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PubMed1995

Female college athletes: a special population for health promotion in primary care.

Female college athletes constitute a population with potential health problems beyond those of their age-mates. The expectations of the elite college athlete for academic and athletic accomplishment and for exemplary personal behavior, in combination with the typical developmental crises of late adolescence, create health risks. This presents the opportunity for effective health promotion as a part of primary care for these young women. The HealthCoRE Program at Texas Tech University Health Sciences Center School of Nursing is an example of how a program approach using a community health perspective, in contrast to an episodic or an "array-of-available-services-cafeteria" approach, can affect the health of female college athletes. Program elements include identification of group and individual health risks and health information interests, individual physical examination including a gynecologic examination, individual client contracts for group and individual activities, and crisis intervention. Three years of experience with the program shows value both from the athletes' perspectives and from their coaches' perspectives. Nurse practitioners are the ideal providers for this type of service because of their knowledge of the community health approach, their skills in health promotion and disease prevention, and their use of health teaching as a therapeutic tool.

Adolescent↗
PubMed1994

[Bronchial hyperreactivity in athletes].

Elite athletics, particularly endurance sports, are characterised by a high prevalence of bronchial hyperresponsiveness (BHR) and exercise-induced asthma (EIA). Findings in several studies suggest short-term high intensity physical activity to cause a transient increase in BHR. Recent studies in Oslo have shown that regular physical endurance training over several years, particularly when combined with such climatic factors as low air temperatures, may result in an increased risk of BHR and EIA among elite athletes--e.g., cross-country skiers. Inhalation beta 2-agonists and steroids have been used by many athletes in endurance sports, particularly skiers. Athletes with symptoms of BHR or EIA should be examined with lung function tests and exercise testing, and the effect of antiasthmatic drugs should be ascertained. Inhaled beta 2-agonists have no beneficial effect upon physical performance in nonasthmatic athletes, and may have a slight limiting effect upon physical endurance.

Adult↗
PubMed1993

Contact lenses for athletes.

The introduction and development of soft lenses and rigid gas-permeable lenses has ushered in a new era in fitting athletes with contact lenses. Many of the well-known disadvantages associated with polymethylmethacrylate (PMMA)-type lenses have been either eliminated or minimized. Fitting athletes with contact lenses must still be viewed with caution, however, since athletes' visual needs are usually much more demanding than those of the general public. An indiscriminate choice of lens design can adversely affect athletic performance and may even create a hazardous situation. An intelligent choice of lens can provide some subtle advantages that may improve athletic performance and provide the margin for victory.

Biocompatible Materials↗
PubMed1993

Increased life expectancy of world class male athletes.

Reliable data are scanty on the incidence of chronic diseases and life expectancy (LE) of highly trained athletes. We therefore studied Finnish male world class athletes to estimate the LE of athletes. Finnish team members in the Olympic games, World or European championships or intercountry competitions during 1920-1965 in track and field athletics, cross-country skiing, soccer, ice hockey, basketball, boxing, wrestling, weight lifting, and shooting were included (N = 2613 men). The reference cohort, 1712 men, was selected from the Finnish Defence Forces conscription register matched on age and area of residence. All referents were classified completely healthy at the time of induction to military service. The stratified Kaplan-Meier product limit method and the Cox proportional hazards model were used to estimate the life expectancies and the mortality odds ratios (OR) and their confidence limits. The mean LE adjusted for occupational group, marital status, and the age at entry to the cohort (and its 95% confidence limits) was in endurance sports (long distance running and cross-country skiing) 75.6 (73.6, 77.5) yr; in team games (soccer, ice hockey, basketball, as well as jumpers and short-distance runners from track and field (73.9 (72.7, 75.1) yr; in power sports (boxing, wrestling, weight lifting, and throwers from field athletics) 71.5 (70.4, 72.2) yr; and in the reference group 69.9 (69.0, 70.9) yr. The increased mean life expectancies were mainly explained by decreased cardiovascular mortality (endurance sports mortality odds ratio OR = 0.49 (95% CL 0.26, 0.93), team sports OR = 0.61 (0.41, 0.92) compared with referents). For maximum life span no differences between the groups were observed.(ABSTRACT TRUNCATED AT 250 WORDS)

Cohort Studies↗
PubMed1996

Hospital care in later life among former world-class Finnish athletes.

OBJECTIVE: To investigate the use of hospital care from all causes among former top-level athletes from different vigorous sports to determine whether health benefits or adverse effects have the greater influence. DESIGN: National, population-based cohort study with a 21-year follow-up. SETTING: Finland. SUBJECTS: A total of 2049 male athletes who had represented Finland during 1920 to 1965, and 1403 male controls classified healthy at 20 years of age. MAIN OUTCOME MEASURE: In-hospital care from all causes was extracted from the national hospital discharge registry for the period 1970 through 1990 expressed as hospital days per person-years of exposure. RESULTS: Compared with controls, the rate ratios (RRs) for all-cause hospital days per person-years of exposure were lower in athletes from endurance sports (RR, 0.71; 95% confidence interval [Cl], 0.70-0.73), mixed sports (including endurance and weight training) (RR, 0.86; 95% Cl, 0.85-0.87), and power sports (RR, 0.95; 95% Cl, 0.94-0.96) (P < .001 for all comparisons) after adjustment for age and occupational group. The lower RR among athletes from endurance sports and other sports involving aerobic activity was largely explained by lower rates of hospital care for heart disease, respiratory disease, and neoplasms, but not for musculoskeletal disorders. CONCLUSIONS: Former elite athletes, particularly those in aerobic sports, use less hospital care. Other beneficial health habits are known to be associated with a physically active lifestyle.

Adult↗
PubMed1996

[Cardiological fitness examination of the athlete and prevention of sudden death].

Sudden death happening to an athlete is a frightening tragedy. Epidemiological data are quite controversial but sudden death occurring during sporting activity is probably not a rare occurrence. Beside drug abuse and accidental causes, cardiovascular abnormalities represent the principal origin of sudden death. Cardiomyopathy in young athletes and coronary artery disease in older athletes are the underlying pathologic substrates for most incidences. A certain proportion of sudden death in apparently healthy athletes was preceded by symptoms of exercise intolerance; pre participation evaluation directed to detect the cardiovascular abnormalities is probably of more value to reduce sudden cardiac death in athletes than detailed and routine sophisticated investigations.

Adolescent↗
PubMed1997

Collapsed ultraendurance athlete: proposed mechanisms and an approach to management.

OBJECTIVE: To review the common conditions causing collapse in ultraendurance athletes, to propose appropriate treatment protocols for the more common medical conditions that are encountered, and to provide practical guidelines for the management of the medical facilities at these endurance events. DATA SOURCES: Books published on the subject, abstracts of the American College of Sports Medicine Annual Congress dealing with the subject over the last 5 years, and electronic search of the Medline and Current Contents databases (last searched May 1995). German articles were included in the search criteria. STUDY SELECTION: Articles dealing generally with the management of medical facilities at endurance events were chosen. Articles dealing more specifically with the common medical conditions encountered at these events were then sourced and included in this review. DATA EXTRACTION: Multiple reader extraction of relevant data. DATA SYNTHESIS: A practical guideline to the management of the medical facility at an endurance event is detailed, expanding specifically on the nature of the conditions causing collapse during or after endurance exercise with a proposed classification of causes of collapse for optimizing immediate management and management protocols for specific conditions such as heatstroke, hyponatremia, hypoglycemia, exercise-associated collapse, and muscle cramps. CONCLUSION: The most commonly encountered medical condition at endurance athletic events is collapse after the event. The popular view that all persons who collapse have dehydration-induced hyperthermia has been challenged. Here we extend that argument and provide diagnostic and management protocols and propose a triage system that considers the most common causes of collapse in ultraendurance athletes. These protocols can optimize the efficient and safe management of large numbers of collapsed ultraendurance athletes. It is proposed that these protocols can optimize the efficient and safe management of large numbers of collapsed ultra endurance athletes.

Adult↗
PubMed1998

[Menstrual disorders in athletes].

It is important to pay attention to bone metabolism in women long before the menopause. Irregular menstruation with anovulatory cycles or amenorrhoea persisting over several years have negative effects on bone formation and total bone mass already within a few years after menarche. They lead to a lack of oestradiol and are often associated with inadequate and unbalanced nutrition (e.g. lack of calcium and proteins). This results in severe impairment of bone formation and a net loss of bone mass. It is the duty of the doctors taking care of female athletes (as well as non-athletes) with irregular menstrual cycles or amenorrhoea to protect them against osteoporosis which may manifest itself 2-5 decades later. In the special case of female athletes a reduced bone mass is an important risk factor for stress fractures which can result in interruption or even in a premature termination of promising athletic careers. Athletes with retarded menarche, irregular menstrual cycles, or amenorrhoea must, therefore, be referred to a gynecologist for further diagnosis and treatment.

Adolescent↗
PubMed1998

Outbreak of acute febrile illness among athletes participating in triathlons--Wisconsin and Illinois, 1998.

On July 14, 1998 [corrected], the Wisconsin Division of Health (WDOH) was notified by the City of Madison Health Department that three athletes were hospitalized with an acute febrile illness. The illness was characterized by fever, myalgia, and headache with illness onset on July 6, 7, and 10, respectively. One of these three athletes had acute renal failure. Two of the athletes had participated in a triathlon held in Madison, Wisconsin, on July 5 (692 registered participants) and all three had participated in a June 21 triathlon in Springfield, Illinois (961 registered participants). Eighty persons were registered for both events. Leptospirosis was suspected by WDOH staff as a likely cause of the illness and CDC was notified. Acute-phase serum specimens from two of the three hospitalized athletes obtained 4 and 8 days following onset of fever have been tested at CDC for leptospirosis using the PanBio enzyme-linked immunosorbent assay (ELISA) IgM screening test (PanBio, Brisbane, Australia); one specimen tested positive. This report presents preliminary findings of an ongoing investigation to identify additional cases of acute febrile illness among athletes participating in these two triathlons and to determine the cause of the illness.

Adolescent↗
PubMedDate not supplied

[Iron deficiency in female athletes].

Iron deficiency and anemia have been reported frequently in athletes. In São Paulo-Brazil among elite athletes overt anemia is uncommon, but our studies showed that they were in a borderline anemic state. Sports anemia is used to describe both pseudodilutional anemia and the true anemia of athletes. We studied 12 female young athletes, all with normal hemoglobin. Four athletes had laboratory features (serum ferritin, red cell volume, and/or transferrin saturation) suggestive of iron deficiency. There are association of high iron body stores with cardiac arrhythmia, carotid atherosclerosis, myocardial infarction, liver and colorectal cancer but minor iron deficiency may impair the physical fitness.

Adolescent↗
PubMed1985

Stress fractures of the sesamoid bones of the first metatarsophalangeal joint in athletes.

Over a period of 11 years 15 cases of stress fractures of the sesamoid bones of the first metatarsophalangeal (MTP) joint were treated in athletes. The mean age of the patients was 22.3 years, and there were 9 males and 6 females in the series. All patients were athletes, who began to suffer from the symptoms during training without any trauma. Eight fractures were located in the medial, six in the lateral sesamoid bone, and in one case both sesamoids were affected. The diagnosis was performed on the basis of the history, symptoms, clinical examination, and radiological, or isotope scanning findings. Ten of the patients were treated conservatively by prescribing an avoidance of excessive physical activity and better training shoes. In five cases surgical excision of the fragmented painful sesamoid bone was performed. There were no complications in the series and the athletes could start gradually training 6-8 weeks after the operation. The histology showed fibrotic non-union at the fracture site and supported the diagnosis of stress fracture. Three of the conservatively treated athletes had mild symptoms in intensive training, others had a good end result.

Adolescent↗
PubMed1993

Impingement of the rotator cuff in athletes caused by instability of the shoulder joint.

An impingement of the rotator cuff can be caused by chronic anterior instability of the shoulder joint. This particular disease is often found in athletes engaged in overhead motion in abduction/external rotation of the arm, such as in ball sports like volleyball or European handball, racket sports like tennis or badminton, or swimming. For those patients that cannot be cured by conservative treatment such as muscular stabilization, surgical treatment is indicated: anterior reconstruction of the capsule and/or the glenoid labrum, and in addition--if necessary--subacromial decompression and revision of the rotator cuff. Between October 1988 and April 1992, we operated on 66 shoulders in 64 top athletes suffering from chronic anterior or multidirectional instability of the shoulder joint that had caused an impingement syndrome of the rotator cuff. In all cases, the athlete was unaware of the instability. Conservative treatment had been unsuccessful. Surgical treatment was successful in close to 90% of the athletes.

Arthroscopy↗
PubMed2003

Avulsion fractures of the tibial tuberosity in adolescent athletes treated by internal fixation and tension band wiring.

Avulsion of the tibial tuberosity is a rarely reported fracture. It is mainly considered as an athletic injury accounting for less than 3% of all epiphyseal lesions. In this study, we hypothesized that the use of tension band wiring as a supplement of the internal fixation for the avulsion fractures of the tibial tuberosity would lead the adolescent athletes to a more effective rehabilitation program and an earlier resumption of their previous activity level. Ten patients were treated in our department over a period of 11 years (1985-1995). Operative treatment was thought necessary for all our cases due to tibial tuberosity displacement. Open reduction and internal fixation in combination with tension band wiring was used. The result in all cases was that the reduction was maintained intact and the fracture united. The functional results were excellent, and all patients returned to their previous athletic activities. Our conclusion is that the combination of internal fixation and tension band wiring for avulsion fractures of the tibial tuberosity seems to be more effective and advantageous than conservative or other surgical methods. Avoiding the need of external support and allowing early joint motion, the method described prevents serious quadriceps atrophy, allowing the young athletes to return earlier to their previous sport activities.

Adolescent↗
PubMed2004

Treatment of full thickness chondral lesions of the knee with microfracture in a group of athletes.

This prospective outcomes study was designed to prospectively investigate the outcome of the microfracture technique when applied to full thickness chondral lesions of the knee in a group of athletes. From 1991 to 1999, 109 patients were treated using the microfracture technique. We prospectively followed up 53 athletes who satisfied our inclusion criteria. Average age was 38 years (range 19-55) and mean follow-up was 72 months (range 36-120). Etiology, clinical signs, symptoms and activity level were noted preoperatively and at final follow-up. Lysholm, Tegner, IKDC and functional tests were utilized. Intraoperatively, location, size of the lesions and associated pathologies were recorded. Roentgenograms, MRI or CT scan were done before treatment and at final follow-up. Etiologic factors were mostly related to sports microtrauma (37.5%) and macrotrauma (21%), while 37.5% of our patients did not report any traumatic etiology and 4% showed patellar malalignment. The most common location was medial femoral condyle (61%). Knee pain and swelling improved in 70%, tibiofemoral crepitus in 60%. Hop test was normal in 70% at final follow-up. Subjective evaluation was 40/100 preoperatively and 70/100 at final follow-up. Lysholm was 56.8 preoperatively and 87.2 final. IKDC revealed: 0 A, 3 B, 40 C and 10 D preoperatively while at final follow-up 70% scored A or B. Tegner improved at 2 years from 3.2 to 6; however, at final follow-up 80% showed a decline in sport activity level (Tegner 5). Microfracture technique can offer clinical, functional and subjective improvement in athletically active patients. However because of the decline in sports participation over time, microfracture may not be the definitive procedure for the athlete's knee and other procedures may be indicated in the future.

Adult↗
PubMed2005

MRI-negative bucket-handle tears of the lateral meniscus in athletes: a case series.

Magnetic resonance imaging (MRI) is the most widely used non-invasive test for assessing intra-articular injuries of the knee. It has been suggested that a negative MRI can be useful in avoiding the need for diagnostic arthroscopy in cases where clinical examination is equivocal. However, the sensitivity and specificity of MRI is not 100%, particularly for tears of the lateral meniscus. Furthermore, a false negative MRI scan may result in premature return to play in athletes, resulting in increased risk of further damage to a torn meniscus. To illustrate this issue, we present a case series of eight elite athletes who all presented with mechanical knee symptoms and where MRI scans revealed no significant intra-articular pathology. Five of the athletes were allowed to return to sport on the basis of a negative MRI. All patients were subsequently found to have a bucket-handle tear of their lateral meniscus at arthroscopy. Two independent, experienced musculoskeletal radiologists were asked to review the MRI films without being given any clinical history of the cases. Although injuries to the popliteus tendon were noted in two of the athletes who had sustained a recent acute injury to their knee, no meniscal tears were identified. Thus arthroscopy remains the gold standard for the assessment and management of high-demand patients with a clinical suspicion of meniscal pathology.

Adolescent↗
PubMed2005

Reliability of a criterion-based test of athletes with knee injuries; where the physiotherapist and the patient independently and simultaneously assess the patient's performance.

UNLABELLED: A new criterion-based evaluation test method, has been developed in order to assess the functional ability of athletes with knee injuries, 'Tests for Athletes with Knee-injuries' (TAK). The physiotherapist and the patient assess independently and simultaneously the patient's performance. The TAK comprises eight demanding functional activities with emphasis on strength, stability, springiness and endurance. OBJECTIVES: To evaluate the inter-rater and intra-rater reliability of TAK between the physiotherapist's and the patient's assessments. Further, to evaluate the relation between the functional tests in TAK and the isokinetic quadriceps muscle strength. MATERIALS AND METHODS: Fifty-nine subjects were included in the study. Thirty-one were anterior cruciate ligament (ACL) reconstructed, fourteen were ACL-injured not reconstructed and fourteen were healthy athletes. The inter-rater-reliability was evaluated by assessments of 59 subjects carried out by two independent physiotherapists using visual observation. The assessment was rated on a 0-10-point scale according to five elaborate criteria drawn up for each test. Simultaneously, the subjects were asked to rate their own performance on each test using a 0-10-point scale. The intra-rater-reliability of TAK was evaluated by a test-retest of 31 patients. The relation between the physiotherapist's and the patients' ratings as well as of the patients' ratings at two different occasions were evaluated. Isokinetic quadriceps muscle strength was measured in a Biodex dynamometer on all 59 subjects in order to study the relation between quadriceps muscle strength and the results of the functional tests in TAK. RESULTS: Inter-rater-reliability showed good consistency between the assessments of the two physiotherapists in seven of eight tests (kappa = 0.62-0.78). The intra-rater-reliability was moderate to good (kappa = 0.43-0.65) in the test-retest study. The consistency of the physiotherapist and the patients' assessments differed, but showed good correlation. The consistency of the test-retest study of the patients' assessment was low. The correlation between the isokinetic quadriceps muscle strength measured in a Biodex dynamometer and the results of the functional tests was moderate in this study. CONCLUSIONS: This criterion-based test method for athletes with knee injuries showed good inter-rater reliability and acceptable intra-rater reliability for the physiotherapists' assessment. The consistency of the patients' ratings was low. The correlation between isokinetic quadriceps muscle strength and functional tests in TAK was moderate. The validity has not been evaluated in this study but will be done in the future.

Adolescent↗
PubMed2004

Adductor-related groin pain in athletes: correlation of MR imaging with clinical findings.

OBJECTIVE: To evaluate gadolinium-enhanced MR imaging in athletes with chronic groin pain and correlate with the clinical features. DESIGN AND PATIENTS: MR examinations performed in 52 athletes (51 male, 1 female; median age 26 years) with chronic groin pain and 6 asymptomatic control athletes (6 male; median age 29 years) were independently reviewed by two radiologists masked to the clinical details. Symptom duration (median 6 months) and clinical side of severity were recorded. Anatomical areas in the pelvis were scored for abnormality (as normal, mildly abnormal or abnormal) and an overall assessment for side distribution of abnormality was recorded, initially without post-gadolinium sequences and then, 3 weeks later (median 29 days), the post-gadolinium sequences only. Correlation between radiological and clinical abnormality was calculated by Spearman's correlation. RESULTS: Abnormal anterior pubis and enthesis enhancement significantly correlated with clinical side for both radiologists (both P=0.008). Abnormal anterior pubis and adductor longus enthesis oedema was significant for one radiologist ( P=0.009). All other features showed no significant correlation ( P>0.05). In the control cases there was no soft tissue abnormality but symphyseal irregularity was present ( n=2). For both radiologists assessment of imaging side severity significantly correlated with clinical side for post-gadolinium ( P=0.048 and P=0.023) but not non-gadolinium sequences ( P>0.05). CONCLUSION: The extent and side of anterior pubis and adductor longus enthesis abnormality on MR imaging significantly and reproducibly correlates with the athletes' current symptoms in chronic adductor-related groin pain.

Adolescent↗
PubMed2006

Anterior cruciate ligament insufficiency: does delay in index surgery affect outcome in recreational athletes.

The aim of the study was to see if delay in anterior cruciate ligament (ACL) reconstruction affects post-reconstruction outcome in recreational athletes. Sixty-two recreational athletes who had arthroscopic ACL reconstructions using quadruple hamstring grafts between 1997 and 2000 were retrospectively evaluated. Patients with less than 2 years' follow-up, those with multi-ligament injuries, reconstructions for previous failed repairs, those whose injury date was unknown, those with pre-injury Tegner activity level greater than 7 (competitive athletes) and those lost to follow-up were all excluded. Forty-six patients (38 males) were entered. The mean follow up was 38 months and the mean time from injury to index ACL reconstruction was 27 months. Apart from two revisions there were no other significant complications. Forty-one (89%) patients were evaluated in a review clinic. There was a significant improvement in the post-reconstruction Lysholm scores and an improvement in the Tegner scores. The Spearman's correlation coefficient between postoperative Lysholm score and the delay until surgery was -0.18 and the correlation coefficient between postoperative Tegner scores and the delay until surgery was 0.14. Thirty-five patients returned to sporting activity. Thirty-seven rated their knee as being normal or nearly normal and 35 said that their knee function was as they had expected it to be. Late ACL reconstruction does not adversely affect the outcome in recreational athletes. ACL reconstruction should be offered to these patients as there is a significant improvement in the knee function and patients are satisfied with the results.

Adolescent↗