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PubMed1990

Intensive training in young athletes. The orthopaedic surgeon's viewpoint.

A young athlete's musculoskeletal system is unique, in that it is not only growing, but is giving support to the growing soft tissues as well. With this in mind, it is easily understood that the fastest growing areas of children skeletal system are at greater risk of injury. No controlled longitudinal studies have yet been performed about the long term effects of injuries occurring in intensively trained young athletes. During the growth spurt, a dissociation between bone matrix formation and bone mineralisation occurs, thus leaving the child with the risks of chronic moderate-to-high overloading, sudden great overload, and diminished bone strength. This may account for both acute and overuse bone injuries in this age group. Epiphyseal plate injuries can have disastrous consequences. About 10% of all skeletal trauma in children involves the epiphysis, but few long-lasting effects have been reported. It is not clear whether intensively trained young athletes are at greater risk of injury than children engaged in free-play activities. It is worrying, though, that about 20% of injuries in sports children require internal fixation. Few studies have addressed injuries to tendons, ligaments and the enthesis in young athletes. It seems that tendon injuries are mild, not requiring surgery, and with a low recurrence rate, but no prospective studies have been performed. Avulsion of the ligamentous insertion occurs more frequently than ligament ruptures in this age group, even though they seem on the increase. Osteochondritis dissecans affects weightbearing joints such as the hip, the knee and the ankle, but elbow lesions in gymnasts and throwers are also relatively frequent. If it occurs before epiphyseal fusion, long term effects are scarce. The centre of growth or ossification where a major tendon is attached may undergo chronic inflammation and avulsion of cartilage and bone, due to the stresses transmitted to it. Typical areas are the inferior pole of the patella, the tibial tubercle and the calcaneal apophysis. Sports activity contributes to the disease by excessive traction at the tendinous and fascial insertion, or as a result of direct pressure. The lumbar spine is subjected to enormous forces in some sports. The true incidence of lumbar disc lesions in sporting children is not known, but it seems that acute trauma may play a major role. With the increase of the intensity and duration of training programmes, degenerative changes may play an adjuvant role.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1995

Common skeletal injuries in young athletes.

The increasing frequency of injury in young athletes over the last 2 decades reflects the increases in sports participation of children of a young age. Physical injury is an inherent risk in sports participation at any age. In general, the factors causing sports injuries can be grouped in 2 separate broad categories: extrinsic and intrinsic factors. However, the great majority of injuries which are sustained are minor and self-limiting, suggesting that children and youth sports are safe. However, a increasing number of children undergo treatment because of the effects that injuries may have on their developing bodies. A child's skeletal system shows pronounced adaptive changes to intensive sports training. Sports injuries affect both growing bone and soft tissues, and could result in damage of the growth mechanisms with subsequent life-lasting damage. Adolescents are particularly vulnerable to injuries, at least partially due to an imbalance in strength and flexibility. During growth there are significant changes in the biomechanical properties of bone. In young athletes, as bone stiffness increases and resistance to impact diminishes, sudden overload may cause bones to bow or buckle. Epiphyseal injuries occur at the epiphyseal growth plates. They are usually due to shearing and avulsion forces, although compression also plays a significant role. Given the remarkable healing potential of bone in youngsters, fractures that initially united with some deformity can completely remodel and appear totally normal in later life. As the risk of injuries sustained by young athletes can be significant, it is essential that training programmes take into account their physical and psychological immaturity, so that the growing athlete can adjust to their own body changes.

Adolescent↗
PubMed1995

Instability and impingement in the athlete's shoulder.

The competitive athlete who participates in a sport requiring overhead motion depends on a shoulder with optimal function. An acute episode of injury or a gradual onset of symptoms in the shoulder can affect the athlete's ability to perform. An understanding of shoulder anatomy and function is essential, and an accurate diagnosis of the underlying pathology is critical for planning treatment options. The correct diagnosis may be less clear when the athlete presents with an insidious onset of shoulder pain. A detailed history and physical examination, as well as an evaluation of the overhead motion and onset of pain, is important when the diagnosis of instability or impingement is considered. Rehabilitation of the rotator cuff often succeeds in alleviating symptoms and restoring function. Surgery is considered when symptoms and diminished function persist despite appropriate nonoperative treatment. Operative repair or reconstruction must be anatomical in nature. Postoperative rehabilitation is equally important in this setting, and a motivated athlete helps to ensure success.

Athletic Injuries↗
PubMed1997

Athletic injury reporting. Development of universal systems.

There are numerous athletic injury reporting systems currently in place. In order for our understanding of athletic injury epidemiology to advance, we must be able to compare data from divergent sources. This paper provides a review of existing athletic injury reporting systems in North America. The epidemiological designs employed in these systems are outlined, along with a description of the strengths and weaknesses of each approach to reporting. The differences between the case-series and cohort methods are delineated and the importance of injury definition, sources of error, denominator data and exposure estimation are discussed within this context. Four recommendations are then offered to assist in moving toward more universal systems for athletic injury reporting. First, comparability of data between systems should be maximised through clear indication of the reporting system design and the methods of data collection. Secondly, an exact definition should be given as to what constitutes a reportable event ('injury'). Thirdly, whenever possible, outcome information should be collected on each reported event so that an injury definition may be applied at the time of data analysis. Lastly, any limitations or sources of error should be acknowledged.

Athletic Injuries↗
PubMed1999

Management of lumbar injuries in athletes.

Lumbar spine pain is a common and disabling condition affecting an athlete's ability to train and compete. The athletic management team must take a cooperative approach to diagnosis and treatment. The presentation pattern and injury history may provide an early cue to diagnosis; information gained by the trainer or therapist at the time of injury is particularly important. The unique anatomy and biomechanics of the lumbar segments leads to certain injury patterns. Knowledge of the potential motion, muscle effectors of motion and mechanisms of injury allows for a highly specific diagnosis. A meticulous physical examination with particular attention to neurological findings should be used to confirm suspicions from the athlete's symptom pattern. Early conservative treatment should be initiated for all patients except those who are mechanically unstable or neurologically impaired. Aerobic and nonpainful sports-specific training may be continued under the care of the trainer or physical therapist. This will limit the loss of skill and endurance when normal activity is resumed. Diagnosis-specific medical and physical therapy should supplement this training activity. A care team that carefully analyses the pain presentation, injury history and symptoms, and directs a diagnosis-specific treatment programme, should manage lumbar spine conditions in the athlete.

Athletic Injuries↗
PubMed2000

Anterior cruciate injuries in the skeletally immature athlete: a review of treatment outcomes.

The documentation of anterior cruciate ligament (ACL) injuries in the skeletally immature athlete has significantly increased over the past decade, primarily due to increased awareness of these injuries within this younger athletic population. The evaluation of these injuries are similar to that in the adult population. Diagnostic studies such as plain radiographs, as well as magnetic resonance imaging, can delineate the location of the ACL failure. Physical presentation most commonly includes an acute haemarthrosis and ligamentous insufficiency. Several studies have demonstrated that the diagnostic reliability of the physical examination is poor in children, especially in patients less than 12 years old. The site of ACL failure in this adolescent population is most commonly at the tibial insertion. We recommend arthroscopic or arthroscopically assisted open reduction and internal fixation with nonabsorbable sutures for all displaced tibial eminence fractures. Mid-substance ACL failures also occur in this athletic age group. The association of meniscal injuries with these ACL failures appears to be greater than 50%. Historically, poor subjective and objective outcomes have been associated with primary and extra-articular repairs. Intra-articular reconstruction is the gold standard. The issue of placing the graft across open physeal plates is under investigation. Recent animal studies as well as human clinical series have demonstrated safety in placing soft tissue, i.e. hamstring grafts, across open growth plates without subsequent angular or leg length discrepancy. Historically, non-operatively treated ACL failures are associated with poor functional outcomes as well as a high incidence of meniscal re-injury. If the treatment of an adolescent athlete with an ACL failure is to be rehabilitation until skeletal maturity, close follow-up is essential to detect functional instability, which may prompt earlier surgical reconstruction.

Adolescent↗
PubMed2000

Commotio cordis: an underappreciated cause of sudden death in athletes.

Over the last few years, the recognised cardiovascular risks of sporting activities have been extended to include cardiac arrest resulting from low-energy precordial chest impact produced by projectiles (e.g. baseball) or bodily contact, in the young, healthy and active athlete [also known as commotio cordis (CC)]. However, case reports of CC in European medical literature can be traced back for at least 130 years. CC accounts for a small, but important, subset of sudden death during sporting activities. It is a devastating electrophysiological event in the young athlete, and one which has generated considerable concern, both in the medical profession as well as in the public. The mechanism of sudden death appears to be caused by ventricular fibrillation, which occurs when the chest impact is delivered within a narrow, electrically vulnerable portion of the cardiac cycle, that is, during repolarisation, just before the peak of the T wave. Resuscitation of these victims is possible with prompt cardiopulmonary resuscitation and defibrillation. Preventive measures, such as the use of age-appropriate safety baseballs and suitably designed chest wall protection, may reduce the risk of sudden death and, thus, make the athletic field a safer place for young athletes.

Adolescent↗
PubMed2005

Management of sport-related concussion in young athletes.

Sport-related head injuries are a common clinical problem. Most head injuries in young athletes are mild traumatic brain injuries or concussions. The highest number of sport-related concussions has been reported in American football. In addition to the well described physical and psychosocial growth, there is ongoing neurocognitive development of the brain during childhood and through adolescence. This developmental process has direct implications in the assessment and management of head injuries in young athletes. Research on the management and long-term outcome following brain injuries in young athletes is limited. Traditionally, the assessment of concussion has been based on clinical history and physical and neurological examination. Increasingly, neuropsychological testing, especially computerised testing, is providing objective measures for the initial assessment and follow-up of young athletes following brain injuries. Numerous guidelines have been published for grading and return to play criteria following concussion; however, none of these have been prospectively validated by research and none are specifically applicable to children and adolescents.

Acute Disease↗
PubMed1995

Correlation of MR imaging and pathologic findings in athletes undergoing surgery for chronic patellar tendinitis.

OBJECTIVE: Jumper's knee, or chronic patellar tendinitis, can be a source of considerable pain in athletes. The changes that occur with shearing of the tendinous fibers from repeated microtrauma can progress to significant degeneration and increase the risk of tendon rupture. In order to better understand this phenomenon, a correlative study relating the MR imaging and pathologic findings was performed. SUBJECTS AND METHODS: Nine high-performance athletes 18-22 years old (mean age, 20 years) underwent operation of 11 knees for long-standing jumper's knee. The average period of symptoms was 3 years (range, 2 to 6 years). MR knee examinations were performed before surgery in all athletes. The symptoms, MR findings, and pathological findings were correlated. RESULTS: There was focal thickening in the proximal one third of the patellar tendon (range, 9-16 mm; mean, 12 mm) in all 11 knees, involving the medial portion of the tendon in 10 and the center in one. On proton-density-weighted MR images, all knees demonstrated a focus of abnormal signal intensity in the proximal one third of the patellar tendon. On T2-weighted MR images, 10 knees demonstrated abnormal signal intensity; eight were isointense to that seen on proton-density-weighted images, and two were relatively hyperintense. Ten tendons demonstrated a poorly defined posterior margin. Pathologically, the areas of abnormal signal intensity corresponded to tissue containing tenocyte hyperplasia, prominent angiogenesis with endothelial hyperplasia, loss of longitudinal collagenous architecture, and microtears with collagen fiber separation. Hyaline degeneration was present in specimens from every patient. CONCLUSION: In athletes with chronic patellar tendinitis, areas of abnormal signal intensity on MR imaging corresponded to degenerative pathologic changes consistent with angiofibroblastic tendinosis. In nearly all patients, the tendon thickening occurred eccentrically. Disproportionate medial tendon thickening may be related to unequal tensile forces across the knee joint, resulting in greater stress on the medial portion of the extensor mechanism of the knee.

Adolescent↗
PubMed1999

Imaging findings in the dominant shoulder of throwing athletes: comparison of radiography, arthrography, CT arthrography, and MR arthrography with arthroscopic correlation.

OBJECTIVE: Conventional radiography, arthrography, CT arthrography, and MR arthrography--including use of the abduction and external rotation position--were compared, with arthroscopic correlation, to determine the spectrum of abnormalities encountered and the relative benefits of each imaging method in the evaluation of shoulder lesions occurring in 17 throwing athletes. SUBJECTS AND METHODS: Each of 36 athletes with shoulder pain aggravated by abduction and external rotation was examined in a single visit during which conventional radiography, arthrography, CT arthrography, and MR arthrography were performed. In 17 of these athletes, imaging findings were compared with those at arthroscopy. All images were independently evaluated by two groups of musculoskeletal radiologists. RESULTS: Structures found to be affected were, in decreasing order of frequency, the following: the posterosuperior labrum, supraspinatus tendon, infraspinatus tendon, humeral head, glenoid cavity and rim, acromioclavicular joint, anteroinferior capsulolabral complex, biceps tendon, and subscapularis tendon. MR arthrography without and with abduction and external rotation yielded the highest sensitivity and specificity for all lesions with the exceptions of bone sclerosis and enthesophytes (which were best seen with CT arthrography). MR arthrography with abduction and external rotation was most accurate for diagnosis of rotator cuff and anteroinferior capsulolabral complex tears. CONCLUSION: On the basis of these preliminary results, we believe that MR arthrography with abduction and external rotation should be part of the imaging evaluation of shoulder pain in throwing athletes, owing to the high sensitivity of this imaging technique.

Adult↗
PubMed2026

Written vs. verbal sleep hygiene strategies administration in track and field athletes: a randomized controlled trial study.

BACKGROUND: Sleep hygiene strategies (SHS) are practical, evidence-informed recommendations to enhance both the quantity and quality of sleep in athletes. However, little is known about how these strategies could be communicated and implemented in practice. The primary objective of this study is to investigate how different methods of delivering SHS (written vs. verbal) affect sleep hygiene and sleep parameters in athletes. METHODS: The study was a three-arms randomized controlled trial (ClinicalTrials.gov Identifier: NCT07083544) involving track and field athletes competing at the regional or national level (N.=66). Athletes were randomized to either a control group (CON=22), a written SHS group (W-SHS=22), or a verbal SHS group (V-SHS=22). Sleep characteristics were assessed by actigraphy and sleep diary during a ten-day baseline period (T0) and a ten-day intervention period (T1). Six objective sleep parameters and the Sleep Regularity Index were assessed. Participants also completed a training diary and the Sleep Hygiene Index (SHI). RESULTS: No statistical differences were found between and within groups in training and sleep parameters, but SHI scores improved significantly in the intervention groups between T0 and T1, with differences compared to the control group. A non-significant improvement in total sleep time was observed in the intervention groups, primarily due to earlier bedtimes. CONCLUSIONS: While significant differences in objective sleep measures were not observed, the trends suggest that both written and verbal SHS interventions can modestly improve sleep-related behaviors, particularly by encouraging earlier bedtimes and slightly extending total sleep duration.

Humans↗
PubMed1995

Factors associated with menstrual irregularities and decreased bone mineral density in female athletes.

Menstrual irregularities occur in some female athletes. The most extreme form of menstrual irregularity is amenorrhea, which has been linked to significant decreases in vertebral bone density and increases in injury prevalence. Many authors have sought to determine the causal factors of athletic amenorrhea, some of which include hormonal status, training and physical parameters, nutritional balance, and psychological stress. The purpose of this paper was to compare studies that have examined the relationship of these variables to menstrual irregularities and bone density. Controversy exists regarding the relative contribution of these variables. The etiology is likely multifactorial and should be evaluated as such. Clinicians treating female athletes must be knowledgeable about the negative consequences associated with menstrual irregularities. Furthermore, it is critical that clinicians provide thorough patient education in order to prevent injuries and the long-term loss of bone density. Appropriate medical and/or psychological referral of the athlete with menstrual irregularities may be necessary.

Amenorrhea↗
PubMed1998

Reliability and responsiveness of disablement measures following acute ankle sprains among athletes.

The minimum amount of change which represents clinical improvement following ankle sprains is unknown. This study considers the usefulness of physiological and behavioral measures commonly employed for this purpose in sports rehabilitation settings. Thirteen collegiate athletes of both genders were measured at approximately 3 and 10 days post-grade I or II ankle sprain. Volumetric displacement and sagittal plane ankle range of motion measures were used as impairment indicators. Motor ability scores (activity count) and a perceived athletic ability measure (visual analog scale) were used to indicate functional limitations. Volumetric displacement and both functional limitation measures demonstrated responsiveness to change between two occasions of measurement separated by 1 week. Observed changes in range of motion deficits could not be distinguished from measurement error. The results of this study suggest that behavioral measures of motor activity and perceived athletic ability may be at least as useful as physical measures of organic dysfunction for assessing clinical improvement following acute ankle sprains among athletes.

Acute Disease↗
PubMed1998

Resistance training and elite athletes: adaptations and program considerations.

The skepticism surrounding the potential benefits of resistance exercise training prevalent just decades ago has evolved over the years to an understanding of the integral nature muscular overload plays in the training programs for athletes. The science of training elite athletes is progressing rapidly, as insights into the physiological adaptations resulting from varying program configurations become available. Resistance training impacts several body systems, including muscular, endocrine, skeletal, metabolic, immune, neural, and respiratory. An understanding and appreciation of basic scientific principles related to resistance training is necessary in order to optimize training responses. Careful selection of the acute program variables in a workout to simulate sports-specific movements is required for optimal transfer of gains made in training to competition. Thus, whether athletes require predominantly eccentric, isometric, slow-velocity, or high-velocity strength or power in their athletic event will dictate the time commitment to each component and form the basis for designing individual workouts. Program variation over a training period is essential to maximize gains and prevent overtraining.

Adaptation, Physiological↗
PubMed1997

Oral contraceptive use among female elite athletes and age-matched controls and its relation to low back pain.

BACKGROUND: Exogenous and endogenous female sex steroids may influence the risk of low back pain. The fact that back pain is a very common symptom during pregnancy supports this theory. Back pain is also more common among female than male athletes. Oral contraceptives have been suggested to increase the risk of low back pain. OBJECTIVE: To evaluate whether the prevalence of low back pain is higher among oral contraceptive users than non-users and if it differs between women taking part in different sports. METHODS: A questionnaire was sent to female elite athletes in volleyball (n = 205), basketball (n = 150), and soccer (n = 361) as well as to age-matched controls (n = 113). The questionnaire comprised questions about age, constitution, occupation, parity and use of contraceptive method as well as previous and current back pain and possible consequences of the back problems. RESULTS: The response rate was 85%. Between 42% and 52% of the women in the different groups used oral contraceptives. The groups were similar in most background variables, except that the volleyball and basketball players were taller. The prevalence of current low back pain was between 21% and 34% in the different athlete groups with an average of 30%, whereas only 18% of the controls suffered from low back pain (p < 0.01). The prevalence of low back pain within each group, athletes as well as controls, was similar in women who used, and did not use oral contraceptives. CONCLUSIONS: This study does not support the theory that low back pain is affected by the use of oral contraceptives. Instead, constitutional factors and mechanical stress during intense physical activity is probably more important.

Adult↗
PubMed2003

Recovery from mild concussion in high school athletes.

OBJECT: A computerized neuropsychological test battery was conducted to evaluate memory dysfunction and self-reporting of symptoms in a group of high school athletes who had suffered concussion. METHODS: Neuropsychological performance prior to and following concussion was compared with the test performance of an age-matched control group. Potentially important diagnostic markers of concussion severity are discussed and linked to recovery within the 1st week of injury. CONCLUSIONS: High school athletes who had suffered mild concussion demonstrated significant declines in memory processes relative to a noninjured control group. Statistically significant differences between preseason and postinjury memory test results were still evident in the concussion group at 4 and 7 days postinjury. Self-reported neurological symptoms such as headache, dizziness, and nausea resolved by Day 4. Duration of on-field mental status changes such as retrograde amnesia and posttraumatic confusion was related to the presence of memory impairment at 36 hours and 4 and 7 days postinjury and was also related to slower resolution of self-reported symptoms. The results of this study suggest that caution should be exercised in returning high school athletes to the playing field following concussion. On-field mental status changes appear to have prognostic utility and should be taken into account when making return-to-play decisions following concussion. Athletes who exhibit on-field mental status changes for more than 5 minutes have longer-lasting postconcussion symptoms and memory decline.

Adolescent↗
PubMed1997

Team physician preferences at National Collegiate Athletic Association Division I universities.

Virtually all National Collegiate Athletic Association (NCAA) Division I universities have physicians who evaluate and treat athletic injuries and other medical conditions. The relationship of these physicians to these institutions ranges from a very loose arrangement to full-time employment. The specialties of the physicians working with the athletes of NCAA Division I universities vary as well. This study attempts to determine the specialty of current team physicians at NCAA Division I universities and their qualifications as well as the preferences of athletic directors when they are seeking to employ a team physician for their university. By comparing IA and non-IA Division I institutions, an attempt is made to determine the possible reasons for differences. This information will then be useful both for physicians-in-training who aspire to be team physicians at the university level and for administrators at these institutions who will be recruiting physicians with the most desirable credentials in the future.

Athletic Injuries↗
PubMed1999

Health care coverage of high school athletics in South Carolina: does school size make a difference?

Despite an apparently high injury rate, medical coverage available to these high school athletes is often not immediately present during practice and games. The purpose of the present study was to examine the current conditions of health care coverage and delivery to the football program and associated athletic departments in the public and private high schools in South Carolina. Additionally, the relationship between student enrollment and medical coverage was examined. A survey, based upon previously utilized instruments, was sent to the athletic directors at the public and private high schools with interscholastic football programs in South Carolina. The survey included questions pertaining to the medical coverage, including personnel, equipment, and record systems, for football practices and games. Based upon the results of the survey, a majority of high schools in South Carolina appear to have adequate sports medicine coverage and compare favorably with the results of similar data from other states. The medical coverage does significantly vary depending upon the enrollment size of the high school. In spite of this finding, the health care provided high school athletes is often inconsistent and training and equipment required for basic first aid is often absent.

Adolescent↗