Cardiovascular disease

Over the last five decades cardiovascular disease (CVD) has been the most common cause of death in the Western world. Inside the EU, 44 of all deaths are attributed to CVD and this is almost twice as many as all cancers put together 2 . CVD rates have decreased during the last few decades in Western countries especially in men below the age of 75 years 3,4 . This development is in contrast to the Eastern European countries, where CVD rates have increased. The positive trend in the Northern...

Prevention of cardiovascular disease

The Bogalusa heart study has shown that atherosclerosis begins early in life 13 . The following risk factors were identified as predictors of fatty streaks and fibrous plaques in the coronary arteries and aorta of young individuals 13 body mass index, systolic and diastolic blood pressure, serum concentrations of total cholesterol, triglycerides, low-density lipoprotein cholesterol and smoking habits. A large number of studies has been performed to assess the effects of increased PA on the...

Congenital heart disease and arrhythmia

There are several different congenital heart defects and arrhythmias, most of which may be subdivided according to their severity. Furthermore, surgical corrections and individual factors may further influence hemodynamics at rest and during exercise. In the 1960s and 1970s, a restriction in physical activities and sports participation was implemented in almost every child with a suspected or proven congenital heart disease or arrhythmia. The discussion and guidelines over the recent years,...

Exercise after acute myocardial infarction

In the 18th century William Heberden and Caleb H. Parry recommended physical activity for patients with angina pectoris 13,14 . Other views soon became dominant and for almost 200 years rest was a major part in the treatment of angina pectoris and in myocardial infarction. In the 1950s the bed rest period after a my-ocardial infarction was shortened and it was reported that the patients having shorter bed rest after a myocar-dial infarction returned to normal activities sooner. It was shown...

Physical inactivity and the burden of cardiovascular disease in type 2 diabetes

Patients with type 2 diabetes have a two- to four-fold increased mortality from cardiovascular disease 6 . The ultimate goal of all therapies in type 2 diabetes is to reduce this burden. In the Aerobic Center Longitudinal Study discussed above 7 , the association between low cardiorespiratory fitness and physical inactivity and total mortality in 1263 men with type 2 diabetes was also studied. After adjustment for age, preexisting and family history of cardiovascular disease, fasting glucose...

Prevalence of eating disorders among athletes

The epidemiology of eating disorders poses a particular challenge to investigators due to problems with case definition, and the tendency of eating-disordered subjects to conceal their illness and avoid professional help. Estimates of the prevalence of the symptoms of eating disorders and clinical eating disorders among female athletes range from less than 1 to as high as 75 108,118,119 . The prevalence of anorexia nervosa (2.2 ), bulimia nervosa (7.2 ) and subclinical eating disorders (10 )...

Multiple choice questions

For each question, please indicate which of the statements a-e is correct. 1 Exercise-induced chest pain and heartburn a are more common in weight lifters and swimmers than runners c require adequate evaluation to exclude a cardiac d occur more often fasting than after meals e are best treated with anticholinergic or sedative 2 Exercise-associated abdominal pain a is generally worse during training than competition b may be associated with diarrhea or a strong urge to have a bowel movement c...

A single static stretch

In the animal models it is known that materials respond in a non-linear fashion during the dynamic and static loading phase of a stretch, indicating viscoelastic behavior 111,116,118 . Recently it was also shown in a human model that the muscle-tendon unit behaves in a similar fashion during stretching 113-115,119-121 . That is, the muscle displays viscoelastic properties in the absence of any measurable EMG response from the target muscle being stretched (Fig. 1.6.12). During the dynamic...

Achilles tendon injuries Chronic Achilles tendon disorders

Chronic Achilles tendon pain is a common clinical feature 29,30 . Most acute Achilles tendon conditions heal with non-surgical and symptomatic treatment, but some patients do complain of longstanding pain and swelling of the Achilles tendon, stiffness and dysfunction, which makes it difficult for them to retain a desired level of activity. A chronic condition is defined as symptoms lasting more than 2-3 months. Even Table 6.1.1 Characteristics of and differences between tibial stress syndrome,...

Achilles tendon ruptures

The incidence of Achilles tendon rupture is approximately 10 100000 population per year. The incidence has increased 3-5 times during the last 30-40 years. The male dominance is from 2 1 to 20 1 in different studies. The average age of the patients is 35-40 years. Sports activity is the triggering factor in 75 . In Scandinavia, Achilles tendon ruptures most often occur during badminton. In the USA, Achilles tendon ruptures are related to basketball and tennis. In the elderly, underlying...

Acute myotendinous groin injuries

The iliopsoas can be strained by a forceful flexion against resistance as occurs when the ground is mistakenly kicked instead of the ball, or in eccentric contraction, e.g. when the thigh is forced into extension. The adductor muscles are usually strained in eccentric contraction, e.g. in a forceful abduction, often with some degree of hip joint rotation, as in a sliding tackle in soccer. The injury usually occurs in the myotendinous junction but can also occur in the tendon itself or at the...

Acute torticollis

Acute neck pain associated with side flexion and rotation. Symptoms and signs. Frequently athletes are awakened from sleep by the pain, or when they wake up in the morning the neck is stiff and sore. Diagnosis. History will usually rule out differential diagnoses. In non-traumatic torticollis, search for underlying malignant, inflammatory or infectious pathology if the condition does not resolve within a short time. Treatment. Muscle relaxants, anti-inflammatory medication or paracetamol....

Acute treatmentspecial emphasis on muscle injury

If an acute trauma has occurred involving joints, muscle or soft tissue injury it is essential to use an aggressive approach in order to stop the bleeding within and around the tissue. To this effect (i) local cooling, (ii) external compression to the injured area, and (iii) elevation of the injured limb is widely recommended (the RICE concept) 1-7 . The pain-relieving effect of cold application is well documented and has also been hypothesized to reduce the activity of inflammatory enzymes 8,9...

Adaptability of older people to exercise Crosssectional perspective

In Fig. 3.3.3 the decline in sports performance that occurs with increasing age was described in terms of changes in world record performances. These athletes represent a highly elite population of individuals, some of whom have continued in competition since adulthood, whilst others are those who have come into a sport as a master or veteran competitor. Physiologic analysis in the laboratory of these athletes reveals that as a general rule, and as with their performance or competition data,...

Adverse effects on growth and puberty

Linear growth and pubertal development are important elements of normal childhood and adolescence. Fig. 3.4.2 (a) Normal growth curve in an early- and a late-maturing boy. Note the difference in height before and particularly during puberty. (b) Growth velocity curve in an early- and a late-maturing boy. Note that peak height velocity decreases with increasing age at the start of the pubertal growth spurt. Peak height velocity in girls occurs on average 2 years earlier than in boys. Danish...

Adverse events

Introduction of infection is a possible adverse effect when using local steroid injection therapy. However, this risk can be almost completely eliminated by using a meticulous aseptic, no-touch technique, and by avoiding injections in areas with suspected infection. Atrophy of the overlying skin with telangiectasia and increased hyperesthesia or hypoesthesia and transparency or subcutaneous fat necrosis is often seen when subcutaneous structures are injected. In the above mentioned study...

Anatomic lesions

A number of anatomic factors and structures attribute to stability and changes in these may lead to increased laxity and instability (Table 6.6.4). Careful assessment of these structures must be performed, usually using clinical testing and radiology. Electromyography, neurography and or arthroscopy are helpful. Purely functional factors may also be important. Scapulothoracic motion may be disturbed due to muscle imbalance, muscle fatigue or even palsy (long Fig. 6.6.25 Directions of shoulder...

Anatomy

The pelvic region is an essential part of the functional anatomy in most sports activities. The pelvis needs to be stable and well controlled for the athlete to perform with skill. The pelvis is the turning point between the upper and the lower part of the body. Multiple muscles and ligaments originate from and or insert onto the pelvis, and to control and stabilize the pelvis a delicate balance exists between these structures to coordinate the movements passing through this region. Two of the...

Ancient and modern drug use

In the third century bc Greek athletes prepared different mushrooms in the belief that it would enhance their performance. Similarly the Roman gladiators used stimulants for faster recovery after injury and chariot racers fed their horses 'potent' mixtures. Members of the Inca people chewed coca leaves before engaging in particularly intensive physical activities and Vikings have been said to eat fly agaric when fighting battles. Various stories about the use of different drugs by athletes...

Ankle joint injuries Ankle arthroscopy

Ankle arthroscopy is a valuable tool in the diagnosis and treatment of various intra-articular ankle disorders. Visualization of intra-articular pathology without arthrotomy is possible, thus reducing the risk of surgical complications. Indications for ankle arthroscopy are osteochondral fractures, chondral lesions, soft tissue impingement, bony impingement, post-traumatic osteoarthritis and loose bodies. Chronic pain at the anterior aspect of the ankle joint is rather frequent in athletes,...

Anterior posttraumatic instability

This is the most common type of shoulder instability. It is the result of a shoulder trauma which causes Table 6.6.4 Pathoanatomic conditions leading to laxity. Abnormal version of either the glenoid or Fraying secondary to hyperelasticity of the deformation Avulsion from glenoid or humeral head Generalized joint laxity Loss of proprioceptive feedback Tendon rupture,SLAP lesion Cumulative microtrauma Paresis due to nerve damage Fig. 6.6.26 Classification of recurrent shoulder instability. Fig....

Anterior tibial compartment syndrome

Anterior tibial syndrome exists in both an acute and a chronic form, both caused by overuse 6 . The acute anterior tibial syndrome is an exertional pain syndrome with dramatic symptoms including pain and major swelling and should be treated by early fasciotomy. Ischemia and muscle necrosis may develop if the diagnosis is missed and treatment is delayed. The subcutaneous fasciotomy should not be used, in order to avoid the tourniquet effect by intact skin in the distal leg and ankle. Chronic...

Assessment of posterior instability of the knee

The posterior cruciate ligament (PCL) is the main structure responsible for preventing posterior translation of the knee 7,11,19,20 . The PCL has two main portions, the anterolateral and posteromedial bundles. The anterolateral bundle is the strongest and is the primary stabilizer against posterior translation of the knee when the knee is at 90 of knee flexion. In this position, it is in its most isolated state. For this reason, the majority of assessment tests for posterior instability of the...

Assessment of posterolateral instability of the knee

The main function of the many structures of the posterolateral aspect of the knee is to prevent excessive recurvatum, varus opening of the knee, and posterolateral rotation of the knee 9,12,14,17,18,2123 . Assessment of potential injury to the posterolateral structures of the knee primarily requires an assessment of abnormalities in motion testing for these motion and translation tests. The external rotation recurvatum test is one of the first tests that should be performed when examining a...

Avulsion fractures

Avulsion fractures about the pelvis occur almost exclusively in the adolescent population. The apophyses make a relatively weak connection to the central bony skeleton through the zone of provisional calcification of the growth plate. Powerful muscle contractions from the muscles around the hip and pelvis are occasionally able to overpower the stability of the growth plate and cause avulsion fractures. There are three typical locations for avulsion fractures of the pelvis (i) anterior superior...

Avulsions of the flexor digitorum profundus

Avulsion of the flexor digitorum profundus tendon is similar to a mallet deformity and is diagnosed as inability to actively flex the distal interphalangeal joint, associated with pain and swelling. Radiographs may show avulsion of the volar base of the distal phalanx. The ring finger is most often involved and is seen in football injuries as the finger is caught in the opponent's jersey. Surgical treatment of the tendon should be performed within 7-10 days to avoid retraction of the flexor...

Background

The benefits of physical activity are well documented and positive effects on diabetes, asthma and body weight have been postulated (see Chapters 4.4, 4.5 and 4.7). Physical activity also seems to decrease the risk of cardiovascular disease and its associated mortality. The positive effects of physical activity on the mu-sculoskeletal system are also well documented, even extending to being a recommended treatment of os-teoarthritis. However, vigorous physical activity and associated injuries...

Basic examination

The general impression of the shoulder contours gives valuable information Is this a muscular or a slight individual Is there atrophy on the affected side of the deltoid (as in axillary nerve palsy), the supraspinatus (as in rotator cuff rupture) or the infraspinatus muscles (as in suprascapular nerve palsy in volleyball players) Is the humeral head in joint (An epulet shoulder is characteristic of acute dislocation.) Is the acromioclavicu-lar joint intact or is the clavicle protruding Ask the...

Biomechanical analysis Offlineonline digitization

Computer systems for biomechanical movement analysis can be divided into offline and online systems. The latter may use active or passive markers. Active markers emit light or sound or other signals which are registered by a receiver unit several times per second. Passive markers most often reflect infrared light, which is flashed by special video cameras. The video signal is looped through a special electronic device, which will extract only the light of infrared intensity. The center of each...

Biomechanics of human skeletal muscletendon flexibility

Physical activity is important to maintain good health, and human movement is not possible without some degree of the fitness component commonly called mus-culoskeletal flexibility. Flexibility training is thought to be an important and effective training stimulus for maintenance and augmentation of flexibility. Clearly the demands of participation in sports require a certain sport-specific musculoskeletal flexibility. In sports such as gymnastics the necessity for immense flexibility is...

Blood supply and inflammatory reaction

It is widely believed that the Achilles tendon is injury prone secondary to a compromised blood supply 2-5 cm proximal to the insertion onto the calcaneus. Using a xenon washout technique it was recently shown that blood flow in the peritendinous region of the human Achilles tendon rose up to 3-7 times during resisted plantar flexion, which parallels the augmented flow to the muscle 49,50 (Fig. 1.6.6). Further, the Fig. 1.6.6 Mean blood flow values as determined with the I33Xe washout technique...

Body composition

Aging is associated with alterations in body composition such that there is an increase in fat mass and a decrease in muscle mass. This results in whole-body mass remaining relatively unchanged. Tzankoff and Norris 11 demonstrated using creatinine excretion as a marker of total body protein content that, in men, fat-free body mass declines progressively from 40 to 80 years of age at a rate equating to 5 per decade. In a 5-year longitudinal study in Finland, the change in lean body mass...

Bone

The usual aging pattern of the skeleton involves the gain of peak bone mass during growth, a plateau in adulthood, and bone loss during aging (Fig. 3.3.5). Bone tissue is renewed throughout life by organized bone cell activities such as osteoclastic bone resorption and osteoblastic bone formation. Bone modeling, which is particularly active during growth, improves bone strength by adding mass and changing the shape and geometry of bone. Remodeling, on the other hand, provides a mechanism for...

Bone tumors

Bone tumors, primary as well as metastases, will present in bone scintigrams as regions with focally increased uptake, often disseminated as in the case of prostate and breast cancer. However, single tumors may be difficult to discern from benign skeletal lesions and may demand further evaluation. Malignant tumors often appear irregular and 'invasive' centrally in the bone (Fig. 5.1.28), while benign lesions often involve the superficial bone tissues, and anamnestical-ly are associated with...

Bones of the knee

The knee joint is composed of four bones the tibia, femur, patella and fibula. The tibia is a long triangular bone beginning proximally at the tibial plateau and extending distally to articulate at the ankle. The femur is a long cylindrical bone, which begins at the femoral head, which articulates with the acetabulum to form the hip joint, and ends distally at the femoral condyles. The patella is a sesamoid bone that articulates anterior to the femur and tibia. The fibula extends proximally to...

Calcium

Calcium is the most abundant mineral in the body, which contains about 0.8-1.2 kg. Approximately 99 of the body calcium is located in the skeleton, which serves as an important calcium depot, while the remaining I occurs as calcium ions of relevance for neuromuscular function. Severe hypocalcemia can cause serious muscle cramps and heart arrhythmias. However, there are no reliable data available concerning the potential effect of calcium supplementation in the treatment of muscle cramps in...

Carbohydrate

The focus with regard to athletes' diets has been on carbohydrate intake in particular, since the body's glycogen stores are very limited. Although glycogen content is increased about two-fold in a well-trained Table 2.4.6 Size of glycogen stores on different diets. From 25 . athlete compared with a sedentary person (Table 2.4.6), the glycogen stores are still a limiting factor for exercise endurance and intensity (see Chapter 1.2). Compared with the fat stores, glycogen stores can supply...

Cardiac structure

The increase in maximal cardiac output (Qmax) following endurance training results from a larger cardiac stroke volume (SV), whereas maximal heart rate (HRmax) is unchanged or even slightly reduced. While heart size is a function of total body size as well as genetic factors, the higher SV achieved by endurance training is attributed to enlargement of cardiac chamber size and to expansion of total blood volume 12 . On the basis of cross-sectional studies in both female and male...

Cardiomyopathies

Hypertrophic cardiomyopathy (HCM) is one of the most common causes of sudden death in young athletes. Athletes with symptoms such as syncope, near-syncope or sudden dizziness, who have pathologic ECG findings with increased QRS amplitudes and ST-T changes or a family history of HCM should therefore be investigated. HCM is a cardiomyopathy with varying degrees of hypertrophy of the left ventricle, often with obstruction of the left ventricular outflow tract. The mechanism for sudden death is...

Cardiovascular adaptation Cardiac output

The pumping capacity of the heart is a critical determinant of endurance performance in exercise events such as running, cycling, rowing, swimming, etc., where a large fraction of total body muscle mass is contracting dynamically. Because of the large dependence on oxidative metabolism for the total energy turnover in exercise activities sustained for longer than 3 min, Fig. i.i.i A recording of the tidal air on a spirometer (constructed by Krogh) at rest and at the beginning of exercise. Fig....

Cardiovascular and respiratory systems

The delivery of O2 to and the removal of the end product of metabolism (CO2) from the working muscles are prime functions of the pulmonary and cardiovascular systems. Maximal oxygen uptake (V02 ) or maximal aerobic power is the recognized measure of aerobic fitness and represents the maximum ability of the body to utilize O2. Both cross-sectional and longitudinal studies have demonstrated a decline in Vo1 with increasing age. When data are expressed in absolute terms (i.e. L min), this decline...

Case story 233

In the summer of 1984 a party of 12 people led by two mountain guides ascended by cable car from low altitude to 3887 m to climb for several days at altitudes between 3600 and 4500 m. On the third day one of the mountain guides, who was 25 years old, noticed unusual shortness of breath while climbing to 4075 m, which improved when descending to a hut at 3611 m. There his appetite was reduced, he had headache, felt weak and slept poorly. He did not want to leave a group of 12 people with only...

Case story 631

A male football (soccer) player, 27 years old, has played at elite level for 9 months. He is suffering from pain in the right groin and remembers one painful episode of hyperextension of the right hip during a match 3 months ago. The physiotherapist in the club has treated him with ultrasound, stretching, massage and some abdominal and back exercises. Six weeks after the groin pain started, he was examined at our sports medicine center. Clinical signs of adductor-related pain, iliopsoas-related...

Case story 641

A 24-year-old-male fell during alpine skiing and hit his head on a tree. He was unconscious for 80-90 s, woke up but was a bit dizzy. After 30 min he felt well, except for a minor headache, and he returned home. 1 If the period following this is uneventful, how should he be treated When can he return to skiing If he was a boxer, when could he return to boxing Because he also injured his arm, he went to the emergency room. When he arrived 4 h after the injury he was alert. On examination a...

Case story 651

The patient is a 32-year-old semiprofessional soccer goalkeeper. He has previously been treated for a complicated fracture of the distal phalanx of the right thumb and minor finger injuries, had resected an exostosis of the lateral region of the right distal femur and glenoid labral lesions in both shoulders, and has had surgical treatment of both Achilles tendons because of tendinopathy. He has played i20 compulsory matches in a row without missing one single match because of injury. During...

Case story 662

A 27-year-old weight lifter gradually developed anterior pain in his left shoulder, extending out anterolateral in the arm. He had pain when weight-lifting, but also in his daily life, lifting shopping bags, during sleep, or working with the arm above horizontal. There were few degrees reduction in flexion, but otherwise normal movements of the shoulder. He had good power in all rotator cuff muscles, but pain when abducting with power against resistance. Neer's and Hawkins' tests were positive,...

Case story 671

A 45-year-old-man has played tennis for 30 years. He had never experienced problems until last year, when he had to stop playing 2 months before the end of the season, because of medial pain in the elbow during serving and smashes. Symptoms resolved. Two weeks into the new season he developed medial and lateral elbow pain during serving and slashing. The medial pain resolved after the matches, but the lateral pain is constant, and gets worse during daily activities. With continued playing he...

Case study 411

A 70-year-old man with a lifelong history of strenuous training underwent cardiovascular testing in a study of veteran male athletes. He had no symptoms. ECG showed signs of an old myocardial infarction. Echocardiography showed a dilated left ventricle with regional hypokinesia of the LV wall and reduced LV function. Nuclear angiography showed decreased left ventricular function both at rest and during exercise. Myocardial scintigraphy revealed a large perfusion abnormality. Despite these...

Case study412

A 14-year-old boy with no previous history of arrhythmias or syncope suddenly loses consciousness during an ice hockey game. He is unconscious for about a minute. When he arrived in the emergency department he had a fast irregular pulse. Systolic blood pressure was 70 mmHg. ECG showed pre-excited atrial fibrillation with a ventricular rate of 220-250 beats min (Fig. 4.1.5a). ECG in sinus rhythm showed pre-excitation (Fig. 4.1.5b). He was successfully treated with radiofrequency ablation and...

Cerebral palsy

According to a recent study cardiorespiratory endurance does not differ significantly between people with cerebral palsy (CP) and the able-bodied, and it is independent of their locomotion ability- But the highest physical working capacity performed by the CP participants was significantly lower than in the controls 49 - In CP children of 5-7 years the lung function was reduced in comparison with normative data for children of the same age- But with a 6-month training program including swimming...

Cervical radiculopathy

The most common cause of cervical radiculopathy is the herniated disk. In patients older than 40 years, symptoms may result from hypertrophic facet and un-covertebral joints and reduced disk height. The prevalence of disk herniations and protrusions is about 30 in the asymptomatic population. Compared to the prevalence of radicular pain 'pathologic' changes such as disk herniation and protrusion most commonly are not recognized by the patient. Symptoms and signs. Pain in the neck often lasting...

Changes in body proportions

From birth to adulthood, the size of the head, trunk and extremities increases by different percentages of the initial size. In general, young children have relatively larger heads and shorter extremities compared to older individuals. Furthermore, there are considerable differences in growth rates and peak growth velocities among body parts. The lower extremities reach their peak growth velocity earlier than the trunk or the arms. And even within an extremity, the growth is not synchronized....

Classical reference

Knee joint changes after meniscectomy. J Bone Joint Surg 1948 30B 664-670. This paper records an investigation of changes found in the knee joint at intervals ranging from 3 months to 14 years after meniscectomy. Radiologic study. After excluding all cases with definite osteoarthritis, a comparison was made between the preoperative and postoperative X-ray films in 107 cases of meniscectomy. Owing to difficulty in securing identical views on separate occasions, the changes...

Classification systems

When taking part in competitions, classifications of the disabled athletes may be necessary for the competition to be fair. This is comparable to weight classes in various able-bodied sports. You don't match flyweight with heavy weight. Likewise you don't match slightly disabled with severely disabled in one-to-one competitions. Still one has to remember that we all are more or less different in character and physical possibilities, disabled or not. Therefore no one can expect any...

Clinical presentationdiagnosis and management

There are two types of stress fractures in the tibia, classified in relation to their location as posteromedial or anterior stress fractures 20 . The diagnosis is based on clinical findings and veri fied by technetium-99 bone scan, radiography, computed tomography (CT) or MRI. The bone scan typically shows an increased bone turnover at the injury site a few days after injury and as X-rays are often normal for several weeks, bone scan may be the first examination to verify a clinical suspicion...

Collagen metabolism and tendon loading

It is commonly believed that, if not inert, tendon is metabolically relatively inactive. However, animal studies suggest that tensile strength, stiffness, cross-sectional area and collagen content are augmented with increases in physical activity, which suggests that the tendon is metabolically active. In contrast, decreased physical activity and immobilization down-regulate collagen biosynthesis 25,27 . Collagen synthesis depends on overall protein synthesis, but appears to also be affected by...

Compartment syndrome

The muscle groups in the forearm are surrounded by fasciae, which are inelastic. A rapid increase in the content of the fasciae, either hematoma, edema or hypertrophy of the musculature, therefore leads to increased compartmental pressure. With small or intermittent increases, a reversible ischemia of the muscle occurs, but the pressure may be so high that it leads to irreversible ischemia and necrosis of the muscle. A compartment pressure of 30 mmHg or more for more than 8 h leads to muscle...

Conceptual models for the etiology of sports injuries

Risk indicators for sports injuries can be divided into two main categories internal personal risk indicators and external, environmental risk indicators 4 . This division is based on partly proven and partly supposed causal relationships between risk factors and sports injuries. However, merely to establish the risk factors for sports injuries, i.e. the internal and external factors, is not enough the mechanisms by which they occur must also be identified. As can be seen in Fig. 3.1.3 sports...

Connective tissue

In addition to the loss of the ability to develop force, musculoskeletal aging is characterized by an increase in the stiffness of movements. Most of the stiffness affecting the movements resides in the soft connective tissues of muscles, tendons and joint capsules. Connective tissue is instantly involved with both active and passive functions of force transmission in muscles and tendons, thus providing a potentially unique environment for studying the accommodation of the extracellular matrix...

CP resynthesis

Postexercise CP resynthesis occurs rapidly with a halftime of 50-60 s and is important for the recovery of power-generating capacity following intense exercise 15 . It is critically dependent upon oxygen availability 16,17 and CP resynthesis is faster in individuals with a high muscle oxidative capacity. Dietary creatine supplementation increases muscle CP levels and postexercise CP resynthesis and is associated with enhanced high-intensity exercise performance 18 . For these reasons there has...

Crash measures

The crash phase includes measures designed to protect the athlete from being injured, even when there is an accident. Examples of crash measures from the area of traffic accidents include seat belts and air bags to protect passengers from being injured in collisions, and use of safety helmets in cyclists. Athlete-related crash measures mainly focus on the physical preparation of athletes to allow them to withstand the forces involved when a collision or a fall occurs. Athlete-related crash...

Cse story 672

A 20-year-old telemark skier falls onto his wrist while skiing above the Arctic Circle. He is unable to seek medical attention until many months later. At that time he complains of chronic pain in his wrist. Plain radiographs demonstrate a scaphoid fracture (Fig. 6.7.22a). What tests are relevant for a scaphoid fracture A patient with a scaphoid fracture will complain of pain on the radial aspect of the wrist. Pressure over the volar tubercle on the scaphoid will result in pain. Also, palpation...

Cyclists palsy ulnar nerve Guyons canal

Cyclists can develop numbness and paresthesias in the ulnar nerve-innervated digits secondary to compression of the ulnar nerve in and distal to Guyon's canal. This condition can arise in any sport that involves repeated compression of the ulnar palm. There are three types of compression that have been described 74 . Type 1 involves motor and sensory branches. The site of compression is proximal to the canal. Type 2 involves the canal to the area of the hook of the hamate and involves the motor...

Cystic fibrosis

Patients with cystic fibrosis may suffer from oxygen desaturation during exercise. Therefore, exercise testing is recommended in all patients with moderate to advanced lung disease to check for this condition. Patients with exercise-induced hypoxemia should be Fig. 3.4.5 Oxygen saturation and heart rate in a 16-year-old boy during an incremental cycle ergometry to volitional fatigue. Oxygen saturation was measured by pulse oximetry, heart rate by ECG. Based on the guideline that exercise with...

De Quervains tenosynovitis

De Quervain's tenosynovitis is the most common form of stenosing tenosynovitis in the wrist and is seen frequently in racquet-ball players 62 (Fig. 6.7.11). This condition is secondary to inflammation of the first dorsal compartment tendons (abductor pollicis longus and extensor pollicis brevis) as they pass through a tight fibro-osseous tunnel at the level of the radial styloid 3 . Clinically, the patient complains of pain about the first dorsal compartment which can radiate along the tendons...

Definitions

Osteoporosis is a condition in which the rate of bone resorption exceeds the rate of bone formation. This imbalance leads to a progressive loss of bone mass, which in turn leads to a decrease in bone strength. It is a major public health concern and it often proceeds unnoticed until a stress fracture occurs. The World Health Organization formed a committee in 1994 to define osteoporosis. That committee created four diagnostic categories Normal, Osteopenia, Osteoporosis and Established...

Deltoid ligament rupture

The deltoid ligament is located on the inside of the ankle. This ligament is thick and strong and, in addition, is in both superficial and deep planes. Damage to this ligament is therefore much more uncommon than to the lateral ligaments. The injury arises following outward rotation of the foot. There can be partial or total rupture of the ligament depending on the amount of force and the direction. Ligament injury can occur in isolation, but is more common in association with a fracture of the...

Diagnosis of tendon overuse injuries with imaging techniques

Magnetic resonance imaging (MRI), ultrasonography and computerized tomography (CT) are non-invasive techniques able to visualize tendon structures. Therefore, it is possible to use these tools to identify the location of tendon overuse injury. MRI offers clear soft tissue contrast and direct sagittal imaging 87 . Hence, patellar tendon structures can also be clearly imaged with MRI. Ultrasonography is one of the most efficient and effective ways of imaging the tendons. It provides an accurate...

Differential diagnosis

Dyspnea in relation to strenuous exercise is common and there is always a risk of interpreting this as asthma. A carefully taken history is mandatory and an exercise challenge test to confirm the presence of EIB should be performed (Fig. 4.5.3). Typically, subjects with EIB report symptoms such as dyspnea and wheeze within the first 5-10 min after the start of the first bout of exercise. Some subjects are able to run through their symptoms, and after 20-30 min seem to attain a 'second wind' and...

Direct in vivo tendon forces during normal locomotion

Normal locomotion and or muscle function usually refers to stretch-shortening cycles 2 , where the active muscle is first stretched (eccentric action) prior to shortening (concentric action). The purpose of SSC is to make the performance more efficient as compared to isolated forms of either isometric or concentric actions. Figure 1.5.23 is a typical example of how the buckle transducer technique, which can be used to characterize the loading of the triceps surae muscle-tendon complex, is...

Distribution of sonographic tendon changes

With ultrasound two distinct findings are seen, depending on whether the proximal two-thirds or the distal third of the Achilles tendon is involved. In tendons exhibiting proximal middle-third Achilles tendinosis with subtotal tendon cross-section involvement, over 90 exhibit changes in the medial segment, and isolated changes in the lateral segment are never seen. The medial distribution suggests that the tendinosis at least in part reflects increased tensile forces over the medial side of the...

Doping and boosting

People with a disability may be taking medications for control of a disease process or specific symptoms, or both. Advising doctors should be aware of drugs that, if used, may be on the International Olympic Committee (IOC) list of doping substances, and in particular of certain products sold over the counter as remedies for the common cold, cough, pain, indigestion, etc., which may contain banned substances. During the Barcelona Paralympic Games in i992, 2i7 tests were performed and three were...

ECG findings in athletes

Resting bradycardia is common in athletes and heart rate values below 30 beats min during the night are not uncommon 6,7 . Pauses (long R-R intervals) in sinus rhythm of 2-2.5 s are often seen and pauses over 3 s have been reported (Fig. 4.1.1). Pronounced sinus bradyarrhythmias during the night are due to a vagal influence on the heart and a normal finding. Sporadic atrial and ventricular premature beats are common and do not require investigation or treatment. The majority of athletes have...

Editors and Contributors

Per Aagaard Team Denmark Test Center, Sports Medicine Research Unit, University of Copenhagen, Bispebjerg Hospital, Copenhagen, DK-2400N, Denmark Steven Abramowitch Musculoskeletal Research Center, Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA Lars Bo Anderson Institute of Exercise andSports Science, University of Copenhagen, DK-2200N, Denmark Arne Astrup Research Department of Human Nutrition, Royal Veterinarian and Agricultural...

Effects of joint immobilization and remobilization

Immobilization of a joint causes atrophy of the articular cartilage and the adjoining tissues of the joint 32 . Casting of the knee (stifle) joint of beagle dogs in 90 flexion for 11 weeks causes up to 20-48 reduction in GAG concentration of articular cartilage 33 . This is noteworthy because the GAGs bind cations and water which maintain the osmotic swelling property and turgor of cartilage. The GAGs are depleted mainly from the superficial zone of articular cartilage. The immobilized...

Effects of mechanical strain on bone turnover and bone remodeling

Bone remodeling is also affected by mechanical strain. The general trend is decreased bone degradation, possibly caused by reduced osteoclast recruitment as mentioned above. Young recruits subjected to military training display increased bone mass at the heel of 3 , but at the same time bone formation and resorption markers go down by 10-12 37 . The impact of physical activity on bone turnover may, however, depend on the kind of exercise performed. In dogs immobilization increases bone...

Effortinduced venous thrombosis

The etiology of effort-induced venous thrombosis is unknown, but it has been described in connection with the 'tennis leg', repetitive muscular use during jogging and kick boxing, in which intimal venous damage may occur as a result of knee hyperextension. There are also case reports of this syndrome occurring in American football and skiing 1 . Anatomic variations of the popliteal fossa veins may be an etiologic factor. The typical patient is the well-conditioned athlete who experiences a...

Elbow dislocation lateral instability and posterolateral rotatory instability

Lateral and posterolateral rotatory instability of the elbow is the late result of a significant trauma, often dislocation of the elbow, and is as such not only a sports injury. Dislocation of the elbow is quite common with an annual incidence of 6 100000 and representing 10-30 of all injuries to the elbow. It is usually caused by falling on an outstretched hand. In persons under the age of 20, 75 of lateral instabilities are caused by elbow dislocations, whereas in persons older than 20 years,...

Endocrine system

Aging is associated with many changes in endocrine function and a number of these changes are important with regard to physical activity. During growth and development an important role is played by growth hormone (GH) which is secreted by the anterior pituitary gland. The secretion of this hormone falls with increasing age. The fall in growth hormone secretion is particularly marked around 40 years and occurs at approximately 14 per decade 40 . The decrement in growth hormone secretion has...

Energetics during exercise

Estimated whole-body ATP turnover increases from about 0.08 mol ATP min at rest to 1-4 mol ATP min during running. The ATP turnover during 100 m running is 3 times higher than that during marathon running, whereas ATP turnover during the 5000 m is only 16 higher than that during a marathon. The difference in energy demand is reflected by a large difference in the energetic processes used. A mixture of the described energetic processes is normally used but the relative contribution varies...

Energy requirement vs nutrient requirement

Under normal conditions the body gives priority to covering its energy needs. In situations where its energy needs are not met, it will use all available energy-yielding substances in the food and body stores to cover energy requirements. This also means that the energy need essentially involves quantitative aspects of the dietary intake. The requirement for essential nutrients, i.e. protein, essential fatty acids, minerals and vitamins, is essentially related to fat-free mass and to a small...

Energy sources at rest

At rest, under postabsorptive conditions, fatty acids constitute the primary energy source, accounting for approximately 60 of energy requirements, leaving about 20 for carbohydrates and proteins, respectively. Postabsorptive conditions are said to be present when no nutrients are entering the blood from the intestinal tract. The energy liberated per gram of nutrient combusted is 17 kJ for carbohydrates and proteins and 39 kJ for fat. Therefore, the demand for fat combustion at rest can be...

Energy sources during exercise in the postabsorptive state

During exercise, the energy consumption may be increased by 20-fold. The primary factor determining whether carbohydrates or fat are preferentially used during exercise is the exercise intensity, the proportion of energy derived from carbohydrates growing progressively larger with increasing intensity. At a moderate exercise level of 100 W, demanding an oxygen uptake of around 1.5 L min, equalling an energy expenditure of 1800 kJ h, the proportions might typically change to 60 carbohydrates and...

Energy sources during exercise in the trained state

One factor counteracting the low fat combustion at high exercise intensities is the effect of training. It has been convincingly shown that, at a certain exercise intensity, a trained individual uses more fat than an untrained individual. This effect is quite strong and occurs after relatively short periods of training. One group of subjects was studied after 5 and 31 days of training for 2 h daily at a moderately high exercise intensity (60 of the pretraining Vo2max) 48 . Following 5 days of...

Epidemiologic evidence

Following the results of a survey by an expert group 5 of the global prevalence of obesity, the WHO has now declared obesity to be one of the major international health problems. The situation continues to worsen for example, the prevalence of overweight and obesity in England has doubled over the past 10-15 years 5 . In this same period energy consumption, estimated on a national level, has been seen to be decreasing. This must mean that energy expenditure by physical exercise has diminished...

Epidemiology

The incidence of lateral epicondylitis is about 50 in recreational tennis players over 30 years of age i . It is rarer in younger persons, probably because their tissue is stronger and more elastic, and in elite players, who in many cases have a better technique than recreational players. Besides racquet sports, lateral epicondylitis is also seen in squash and table tennis. The male female ratio is nearly i. The most important factors for development of lateral epicondylitis in tennis players...

Ergogenic substances

A number of diet-related supplements have been credited with the ability to improve performance. Today some of these are included in the list of doping drugs, such as caffeine (max 12 mg mL is allowed in urine) and alcohol. Among the (still) legal and most often used diet supplements are creatine, Q10, antioxidants and ginseng. The daily need of creatine is approximately 2 g day and it is covered through both the diet and the body's own production (through the amino acids argi-nine and...

Etiology of tendon overuse injury

In spite of the high incidence of tendon overuse injury, the etiology of this disease is unclear. The incidence of patellar tendon overuse injury also varies within the tendon. In the order of frequency, the incidence has by some authors been found to be 81 in the infrapatellar insertion, 13 in the tuberosity and 6 in the quadriceps patellar insertion site 85 . It has been generally believed that tendon overuse injury is related to cumulative trauma on tendons by repetitive mechanical loading....

Evaluation of joint range of motion

The goniometer is the gold standard tool for clinical measures of joint range of motion. These instruments are inexpensive and portable, and require only a basic understanding of anatomy for measurements on most joints. However, measurement sensitivity may preclude detection of clinically relevant effects, which is especially true when factoring in intertester variability. Therefore, it is advisable for the same tester to perform repeated measurements. It is also important for a tester to...

Evaluation of joint stability

Most clinical assessments of joint stability involve manual tests that, for the most part, require a high degree of expertise. Furthermore these manual tests are graded according to a subjective assessment of joint motion. The Lachman test for anterior knee instability and the anterior drawer tests for ankle and anterior shoulder instability are common clinical tests. In general the clinician attempts to assess the magnitude of translation and the quality of the ultimate restraint to...

Evaluation of muscle function

In sports medicine the restoration of muscle function is by far the largest component of most rehabilitation protocols. It follows that most standard evaluations of progress in rehabilitation primarily involve an assessment of muscle function. This assessment is usually based on some measurement of force-generating capacity. A multitude of factors must be considered when choosing a particular test of muscle function. Typical considerations include 1 What are the specific muscle groups of...

Examination of medialsided knee injuries

The tibial collateral ligament and associated medial collateral ligament complex is the primary stabilizer to valgus instability of the knee 17,18 . Since it is primarily isolated when the knee is flexed to 30 , this is the best position to perform stability testing for MCL complex injuries. In performing the valgus stress test at 30 of knee flexion, the patient is placed on the examination table such that one hand of the examiner is placed with the fingers over the medial joint line to measure...

Exercise and sports possibilities

It is important to realize that exercise and sport is not only for those who want to take part in competitions. Today sports clubs for the disabled organize all those who are interested in doing exercise and sport together with fellow men and women. In many clubs only 10 or less of the members take part in competitive sports, while the others only take part in the training and exercise activities. On the other hand, several high-level competition athletes are coached in clubs for the...

Exercise Calculate your own BMR

Table 2.4.2 Calculation of basal metabolic rate based on age, sex and body weight (W). From 1 . Table 2.4.2 Calculation of basal metabolic rate based on age, sex and body weight (W). From 1 . been established in order to calculate BMR with reasonable accuracy based on anthropometric data (weight, length, age and sex) 1 . It has been postulated that for survival, 24-h energy turnover represents about 1.27 times BMR, and for a sedentary lifestyle total energy turnover represents about 1.55 times...

Exercise in patients with stable heart failure

In congestive heart failure exercise tolerance is severely limited the peak pulmonary oxygen uptake may be less than 10 mL O2 kg min. This is due to central factors like attenuated myocardial function (the cardiac ejection fraction is often less than 20 ), decreased inotropic response and increased diastolic pressures, and peripheral factors such as reduced vasodilator response, increased activity of sympathetic afferents and impaired muscle function. Exercise training programs, for example...

Extensor carpi ulnaris tenosynovitis

Extensor carpi ulnaris (ECU) tenosynovitis is an uncommon condition seen typically in racquet sports 62,69 . The ECU is notable because of its distinct sheath which crosses the wrist (Fig. 6.7.12) 70 . The ECU is believed to contribute to the stability of the wrist. Patients with ECU tenosynovitis typically present with dorsal ulnar wrist pain and swelling. Examination demonstrates tenderness over the ECU at the wrist with pain provoked by ulnar deviation of the wrist and restricted...

Extensor insertional tenosynovitis

Extensor insertional tenosynovitis can occur in any of the extensor tendons. Pain along the tendon is the presenting complaint. The second dorsal compartment (extensor carpi radialis longus and brevis) is the most common of the extensor tendons to be affected. It may be associated with bony thickening at the insertion site which is referred to as carpal bossing 66-68 . This condition should be distinguished from a dorsal wrist ganglion where the mass is more proximal and transilluminates....

F

Fig. 5.1.9 (a) Medial elbow pain in a competitive throwing athlete. Coronal MR image discloses a non-acute high-grade tear at the ulnar attachment of the anterior band of the medial collateral ligament (arrow). Note the poor tissue remodeling, with residual signal hyperintensity. (b) Axial fast spin echo sequence in the same patient discloses an osteophyte (curved arrow) off the posteromedial margin of the elbow joint. Note the thinning of cartilage over the posterior margin of the trochlea...

Female reproductive function nutritional disorders and bone mineral content

If menarche is delayed beyond the age of 16, the condition is referred to as primary amenorrhea. Secondary amenorrhea is defined as a period of more than 6-months without menstruation, in a girl who has experienced her menarche. These conditions may be a consequence of poor nutrition and low body weight or, rather, low body fat. This is known for a fact from disorders of malabsorption. It is also known that the psychiatric disorder anorexia nervosa is accompanied by delayed puberty and primary...

Fiber types

Within the individual motor units muscle fibers with specific characteristics exist with regard to contractile, histochemical and metabolic activity. Furthermore, muscle fibers from a given motor unit are known to be located over a relatively large area of the cross- sectional area of the muscle (up to 25 ), indicating that within a given small muscle region all fibers represented in the muscle will be present. Two main categories of motor unit exist, one of which possesses a relatively slow...