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PubMed2000

Shoulder injuries in overhead athletes. The "dead arm" revisited.

The following statements summarize this article: Three distinct categories of Type 2 SLAP lesions exist: (1) anterior, (2) posterior, and (3) combined anteroposterior. Posterior Type 2 SLAP lesions have distinct clinical and anatomic features that distinguish them from anterior Type 2 SLAP lesions. Posterior and combined Type 2 SLAP lesions can be disabling to overhead-throwing athletes because of posterosuperior instability and anteroinferior pseudolaxity. The Jobe relocation test is positive with posterosuperior pain in patients with posterior or combined anterior-posterior Type 2 SLAP lesions and is negative in patients with anterior Type 2 SLAP lesions. Rotator cuff tears are frequently associated with posterior or combined anterior-posterior SLAP lesions, are lesion-location specific, and typically begin from inside the joint as undersurface tears. Repair of posterior SLAP lesions can return overhead-throwing athletes to full overhead athletic functioning. The peel-back mechanism is a likely cause of posterior Type 2 SLAP lesions. To securely repair the posterosuperior labrum to resist torsional peel-back, sulure anchors must be placed posterior to the biceps at the corner of the glenoid. The repair must be protected against external rotation past 0 degree for 3 weeks to avoid undue premature torsional stresses on the repair from the peel-back mechanism. A tight posteroinferior capsule predisposes to Type 2 SLAP lesions in overhead athletes. Shoulders at risk for the dead arm syndrome have a marked loss of internal rotation caused by contracture of the posteroinferior capsule such that less than a 180 degrees arc of rotation is achieved with the arm abducted 90 degrees (the 180 degrees rule). Type 2 SLAP lesions that cause the dead arm syndrome in overhead-throwing athletes are most likely acceleration injuries that occur in late cocking rather than deceleration injuries in follow-through. Rehabilitation of athletes with the dead arm syndrome must include the entire kinetic chain. The root cause of the dead arm syndrome is the Type 2 SLAP lesion.

Athletic Injuries↗
PubMed2000

Athletic footwear: design, performance and selection issues.

The purpose of this paper is to assist the practitioner in understanding the various advantages and disadvantages associated with the use of athletic footwear. In addition, the various components of a typical athletic shoe are described, including the upper, the midsole/outsole, the last, as well as the lasting process. Since the various models of athletic shoes that are available to the consumer can change in a very rapid and unpredictable manner, it is extremely difficult for the clinician to maintain a database of current shoe models and features. This paper stresses the importance of the clinician providing the athlete a list of footwear features and components based on their particular foot classification or problem, rather than attempting to recommend a specific model of athletic shoe. A detailed explanation of these features is provided to assist the practitioner in helping the athlete select the most appropriate shoe.

Athletic Injuries↗
PubMed1999

Athletic injury and minor life events: a prospective study.

Minor life events were examined in an attempt to determine their contribution to athletic injury risk. Male and female athletes (N = 98), from both team and individual sports (hockey, volleyball, and triathlon) were examined over the course of a competitive season. A high rate of injury was noted among these athletes (30%-46% of the members of each team sustained at least one injury during the season). The injured athletes were found to have a significant increase in minor life events for the week prior to injury. No significant changes in minor life events occurred for the non-injured athletes. The results of the present study provide substantial evidence for a link between minor life events and athletic injury.

Adult↗
PubMedDate not supplied

Microscopic lumbar discectomy results for 60 cases in professional and Olympic athletes.

BACKGROUND CONTEXT: There is no documented information indicating time for return to play after lumbar discectomy in professional and Olympic athletes. PURPOSE: To determine the rate of return to sport and the average time of recovery in elite athletes undergoing microscopic lumbar discectomy (MLD). STUDY DESIGN: Between 1984 and 1998, the senior author performed 60 MLDs on 59 professional and Olympic athletes with lumbar herniated nucleus pulposus. PATIENT SAMPLE: Sixty consecutive MLDs performed on professional and Olympic athletes were reviewed. OUTCOME MEASURES: The rate of return and the average time to return to sport were determined. Also, the distribution of pain and presence of neurologic deficits were recorded. METHODS: A retrospective review was performed. RESULTS: Follow-up indicated that all but 7 of the 60 cases had returned to their sport, including one who underwent a second MLD for a herniation at an adjacent level. The average time from surgery to return was 5.2 months for the entire group, with a range of 1 to 15 months. CONCLUSION: MLD was effective in correcting the problems that forced the athletes to seek help, and the time to return often depends on factors other than their medical condition. Postoperatively, a complete trunk stabilization rehabilitation program was effective in returning these athletes to a high level of competition.

Adult↗
PubMed1990

Injuries to elite wheelchair athletes.

The purpose of this project was to describe the nature, type, and frequency of athletic injuries incurred by the elite wheelchair athlete. Nineteen athletes participated in a 1-year injury recall study at an elite wheelchair training camp. An injury was defined as anything the athlete expressed concern about and (a) caused a loss of participation due to an injury or illness or (b) an injury in which a fracture, dislocation, or subluxation occurred and the athlete was able to continue participation. There were 10 male and 9 female subjects who reported their injuries from 1 June 1987 to 31 May 1988. Fifty injuries were reported, strains and muscular injuries accounted for almost half of the injuries. Physicians were the primary care provider for 37% of the injuries, followed by physical therapists and athletic trainers at 26% and 15% respectively. Slightly over 57% of the injuries were classified as minor, missing 7 days or less of participation and 32% were classified as major, missing 22 days or more of participation. The upper extremity was the most frequently injured, followed by the lower extremity, head and spine, and illnesses. Conventional treatments of ice, heat, modalities, and medications, were the most common methods of treating these injuries. Flexibility and strength training programmes should be implemented throughout the competitive season. Careful consideration of the training programme and workout intensity should also be evaluated.

Arm Injuries↗
PubMed1992

[Athletic capacity after surgical management of acromioclavicular joint separation].

Acromioclavicular separation is a common injury in sports. This study was done to show the activity and problems of athletes after operative treatment of this kind of injury. Between 1986 and 1989 21 athletes with acromioclavicular separation had been treated by operation. The coracoclavicular ligaments had been sutured and augmented by a PDS cord. The acromioclavicular ligaments had also been reattached and the ac-joint had been transfixed with a Kirschner-wire. The results show 18 athletes doing their sports on the same level as preoperatively. Two athletes with a frequency of sporting activity once a week could not continue their sporting activity. One athlete changed the disciplines to less shoulder stressing kind of sport. The comparison of clinical and radiological results showed no correlation, even patients with an osteoarthrosis of the ac-joint and coracoclavicular ossifications had best clinical results. We recommend therefore operative treatment for acromioclavicular separation in athletes.

Acromioclavicular Joint↗
PubMed2004

Visual p300 effects beyond symptoms in concussed college athletes.

In order to assess whether cerebral anomalies may be observed in the absence of clinical symptoms, the current study compared the effects of concussions on attentional capacities (reaction times, accuracy) and Event-Related Potentials (ERPs) in concussed athletes with (n = 10) or without (n = 10) symptoms as well as in athletes who never had a concussion (n = 10). The P300 response was recorded from 28 electrodes during a modified visual oddball paradigm. Participants were instructed to press a key upon the appearance of the frequent stimuli as well as when a rare nontarget stimulus followed the frequent one. The other key was to be pressed when the subsequent rare stimuli (rare target) appeared until a frequent one reappeared. The symptomatic athletes displayed longer reaction times than the other two groups of athletes. The P300 amplitude to the rare target stimuli was significantly more attenuated in the symptomatic athletes than in the other two groups. Moreover, the P300 amplitude varied inversely with the severity of post-concussion symptoms but was not influenced by time elapsed since injury. Although the clinical significance of the P300 differences shown by the symptomatic athletes is still uncertain, the results do indicate that symptom severity may be a crucial indicator of functional impairments following mild traumatic brain injury.

Adult↗
PubMed1989

Sports injuries in elderly athletes: a three-year prospective, controlled study.

A 3-year prospective, controlled study of sports injuries in elderly athletes (over 60 years of age) treated at an outpatient sports clinic was carried out in order to determine the number, profile, and specific features of these injuries compared with those of young athletes (between 21 and 25 years). During the study period, 57 elderly and 457 young adult athletes visited the clinic. The majority of the patients in both groups were male (83% of the veterans and 85% of the young). Forty-eight veterans (84%) were endurance sportsmen, while only 115 of the young patients (25%) went in for endurance sports. In both groups the knee joint was most frequently affected, in the young athletes (36%) more frequently than in the elderly (21%). In the elderly athletes shoulder (18%) as well as Achilles tendon and calf (20%) complaints were significantly more common than among young athletes (7% and 5%, respectively). Most (70%) of the injuries in the elderly were overuse injuries, but these comprised only 41% in the young.

Adult↗
PubMed2001

Percutaneous nucleotomy in elite athletes.

Percutaneous nucleotomy in elite athletes is considered a minimally invasive treatment of lumbar disc herniation. However, long-term effectiveness has not been established by careful follow-up studies. This article evaluates the outcome of percutaneous nucleotomy in elite athletes who have undergone the procedure. Thirty elite athletes with lumbar disc herniation who underwent percutaneous nucleotomy and had been followed for at least 2 years were compared with a matched group of 42 nonathletes. The outcome in athletes was worse than in nonathletes. Early return to vigorous sports activity in less than 3 months correlated with increased symptoms. Similarly, more extensive resection of disc material was associated with an unexpected rapid worsening of the outcome and the lower rate of return to preoperative sports. Patient selection and postoperative management of athletes and nonathletes undergoing percutaneous nucleotomy should be the same, and the procedure in athletes is probably not worthwhile if they do not obey postoperative management such as the timing of return to sports activity.

Adolescent↗
PubMed2002

Hip muscle imbalance and low back pain in athletes: influence of core strengthening.

PURPOSE: The influence of a core-strengthening program on low back pain (LBP) occurrence and hip strength differences were studied in NCAA Division I collegiate athletes. METHODS: In 1998, 1999, and 2000, hip strength was measured during preparticipation physical examinations and occurrence of LBP was monitored throughout the year. Following the 1999-2000 preparticipation physicals, all athletes began participation in a structured core-strengthening program, which emphasized abdominal, paraspinal, and hip extensor strengthening. Incidence of LBP and the relationship with hip muscle imbalance were compared between consecutive academic years. RESULTS: After incorporation of core strengthening, there was no statistically significant change in LBP occurrence. Side-to-side extensor strength between athletes participating in both the 1998-1999 and 1999-2000 physicals were no different. After core strengthening, the right hip extensor was, on average, stronger than that of the left hip extensor (P = 0.0001). More specific gender differences were noted after core strengthening. Using logistic regression, female athletes with weaker left hip abductors had a more significant probability of requiring treatment for LBP (P = 0.009) CONCLUSION: The impact of core strengthening on collegiate athletes has not been previously examined. These results indicated no significant advantage of core strengthening in reducing LBP occurrence, though this may be more a reflection of the small numbers of subjects who actually required treatment. The core program, however, seems to have had a role in modifying hip extensor strength balance. The association between hip strength and future LBP occurrence, observed only in females, may indicate the need for more gender-specific core programs. The need for a larger scale study to examine the impact of core strengthening in collegiate athletes is demonstrated.

Adult↗
PubMed2001

Head injury in athletes.

HEAD INJURIES INCURRED during athletic endeavors have been recorded since games were first held. During the last century, our level of understanding of the types of cerebral insults, their causes, and their treatment has advanced significantly. Because of the extreme popularity of sports in the United States and worldwide, the implications of athletic head injury are enormous. This is especially true considering the current realization that mild traumatic brain injury (MTBI) or concussion represents a major health consideration with more long-ranging effects than previously thought. When considering athletic injuries, people who engage in organized sports, as well as the large number of people who engage in recreational activities, should be considered. There are 200 million international soccer players, a group increasingly recognized to be at risk for MTBI. The participation in contact sports of a large number of the population, especially youth, requires a careful and detailed analysis of injury trends and recommended treatment. There are numerous characteristics of this patient population that make management difficult, especially their implicit request to once again be subjected to potential MTBI by participating in contact sports. Recent research has better defined the epidemiological issues related to sports injuries involving the central nervous system and has also led to classification and management paradigms that help guide decisions regarding athletes' return to play. We currently have methods at our disposal that greatly assist us in managing this group of patients, including improved recognition of the clinical syndromes of MTBI, new testing such as neuropsychological assessment, radiographic evaluations, and a greater appreciation of the pathophysiology of concussive brain injury. The potential for long-term consequences of repetitive MTBI has been recognized, and we no longer consider the "dinged" states of athletic concussions to have the benign connotations they had in the past. We review the historical developments in the recognition and care of athletes with head injuries, the current theory of the pathophysiology and biomechanics of these insults, and the recommended management strategy, including return-to-play criteria.

Athletic Injuries↗
PubMed2002

Sacral stress fractures: an unusual cause of low back pain in an athlete.

STUDY DESIGN: A case report of a sacral stress fracture causing low back pain in an athlete. OBJECTIVE: To document the occurrence of sacral stress fractures in athletes and to recommend it in the differential diagnosis of low back pain, especially in runners and volleyball players. SUMMARY OF BACKGROUND DATA: Low back pain is common both in the general population and in athletes. Athletes place high physical demands on their bodies, which often lead to stress fractures. Sacral stress fractures can cause back pain and are often not included in the differential diagnosis of back pain. METHODS: The authors were involved in the care and treatment of this patient and reviewed all medical records, radiologic tests, and related literature. RESULTS: In a 16-year-old volleyball player with a 4-week history of low back pain, magnetic resonance imaging of her pelvis revealed a stress fracture of the left sacral ala. She was treated with nonsteroidal anti-inflammatory agents, rest, and conditioning exercises and had a good functional outcome. CONCLUSION: Sacral stress fractures should be included in the differential diagnosis of athletes with low back pain, particularly runners and volleyball players. To the authors' best knowledge, this is the first report of a volleyball player with a sacral stress fracture. A review of the literature yielded 29 cases of sacral stress fractures in athletes, mainly runners.

Adolescent↗
PubMed2004

Radiographic changes in the lumbar spine in former elite athletes.

STUDY DESIGN: The authors conducted a retrospective cohort study. OBJECTIVE: The objective of this study was to clarify the occurrence of radiographic changes (vertebral osteophytes, heights of lumbar discs, concavity index) of the lumbar spine in former elite athletes of different track and field disciplines. SUMMARY OF BACKGROUND DATA: The influence of physical activity on occurrence of radiographic changes in the lumbar spine is not well known and seems to be contradictory. The loadings in the different track and field disciplines seem to play an important role in the development of radiographic changes. METHODS: One hundred fifty-nine former male elite track and field athletes were selected for a radiologic study. The heights of lumbar discs, the concavity index, the presence of anterior vertebral osteophytes, a radiographic evaluation according to Kellgren and Lawrence, and the FFbH-R score for the assessment of functional limitations in activities of daily living (ADLs) were determined. The influence of age, body mass index, current physical activity, and training history was also examined. RESULTS: In high jumpers and throwers, the absolute heights of lumbar discs increased from level T12/L1 to a maximum at L4/L5 and decreased again from level L4/L5-L5/S1. In endurance athletes and other jumpers, the absolute heights increased linearly from level T12/L1 to a maximum at L5/S1. The concavity index did not yield any significant differences between athlete categories. Shot putters, discus throwers, and high jumpers showed a significantly higher prevalence of osteophytes after adjustment for possible confounders. According to Kellgren and Lawrence, the highest prevalence of radiographic changes in the lumbar spine is seen in javelin throwers. Significant differences in the assessment of functional limitations in ADLs are not found between the disciplines. CONCLUSION: In throwing disciplines, the lumbar spine is more highly loaded than in jumpers and runners. Despite the observation of evident degenerative changes in some former athletes, there were only minor changes seen in ADLs. Even if body constitution is taken as a preselection factor, athletes in throwing disciplines as well as high jumpers have a higher risk of developing vertebral osteophytes of the lumbar spine.

Adult↗
PubMed2006

Articular cartilage repair in the adolescent athlete: is autologous chondrocyte implantation the answer?

OBJECTIVE: To determine the evidence base for recommendations regarding autologous chondryocyte implantation in adolescent athletes. MATERIALS AND METHODS: All literature on articular cartilage repair from MEDLINE search dated 1990 to 2006 was reviewed. The majority of articles describe surgical technique and indications. Three techniques for secondary articular cartilage repair have been identified: autologous chondrocyte implantation, autologous osteochondral implants, and marrow stimulation techniques. The initial literature search identified 4 studies that reported the effectiveness and durability of autologous chondrocyte implantation in adults and 2 studies that reported the outcomes of autologous chondrocyte implantation in adolescent athletes. No results of osteochondral implantation or marrow stimulation techniques in adolescent athletes have been published. RESULTS: Acceptable repair rates with all 3 techniques have been reported in adult athletes. Two studies reported high success using autolgous chondrocyte implantation (ACI) in children. CONCLUSIONS: Articular cartilage injury in young athletes remains a difficult problem. The ideal situation is early diagnosis and primary repair, particularly with lesions of the knee, elbow, and ankle. In cases where primary repair is not possible or has been unsuccessful and the lesion is large or symptomatic, secondary repair with either marrow stimulation, microfracture, autologous chondrocyte implantation, or autologous osteochondral grafting may be used. However, at present only the results of ACI repair have been reported for adolescent athletes.

Adolescent↗
PubMed2006

Orofacial/cerebral injuries and the use of mouthguards by professional athletes in Switzerland.

The objective of the present study was to measure the occurrence of orofacial and cerebral injuries in different sports and to survey the awareness of athletes and officials concerning the use of mouthguards during sport activities. Two hundred and sixty-seven professional athletes and 63 officials participating in soccer, handball, basketball and ice hockey were interviewed. The frequency of orofacial and cerebral trauma during sport practice was recorded and the reason for using and not using mouthguards was assessed. A great difference in orofacial and cerebral injuries was found when comparing the different kinds of sports and comparing athletes with or without mouthguards. 45% of the players had suffered injuries when not wearing mouthguards. Most injuries were found in ice hockey, (59%), whereas only 24% of the soccer players suffered injuries when not wearing mouthguards. Sixty-eight percentage of the players wearing mouthguards had never suffered any orofacial and cerebral injuries. Two hundred and twenty-four athletes (84%) did not use a mouthguard despite general acceptance by 150 athletes (56%). Although the awareness of mouthguards among officials was very high (59%), only 25% of them would support the funding of mouthguards and 5% would enforce regulations. Athletes as well as coaches should be informed about the high risk of oral injuries when performing contact sports. Doctors and dentists need to recommend a more intensive education of students in sports medicine and sports dentistry, and to increase their willingness to become a team dentist.

Adult↗
PubMed2004

Perception of Nigerian athletes of the use of mouth guards to prevent the stresses of sports injury.

OBJECTIVE: The perception of Nigerian athletes of the use of mouth guards to prevent the stresses of sports injuries was examined using psychological, sociological, and physical stress variables. METHODS: The descriptive survey research design was used in this study. Participants (n = 333) were selected using the purposive random sampling technique and data were collected using the 4 point Likert type instrument. The coefficient alpha was used to determine the reliability of the instrument with r = 0.79 for psychological, r = 0.66 for physical, and r = 0.74 for sociological stress. RESULTS: The result reveals that female athletes perceived the use of mouth guards as being more important to prevent the stresses of sports injuries than male athletes, while athletes who had used mouth guards for longer periods also perceived them as being more important to prevent the stresses of sports injuries compared to those who had used them less. The result also revealed a significant difference (p<0.05) among the various sport groups as independent variables on the psychological and physical stress variables. Scheffe post hoc analysis was used to identify the group where significant difference was found. CONCLUSIONS: The study concluded that since the impact of injury is perceived to affect the cognitive function of athletes, athletes should be educated on the use of mouth guards in order to reduce the incidence of oral and dental injuries to the barest minimum.

Adolescent↗
PubMed2004

Skeletal muscle pathology in endurance athletes with acquired training intolerance.

BACKGROUND: It is well established that prolonged, exhaustive endurance exercise is capable of inducing skeletal muscle damage and temporary impairment of muscle function. Although skeletal muscle has a remarkable capacity for repair and adaptation, this may be limited, ultimately resulting in an accumulation of chronic skeletal muscle pathology. Case studies have alluded to an association between long term, high volume endurance training and racing, acquired training intolerance, and chronic skeletal muscle pathology. OBJECTIVE: To systematically compare the skeletal muscle structural and ultrastructural status of endurance athletes with acquired training intolerance (ATI group) with asymptomatic endurance athletes matched for age and years of endurance training (CON group). METHODS: Histological and electron microscopic analyses were carried out on a biopsy sample of the vastus lateralis from 18 ATI and 17 CON endurance athletes. The presence of structural and ultrastructural disruptions was compared between the two groups of athletes. RESULTS: Significantly more athletes in the ATI group than in the CON group presented with fibre size variation (15 v 6; p = 0.006), internal nuclei (9 v 2; p = 0.03), and z disc streaming (6 v 0; p = 0.02). CONCLUSIONS: There is an association between increased skeletal muscle disruptions and acquired training intolerance in endurance athletes. Further studies are required to determine the nature of this association and the possible mechanisms involved.

Adult↗
PubMed2005

Psychological predictors of injury among elite athletes.

OBJECTIVES: To establish injury rates among a population of elite athletes, to provide normative data for psychological variables hypothesised to be predictive of sport injuries, and to establish relations between measures of mood, perceived life stress, and injury characteristics as a precursor to introducing a psychological intervention to ameliorate the injury problem. METHODS: As part of annual screening procedures, athletes at the Queensland Academy of Sport report medical and psychological status. Data from 845 screenings (433 female and 412 male athletes) were reviewed. Population specific tables of normative data were established for the Brunel mood scale and the perceived stress scale. RESULTS: About 67% of athletes were injured each year, and about 18% were injured at the time of screening. Fifty percent of variance in stress scores could be predicted from mood scores, especially for vigour, depression, and tension. Mood and stress scores collectively had significant utility in predicting injury characteristics. Injury status (current, healed, no injury) was correctly classified with 39% accuracy, and back pain with 48% accuracy. Among a subset of 233 uninjured athletes (116 female and 117 male), five mood dimensions (anger, confusion, fatigue, tension, depression) were significantly related to orthopaedic incidents over the preceding 12 months, with each mood dimension explaining 6-7% of the variance. No sex differences in these relations were found. CONCLUSIONS: The findings support suggestions that psychological measures have utility in predicting athletic injury, although the relatively modest explained variance highlights the need to also include underlying physiological indicators of allostatic load, such as stress hormones, in predictive models.

Adolescent↗