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In the discussion of limiting the growth of medical spending there are intentions to exclude the costs of sport injuries from coverage by the public health insurance system. The aim of this study is to analyse typical sport injuries and to compare them with injuries from other fields of accidents and thus to deliver arguments in the discussion of costs in public health system.
UNLABELLED: This self-directed learning module highlights new advances in this topic area. It is part of the study guide on sports medicine and performing arts in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article uses case vignettes as a vehicle to elaborate on (1) ankle pain in a runner, (2) heel pain in an adolescent, (3) anterior knee pain in a runner, (4) lateral knee pain in a cyclist, (5) shin splints in a runner, (6) buttock pain in a hiker, and (7) collapse of a marathoner from hyponatremia. OVERALL ARTICLE OBJECTIVE: To summarize lower-limb injuries commonly seen in endurance sports.
One-hundred-and-two high-level players of the field-games soccer, Gaelic football and hurling began a two-year investigation into the intrinsic causes of sports-injuries; 86 completed the study. During the first year all injuries, and the time affected by injury, were recorded. The subjects then underwent flexibility tests, an accurate photogrammetric assessment of posture, measures of speed and acceleration, and a clinical assessment of anatomical and physiological factors thought to be associated with the risk of sports injury. Time affected by injury was then recorded for a further 12-month period. Stepwise multiple-regression analysis revealed that the number of days of injury during the second 12-month period could be predicted from (1) the days of injury during the first 12-month period, (2) posture, (3) acceleration over 10m from a standing start, and (4) the number of musculo-skeletal clinical defects. Flexibility scores were not found to be significant predictors of injury. It is suggested that injury prevention programmes should concentrate on improving posture and the rehabilitation from previous injury rather than flexibility; and that research should be undertaken into the effectiveness of such interventions.
The primary intention of this study is the grouping of sports accidents, being described by the athletes in their own words in a classification system of specific accident classes with regard to specific motions and topography. The investigation is based on the data of the sports insurance Gerling-Konzern during a 15-year period in Rhineland Palatinate (1981-1995). The study is based on the insurance documents and clinical protocols if available. 137 accident protocols were related to this 15-year period including weight lifting (n = 1) and martial arts (n = 136). Listed in hierarchical order we received the following results: judo (n = 47), karate (n = 44), wrestling (n = 22), taekwondo (n = 9), boxing (n = 7), ju-jutsu (n = 5), fencing (n = 1) and aikido (n = 1). In accordance to accident types there were no sex related differences. As special preventive measures we suggest the use of protective mouthguards and solid glasses, proprioceptive training and physiological taping for knee, ankle and elbow joints.
In recent years several construction elements resulted in an increasing stiffening of the sport shoe so that the foot was partly forced to make its own movements inside the shoe. A new sport shoe concept is presented basing on the results of anatomic and biomechanical studies, its innovative feature being decoupling of the foot movement between the calcaneal part of the foot and the metatarsus (= torsion). The foot is given an opportunity to transmit its freedom of movement in the longitudinal axis of the foot to the shoe without the shoe acting as a lever, this goal being achieved by a limited liberation of the metatarsal pronation/supination and a controlled uncoupling of the metatarsus from the calcaneal part of the foot.
BACKGROUND: Chronic exertional compartment syndromes (CECS) are well known in sports medicine. Most commonly affected is the tibialis anterior muscle compartment in runners and walkers. Only a few cases of CECS of the forearm flexor muscles have been reported. OBJECTIVES: To determine pressure levels inside the deep flexor compartment of the forearms during a sport specific stress test. METHOD: Ten healthy, high level climbers were enrolled in a prospective study. All underwent climbing specific ergometry, using a rotating climbing wall (step test, total climbing time 9-15 minutes). Pressure was measured using a slit catheter placed in the deep flexor compartment of the forearm. Pressure, blood lactate, and heart rate were recorded every three minutes and during recovery. RESULTS: In all the subjects, physical exhaustion of the forearms defined the end point of the climbing ergometry. Blood lactate increased with physical stress, reaching a mean of 3.48 mmol/l. Compartment pressure was related to physical stress, exceeding 30 mm Hg in only three subjects. A critical pressure of more than 40 mm Hg was never observed. After the test, the pressure decreased to normal levels within three minutes in seven subjects. The three with higher pressure levels (>30 mm Hg) required a longer time to recover. CONCLUSIONS: For further clinical and therapeutic consequences, an algorithm was derived. Basic pressure below 15 mm Hg and stress pressure below 30 mm Hg as well as pressures during the 15 minute recovery period below 15 mm Hg are physiological. Pressures of 15-30 mm Hg during recovery suggest high risk of CECS, and pressures above 30 mm Hg confirm CECS.
OBJECTIVES: To examine the diagnosis and management of adults attending a sports injury clinic, to establish to what extent the management of the two most common injuries treated at this clinic is evidence based, and to explore factors that affect management. METHODS: A retrospective examination of 100 random case notes extracted age, sex, sport, type and site of injury, treatment, and outcome. Systematic literature reviews examined the extent and quality of scientific evidence for the management of the two most commonly presenting injuries. A clinical attachment period and practitioner interviews allowed recognition of factors impinging on management decisions. RESULTS: Patellofemoral pain syndrome (PFPS; 10% of all injuries) and Achilles tendinopathy (6% of all injuries) were the most commonly presenting injuries. The mean (SD) number of treatments used for PFPS was 2.8 (0.9). The mean number of treatments used for Achilles tendinopathy was 3.7 (1.0). Clinicians reported that personal experience formed the basis of management plans in 44% of PFPS cases and 59% of Achilles tendinopathy cases, and that primary research evidence only accounted for 24% of management plans in PFPS and 14% in Achilles tendinopathy. Practitioners were unaware of literature supporting over 50% of the treatment modalities they used. However, clinicians were often using evidence based treatments, unaware of the supporting research data. CONCLUSIONS: This study highlights a lack of evidence base, a lack of knowledge of the research evidence, and a lack of management based on the current evidence that is available for these conditions. Practitioners practised evidence based medicine in under 50% of cases.
Illness and aging both cause many structural and functional alterations in the human body, rendering elderly people liable to overloading of the musculoskeletal and cardiovascular systems. It should, however, be kept in mind that immobilisation and inactivity have even more deleterious effects on structures and functions in the elderly than in younger adults. Most physically active elderly people are selected individuals with respect to their superior health and physical capacity compared with inactive persons of the same age, thus making it possible to further improve their physical capacity. They will, however, be affected by some of the drawbacks of physical overloading, mostly due to the diminished ability of aging body systems to adapt to high levels of loading. The safety margin of an exercise dose tends to decline with aging. Exertional injuries are common among the elderly, and are connected mostly with degenerative aging processes. Acute injuries are common in those elderly people participating in sport activities which demand high coordination, reaction time, and balance capabilities, such as ball games, down-hill skiing, and gymnastics. Muscle has been reported to be the most commonly acutely injured tissue among active elderly athletes. The lower extremities are the most susceptible to injury. A large proportion of injuries (acute and exertional) are mild and can be treated by brief cessation of training and competition activities. Some of the injuries are, however, long term and cause disability not only during training and competition, but also in the normal activities of daily living. It is important that these injuries are treated as soon as possible and in the most effective way, similarly to injuries suffered by younger people. In treating elderly people, it is most important to avoid the detrimental effects of immobilisation; this requires active treatment and rehabilitation with compensatory exercise therapy. The best 'treatment' for sports-related injuries is prevention. Good agility, technical skills, and cardiovascular and musculoskeletal fitness are important in injury prevention among the elderly. Appropriate training programmes, the use of safe and familiar equipment, careful warming up and cooling down, multiphasic training [including the training of neurophysiological functions (balance, coordination and reaction time)] and muscle strength are essential aspects of injury prevention.
The epidemiology of sports injuries helps identify the necessity for medical event coverage, injury risk factors, and potential prevention strategies. The preparticipation examination provides an opportunity for the team physician to identify athletes at risk of injury, to teach injury prevention, and to address athlete wellness. Knowledge of performance-enhancing drugs, nutritional supplements,and banned and legal medications is critical in caring for athletes.
BACKGROUND: The mechanisms by which endurance training produces physiological hypertrophy have been thoroughly investigated but not with young athletes. The aim of our study was to investigate arterial blood pressure exercise responses in young athletes who started heavy training by the age of 11, participating in metabolically different sports (cycling, kayaking, and soccer) and to analyse the influence that arterial blood pressure at maximum exercise and VO(2) max could have on the development of cardiac mass in these subjects. SUBJECTS AND METHODS: We studied a group of well trained normotensive male subjects, comprising 37 cyclists, 15 soccer players and 12 canoeists (mean age, 16+/-1 years). Evaluation included a clinical history and physical examination, M-mode and two-dimensional echocardiography, 12-lead resting electrocardiogram and a graded exercise test with direct determination of VO(2) max. Systolic and diastolic blood pressure were measured at rest and maximum exercise. Determination of the left ventricular mass index (LVMI) was performed using Devereux's formula with correction for the body surface area. RESULTS: Cyclists showed values of LVMI in g m(-2) significantly higher than those of other subjects (123 vs. 92 and 113). Canoeists showed the maximal arterial blood pressure at maximum exercise in mmHg (190 vs. 172 and 170) and cyclists showed the maximal VO(2) ml kg(-1) min(-1) uptake (57.6 vs. 48.5 and 53.3). A linear correlation was found between LVMI and VO(2) max (r=0.4727, P<0.001) and this correlation was also significant with systolic blood pressure at maximum exercise (r=0.2909, P<0.01). No differences in LVMI were found when comparing those subjects who presented systolic blood pressure at maximum exercise equal or greater than 195 mmHg with those who presented less than this value. CONCLUSIONS: It can be concluded that VO(2) max is the variable that better correlates with the LVMI. Athletes who reach greater systolic blood pressures at peak exercise have a tendency to develop greater LVMI. In comparison with soccer players and canoeists, cyclists are the sportsmen who develop a greater LVMI and VO(2) max.
108 world class athletes (54 males, 54 females) practicing modern pentathlon had been interviewed about their individual training and competition efforts as well as their sports related injuries, damages and diseases in the last world cup season using a standardized empirical questionnaire. The mean training extent was about 25 hours per week, the mean number of national and international competitions athletes made was 9, especially concerning swimming and running. Mean number of health threatening incidents of each athlete had been 2 with 41% diseases such as otitis and pharyngitis, 23% injuries such as contusions and distortions and 33% damages such as tendinitis, periostitis and strains. Head and neck involvement were more frequent than those of pelvis and the lower extremities. Training efforts were the most frequent reasons for health threatening events (84%), especially concerning diseases and damages, whereas most of the injuries happened during competitions (p<.01). Most of the injuries happened practicing horse riding during competitions (9%). Running was the most frequent reason for damages, whereas horse riding is the leading cause for injuries, furthermore damages and injuries are typical for fencing. Swimming is often associated with diseases. In contrary shooting did not show typically affiliated health threatening events. The incidence of health threatening incidents concerning world class athletes practicing modern pentathlon is quite low. Especially running and swimming combined with a high training extent empirically predisposed to suffer from damages and diseases. Horse riding with a quite low training extent and fencing show a higher incidence of injuries. From the training-methodological point of view the training extent should not be too extended. Due to a high number of diseases it may be profitable to be in attendance of an inner medicine physician.
Caffeine is suspected to affect gastrointestinal function. We therefore investigated whether supplementation of a carbohydrate-electrolyte solution (CES) sports drink with 150 mg/l caffeine leads to alterations in gastrointestinal variables compared with a normal CES and water using a standardized rest-exercise-rest protocol. Ten well-trained subjects underwent a rest-cycling-rest protocol three times. Esophageal motility, gastroesophageal reflux, and intragastric pH were measured by use of a transnasal catheter. Orocecal transit time was measured using breath-H(2) measurements. A sugar absorption test was applied to determine intestinal permeability and glucose absorption. Gastric emptying was measured via the (13)C-acetate breath test. In the postexercise episode, midesophageal pressure was significantly lower in the CES + caffeine trial compared with the water trial (P = 0.017). There were no significant differences between the three drinks for gastric pH and reflux during the preexercise, the cycling, and the postexercise episode, respectively. Gastric emptying, orocecal transit time, and intestinal permeability showed no significant differences between the three trials. However, glucose absorption was significantly increased in the CES + caffeine trial compared with the CES trial (P = 0.017). No significant differences in gastroesophageal reflux, gastric pH, or gastrointestinal transit could be observed between the CES, the CES + caffeine, and the water trials. However, intestinal glucose uptake was increased in the CES + caffeine trial.
Exercise training and sports participation is an important part of the physical, psychological and metabolic growth of any child and adolescent, and this is also true for patients with congenital heart disease (CHD). As one can expect, exercise tolerance varies widely according to the CHD and to the treatment received, but the functional result achieved in the single patient is more important. Individual counselling is necessary and should be based on observations/results of thorough cardiovascular assessment. Exercise testing is the ideal tool to identify patients in whom exercise may induce arrhythmias or haemodynamic instability. In general, some degree of aerobic, isometric exercise training can be granted to most patients operated on for CHD. Serial evaluations may be required because of changing haemodynamic and functional status with time.
This paper describes the medical activity performed during the 1990 World Games for the Disabled, in Saint-Etienne, France. These Games were attended by 1200 athletes, 229 consultations were performed, and 175 treatments were administered by the medical team. This activity represents a rather high frequency of medical problems, linked either to the disabling disease or to sports injuries. There is a need for specific equipment, for better training of disabled athletes and for improved preparation.
Especially in the endurance disciplines, the performance of women went up considerably in the course of the past few decades. This seems to be peculiar to the female sex and can be taken as a hint to a higher adaptability of the female organism with respect to the various motor capacities required for strength and endurance. During the past 10 years, however, the rate, with which the performance gap in the endurance disciplines narrowed, has slowed down distinctly. Thus, it seems, that the era during which the women vigorously caught up on the men, is coming to an end in the endurance sports. The different capacity of the sexes with respect to strength is rooted in the differently dimensioned cross sections of the muscle fibres and in the higher activation capability of the skeletal muscles of men. No differences exist with respect to the relative proportions of the ST-, FTa- and FTb-fibres and with respect to the biochemistry of the muscles. Just as in case of men, the adaptation of the cardiovascular system to endurance training manifests in a uniform enlargement of all of the heart's cavities. It is true, that women have a smaller heart volume and lower values for the maximum oxygen uptake, but these differences or by no means related to sex alone. Very often, they are produced by the fact that the endurance training of the women did not go that far. As regards the energy substrates, there is the hypothesis that women have better utilization of free fatty acids under conditions of prolonged and intensive physical work.(ABSTRACT TRUNCATED AT 250 WORDS)
With increasing age, there is a change in the mitochondrial pattern of muscle tissue which leads to a loss of compliance of the arterial vessel wall and therefore to a slight change in contraction mode of the heart and also to a decrease of stroke and circulation volume. In the same way, lung function parameters such as vital capacity and forced ventilatory capacity are changes in the elderly. In addition to these, a higher incidence of general disease will change the organism, particularly heart circulation and the pulmonary system. In order to judge physical performance and sporting activity, certain physiological and pathophysiological features of aging have to be taken into consideration in the elderly. Avoiding any risks should be always above to intention of gaining a better physical condition, although this is desirable in principle.
In endurance sports heart frequency at the aerobic threshold (2 mmol/l lactate) is recommended for extensive training and heart rate at the anaerobic threshold (4 mmol/l lactate) for intensive training. Both values could be estimated by means of exercise tests in the laboratory as well as in the field. However for training-recommendations only data estimated on a specific exercise procedure should be used.
Asthmatic children can tolerate physical exertion relatively well. They should undergo physical training for social, psychological, educational, and medical reasons. It is important to understand the different effects of different kinds of sport on coordination, flexibility, speed and endurance. Details are described. Swimming is especially recommended for children with an exercise-induced asthma. A high air temperature is favorable. An interval-training is more suitable than a continuous work such as jogging. Postexercise bronchial obstruction can be prevented by prophylactic medication with selective beta-2-sympathomimetica or cromolyn sodium. Details of an endurance-training are described.