradial capsular pouch in combination with osseous refixation of the slack radial ligament.

Chronic Disease↗

Biophysical and physiological integration of proper clothing for exercise.

In this chapter, I have presented a potpourri of examples of proper clothing to wear during various exercise demands in different environments. These examples are not wholly exact for all persons. For example, during the 1984 Olympics in Los Angeles, clothing wear related to the particular environment was totally different. We have already described the aerodynamic necessities of cyclists and runners. At the other extreme, equestrians had to contend with a warm, moderately humid environment, plus a solar load that added to the effective heat stress, while wearing clothing having clo values of nearly 0.8-0.9, plus headgear that limited evaporative heat loss. Obviously, garments with high water vapor permeation and bellows properties were necessary. Runners in the marathon faced equal thermal challenges. In addition, they incurred variable levels of hypovolemia and cardiovascular strain. A. Salazar, for example, was advised to omit shower sprays, and he ran with a prototype high-permeability singlet. The excessive wetting plus time to maneuver to the spray was deemed of no value, since Mr. Salazar chafes easily from wet clothes (L. Armstrong, personnel communication). One interesting response to this advice is to consider the clothed runner as a wet globe thermometer under forced convection. A high-contact fabric, especially one like cotton, does allow evaporative cooling, provided that the skin-ambient vapor pressure gradient is not diminished by high relative humidity. Salts in sweat may reduce the skin's vapor pressure ; however, Woodcock and Breckenridge point out that "secreted sweat (especially with heat acclimation) is so dilute that no appreciable lowering of vapor pressure would occur unless sweat were concentrated many times by evaporation." Thus, the degree of "human" wet bulb depression simulated by a completely wet runner may or may not be an advantage, since all other variables are also constant (i.e., humidity, weight of clothing as in Figure 13, etc.) or the level of hypovolemia is not excessive and the person is fully heat acclimated. Problems such as these may be theoretical, but they serve to show that the thermal biophysics and physiology of exercise follow similar fundamental pathways that can be highly pertinent. As we sought to point out in this chapter, these pathways have merged in the last 30 years with developments such as warmth without bulk for backpackers (which is a welcomed contrast to heavy arctic wear), materials that allow athletes to remain somewhat comfortable while sweating, and other advances that luckily have replaced the less appealing sports apparel such as the old woolen baseball uniform.(ABSTRACT TRUNCATED AT 400 WORDS)

Biophysical Phenomena↗

Dynamic electromyographic analysis of the throwing shoulder with glenohumeral instability.

Fifteen male athletes who were skilled in throwing and who had chronic anterior instability of the shoulder (Group 1) were evaluated by dynamic intramuscular electromyography while pitching a baseball. Indwelling wire electrodes recorded the levels of activity in the biceps, middle deltoid, supraspinatus, infraspinatus, pectoralis major, subscapularis, latissimus dorsi, and serratus anterior throughout the entire pitching sequence. These signals were synchronized electronically with records of the pitch that were made using high-speed photography. The pitch was divided into five phases: wind-up, early cocking, late cocking, acceleration, and follow-through. The results were compared with previous identical studies of twelve healthy, uninjured male athletes who were skilled in throwing (Group 2). Activity increased mildly in the biceps and supraspinatus in Group 1 as compared with Group 2. Similar patterns of activity were demonstrated in the deltoid. In Group 1 the infraspinatus had increased activity during early cocking and follow-through but had decreased activity during late cocking. The pectoralis major, subscapularis, latissimus dorsi, and serratus anterior in Group 1 all were shown to have markedly decreased activity. The study revealed a difference between Groups 1 and 2 in all of the muscles of the shoulder that were tested with the exception of the deltoid. The mildly increased activity levels of the biceps and supraspinatus that were found in Group 1 may compensate for anterior laxity. The marked reduction in activity in the pectoralis major, subscapularis, and latissimus dorsi added to the anterior instability by decreasing the normal internal-rotation force that is needed during the phases of late cocking and acceleration.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

[Rupture of the ulnar, collateral ligament of the metacarpophalangeal joint of the thumb, so-called 'wobbly thumb'].

A stable metacarpophalangeal joint of the thumb is indispensable for a normal grip function of the hand. The joint is stabilized by collateral ligaments. A rupture of the ulnar, collateral ligament is often caused by a sports trauma, as indicated by the denominations "skiërs duim", "goalkeeper's thumb" and "baseball thumb". Many surgeons are not familiar with the phenomenon of an insufficient collateral ligament, also called "wackeldaum". In the period 1981-1985 a consecutive series of 35 patients with a ruptured ulnar collateral ligament was operated in the De Wever hospital Heerlen (Netherlands). On the basis of our own patients, attention is given to the diagnosis, therapy and results of the operative treatment of these lesions.

Adolescent↗

Substance-abuse policies and guidelines in amateur and professional athletics.

Substance-abuse policies and guidelines in amateur and professional athletic organizations are described. Amateur athletic organizations, which are governed by the U.S. Olympic Committee or the National Collegiate Athletic Association (NCAA), have developed programs that include mandatory drug testing. Drugs banned by the two organizations include psychomotor stimulants, sympathomimetic amines, narcotic analgesics, anabolic steroids, miscellaneous central nervous system stimulants, and, in the case of the NCAA, certain street drugs. Professional organizations have been somewhat slower to follow and, with the exception of tennis, do not allow mandatory drug testing. Each formal drug-screening program includes penalties for violators. The enforcement practices of the organizations representing tennis, baseball, basketball, and football are described. One aspect unique to professional sports is the employee-assistance program, which allows the impaired athlete to receive treatment while continuing to play and receive a salary. As drug-control programs become more common in athletics, opportunities may arise for pharmacists to participate in the areas of drug information and educational services.

Doping in Sports↗

The perception of vocal signals by blue monkeys and grey-cheeked mangabeys.

Old World forest primates may need to signal vocally over long distances in noisy habitats. Perceptual experiments focused on the audibility of signals in noise were conducted in the laboratory using standard psychoacoustical methods. Six human listeners, two blue monkeys (Cercopithecus mitis), and two grey-cheeked mangabeys (Cercocebus albigena) served as subjects. Based upon measurements of East African rain forests (Brown and Waser 1984) testing was conducted in the presence of simulated rain forest noise, or in the quiet. Signals consisted of pure tones 2-seconds in duration ranging in frequency from 63 Hz to 32 kHz, or recordings of vocalizations. Test vocal signals for monkey subjects were the blue monkey chirp, pyow, trill, ka, ka-train, grunt and boom calls; the mangabey chorused grunt, soft grunt, gobble and staccato bark calls. Human listeners were tested with the consonant-vowel stop consonants: ba, pa, da, ta, ga, ka; the two-syllable words: baseball, lifeguard, vessel and leisure; and the sentence "Can you hear me?" The results showed that mangabeys exhibit an audibility function nearly indistinguishable from that for blue monkeys (Brown and Waser 1984). Compared to terrestrial open country monkeys, these arboreal rain forest monkeys possess enhanced low-frequency sensitivity which coupled with mechanisms specialized for low-frequency vocal production may function as a long-distance communication system. Testing with vocalizations in the presence of a masking noise revealed that monkey calls were about 10 dB more audible in noise than were human speech sounds. No differences were found between the audibility of graded or discrete calls. Testing for species-specific abilities was conducted with a subsample of six calls. While differences were not found when testing was conducted in the quiet, in the presence of forest noise, monkeys were about 3.4 dB more sensitive to the calls of conspecifics than to the calls of sympatric species. These findings support the idea that differences in the audibility of the vocalizations of related species is principally due to acoustical differences between signals, yet more subtle receptive specializations may have evolved as well. Hence selection may have acted on both receptive and productive mechanisms to promote vocal communication under adverse environmental conditions.

Adult↗

Athletic injuries of the wrist.

The wrist is at risk for injury in many athletic endeavors, often in acute falls or dorsiflexion injuries and at other times from repetitive stress involved with fitness routines or specific motions called for in the sport. Dorsiflexion accounts for most wrist problems giving rise to compression injuries dorsally such as scaphoid impaction, triquetrohamate impaction, and occult ganglions. These are seen most often in weight lifters, gymnasts, and push-up enthusiasts. Tension injuries occur on the palmar aspect of the wrist with disruption or attenuation of the supporting ligaments or interosseous membranes. This provides scapholunate tears, scapholunate dissociation, lunatotriquetral, midcarpal instability problems, and so forth, which are generally the result of single energetic injuries commonly associated with contact sports. Distal radioulnar injuries include chondromalacia of the ulnar head, ulnar head subluxation, and ulnocarpal impingements with tears of the triangular fibrocartilage. Forceful rotational injuries are generally associated with the former and stressful ulnar deviation with the latter, where tennis players and baseball batters are at risk. Fracture of the hook of the hamate and pisotriquetral chondromalacia are common in sports requiring holding a club, handle, or bat. Precise, early diagnosis affords the best chance for successful treatment.

Adult↗