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 )...

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,...

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...

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 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...

Arrhythmias

Exercise increases vagal tone and may decrease the need for rate regulation by drugs. When heart rate is well controlled during exercise, the subject may exercise to tolerance. Patients with atrial fibrillation are, however, often treated with anticoagulants and should therefore avoid contact sports. Patients with chronic atrial fibrillation can improve functional capacity through an exercise rehabilitation program 30 . Subjects with atrial fibrillation may compete at high level even in...

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...

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 response to stretch

The relationship between the force and the deformation (expressed as the slope of the line, AF AL) is the stiffness of the structure 116 . That is, the increase in deformation is proportional to the applied force (Hooke's law), such that a stiffer structure will deform less for a given applied external load. The reciprocal of stiffness (AL AF) is termed compliance. The area under the curve is the energy absorbed by the structure that can potentially be returned when the load is removed. The...

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...

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 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...

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...

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....

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...

Causes of overtraining

During exercises performed at intensities well below the aerobic-anaerobic transition, no significant rise in blood lactate levels and only slight stimulation of sympathetic activity is to be expected. In contrast to this, prolonged training performed at intensities exceeding the range of the individual anaerobic threshold is characterized by a disproportionate increase of stress hormone (free epinephrine and norepinephrine) concentration, and thus the frequency of such training sessions should...

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...

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

Ekstrand J, Gillquist J, Liljedahl SO. Prevention of soccer injuries. Supervision by doctor and physiotherapist. Am J Sports Med 1983 11 116-120. This study is recognized as the first randomized controlled trial (RCT) examining the effects of an injury prevention program in sports. Ekstrand and his coworkers used the classic four-sequence injury prevention approach in a series of studies. Firstly, they described the magnitude of the problem of soccer injuries in terms of their incidence and...

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...

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...

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...

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...

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...

Definitions

Eating disorders are characterized by disturbances in eating behavior, body image, emotions and relationships. Athletes constitute a unique population, and special diagnostic considerations should be made when working with this group 105,115,116 . Despite similar symptoms subclinical cases in athletes are easier to identify than in non-athletes 108 . Since athletes, particularly at the elite level, are evaluated by their coach every day, changes in behavior and physical symptoms may be...

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...

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...

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...

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...

Energy density vs nutrient density

The energy density of a diet refers to the amount of energy per weight or volume, while the nutrient density refers to the amount of nutrient in relation to energy, i.e. g 10 MJ. Foods rich in fat and sugar have a high energy density, while their nutrient density is low. Persons with a high energy turnover, i.e. endurance athletes, may however cover their nutrient needs even on a diet with low nutrient density if they are in energy balance, while a low nutrient density may be detrimental in...

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 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...

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...

Focal brain injuries

Focal brain injuries usually involve some noticeable localized damage to cranial tissues and blood vessels. These include epidural hematoma, subdural hematoma, intracerebral hematoma and cerebral contusion. A hematoma is a blood clot within the brain or on its surface. Epidural hematoma is an infrequently occurring sequel to head trauma (0.2-6 ). It occurs as a result of tears of the middle meningeal artery and is not due to a brain injury. Due to pressure cased by the hematoma on the brain,...

Functional adaptations

In addition to structural adaptations, endurance training produces functional improvements in cardiac performance during exercise 25 . Most notable is a more rapid early and peak ventricular filling rate during diastole. An enlarged blood volume, together with greater ventricular compliance and distensibility, and a faster and more complete ventricular relaxation are important factors allowing stroke volume to increase even at high heart rates during exercise 9,26 . Improved myocardial...

GI physiology with exercise

Gastrointestinal physiology has traditionally been studied at rest and the methodology is typically vali dated for resting conditions. Experimental stress on the GI tract is more typically generated by drugs or disease. Evaluation of GI physiology under the stress of exercise often requires extensive modifications in experimental techniques and most GI physiologists are untrained in these methods. Intestinal motility, for example, is extremely sensitive to motion artifact. This has limited the...

GI symptoms abdominal pain cramps and diarrhea

Initial reports found that up to half of all marathon runners have occasional loose stools or three or more bowel movements per day. Furthermore, the urge to defecate, abdominal cramping and increased flatulence are common lower GI symptoms of runners. A small percentage of marathoners report bloody bowel movements with running. Upper GI symptoms such as heartburn are not infrequent, particularly during running. Other upper tract symptoms include increased eructations, abdominal pain, nausea...

Glycogen resynthesis

During the postexercise period, restoration of muscle glycogen reserves is crucial for recovery of exercise capacity 22,23 . Glucose is the major precursor for glycogenesis and must be supplied in the postexercise period to facilitate muscle glycogen resynthesis. The lowering of muscle glycogen levels during exercise results in activation of the enzyme glycogen synthase 24 and the more extensive the glycogen depletion, the greater the activation of glycogen synthase and glyco-gen storage 25 ....

Gymnasts wrist

The popularity of gymnastics has increased over the past two decades. There are often overuse injuries at the level of the wrist associated with gymnastics 12 . Chronic repetitive compressive forces on the distal radius have adverse effects on enchondral ossification. Repeated microtrauma may disrupt the metaphyseal vascular network. This may result in a wide and irregular physis 3 . Patients will present with a prolonged history of dorsal wrist pain that is exacerbated by activities and may...

Haglunds disease

Haglund's disease is similar to Osgood-Schlatter's disease in the knee joint as far as symptoms and origin are concerned. This disease occurs particularly in young people between 12 and 14, and the problem disappears during late puberty. The Achilles tendon attachment is strained where the tendon attaches to the heel bone, probably after running on a hard surface, when the Achilles tendon attachment is subject to repeated tension. Fragmentation of bone then occurs and can be seen on...

Heat injury

When the body core temperature increases above the normal level, due to internal or environmental heat stress, clinical symptoms of heat illness may develop. These symptoms range from mild discomfort, swelling of the legs, dizziness or ortostatic syncope in the upright position, heat cramps and heat exhaustion, to the severest form of heat illness, heat stroke, which may be lethal. Heat exhaustion is usually the result of fluid loss from the vascular system with accompanying cardiovascular...

Hormonal regulation of carbohydrate metabolism during exercise

Changes in insulin and glucagon have been reported to account for practically all of the increase in hepatic glucose output with exercise 65,66 . It is believed that the decrease in insulin concentration with exercise makes the liver more sensitive to the stimulation by glucagon. Sympathetic nervous stimulation seems to have no role in stimulating hepatic glucose output during exercise in humans, whereas epinephrine has a stimulating effect, additional to that of glucagon, during prolonged...

Hypothenar hammer syndrome

Thrombosis of the ulnar artery in Guyon's canal may occur in sports such as judo, karate, basketball, hockey, handball and lacrosse 3,5,77,78 . It may occur as a result of a single traumatic event or as a repetitive trauma 10 . The ulnar nerve and ulnar artery are susceptible to injury in Guyon's canal. Injury to the ulnar artery may involve only the intima, in which case thrombosis occurs. A true aneurysm results from fusiform swelling of all three areas of the arterial wall, and false...

Imaging

Plain radiographs are usually the first choice in most conditions involving the pelvis and the hip joints (Fig. 6.3.4). When osseous involvement is suspected a stan- Fig. 6.3.4 X-ray of a female long-distance runner with groin pain. The X-ray shows a stress fracture in the pubic bone (arrows). Fig. 6.3.4 X-ray of a female long-distance runner with groin pain. The X-ray shows a stress fracture in the pubic bone (arrows). dard radiologic examination should include an antero-posterior projection...

Imaging of specific injuries

MR imaging has been shown to be accurate in depiction of meniscal and ligament tears of the knee 6,7 . Meniscal tears are classified by an intrameniscal grading system for internal signal 8 or by the presence of abnormal meniscal pathology, in which the diagnosis of a radial split, displaced fragment or bucket-handle tear may be seen (Fig. 5.1.6). An awareness of normal meniscal vascularity is essential in order to aid in preoperative planning for potential meniscal repair. While a high...

Immune system

During both moderate and vigorous physical activity leukocytes in the blood increase, which is a strengthening of the defence system. However, after prolonged intensive exercise with a duration of more than an hour at above 75 of aerobic capacity, a weakening of the immune system is found hours to days afterwards. Experimental research in animals support this hypothesis 96 , but in humans the risk of infections has been studied in epidemiologic studies. About 10 studies have reported on upper...

Important questions to be asked about the present symptoms in athletes with groin pain

What is the precise location What are the symptoms Does the pain radiate anywhere What can provoke the symptoms When does it happen The present activity level is also important, including not only sports-related activities but also work and leisure time activities. groin or the gluteal region, a rather comprehensive examination is required. In such cases a systematic approach is imperative. It is important to realize that most examination methods are not evaluated scientifically and...

In vivo tendon and ligament force measurements in humans

Information on the forces produced by individual skeletal muscles, tendons and ligaments is important to the understanding of muscle mechanics, muscle physiology, musculoskeletal mechanics, neurophysiol-ogy and motor control. The methods applied to produce these forces have been both direct and indirect. Indirect estimation can refer to such methods as the mathematical solution of the actual muscle force in the indeterminate musculoskeletal system. Electromyography (EMG) has been used as an...

Inflammation in pelvic joints

Inflammatory conditions may be seen in the joints of the symphysis and sacroiliac joints. Sacroiliitis is not uncommon in outdoor winter sports. Sacroiliitis can also be a symptom in a generalized disease such as rheumatoid arthritis or Bechterew's disease. Pain and or discomfort may radiate to the groin, to the hip joint, or to the thigh. Changes in the sacroiliac joints may be present without the athlete feeling any pain. The symptoms may be vague and most pronounced in the morning. Long...

Instability

Instability is usually a result of an acute injury. This type of trauma is not uncommon among e.g. skiers, cyclists, ice hockey players and wrestlers (Fig. 6.6.32). In cases with extreme hyperlaxity, AC (as well as stern-oclavicular) instability may occur without trauma. The classic trauma is a fall when the athlete is holding the arm in adduction. This will induce a force acting to push the shoulder downward. Since the clavicle is medially fixed to the sternum and rests on the rib cage, the...

Introduction

A physically active lifestyle and active participation in sports and physical activity is important for all age groups. Reasons to participate in sports and physical activity are many, such as pleasure and relaxation, competition, socialization, and maintenance and improvement of fitness and health. However, sports participation also entails a risk for overuse injuries as well as acute injuries, which may even lead to death or permanent disability. In the following chapters the health benefits...

Is there a special nutritional problem in training athletes

Elite athletes represent a group of individuals with usually high energy turnover, who experience intensive physical stress. The high energy turnover results in emptying their glycogen depots and in increased fat and protein turnover over shorter or longer intervals. Thus their training and competition schedule dominate their daily life and call for specific energy and nutrient demands and meal patterns. The principle behind any dietary advice to athletes is that priority should be given to...

Lactate formation

During glycolysis muscle glycogen or blood-borne glucose are partially degraded to pyruvate or lactate in about 10 well-defined enzymatic steps. Glycolysis from glycogen results in a higher yield of ATP (3 moles of ATP per mole of glucosyl unit) than glycolysis from glucose (2 moles ATP per mole glucose). Glycolysis to pyruvate precedes the aerobic combustion of CHO in the mitochondrion and is therefore named aerobic gly-colysis. Pyruvate can be transferred to lactate, which is a dead-end...

Lateral and posterolateral rotatory instability

The symptoms of lateral and posterolateral rotatory instability are not typical. They vary according to the degree of instability. Redislocations are rare. Most commonly complaints are vague diffuse elbow pain, clicking, catching, locking and snapping during activity. Posterolateral rotatory instability most often shows as episodes of apprehension when the arm is supinated in extension, or during supination in slight flexion when valgus stress is applied to the arm 18,51 . Demonstration of...

Left ventricular and right ventricular cavity dimension and wall thickness

The advances in non-invasive techniques like ultrasound and magnetic resonance imaging have made studies of left ventricular (LV) dimensions in athletes easy and accurate and there are now numerous concordant studies. Most studies have used echocardiogra-phy. LV end-diastolic diameter is normally between 43 and 59mm in adult men and 40-52 mm in women, depending mostly on body size. Wall thickness refers to the interventricular septum which is normally 812 mm or the LV posterior wall which is...

Legal substances or procedures

In addition to the doping substances described above, it is clear that legal approaches can also result in performance enhancement. With regard to endurance, it has been documented that altitude training, especially if training is carried out at a moderate altitude ( 1000 m) and the rest of the time is spent at a somewhat higher altitude ( 2500 m), can result in some marginal improvement. Furthermore, the use of artificial low-oxygen 'altitude' houses has been shown to increase Hb concentration...

Ligament dynamization

The glenohumeral ligaments and capsule are relatively lax in the midranges of joint rotation and seem to function only at the end ranges to limit excessive translations and prevent further rotation of the humerus with respect to the scapula 18,26,33,37 . Studies have demonstrated that the rotator cuff tendons attach directly to the various capsuloligamentous components 38 . Therefore, it is possible that the glenohumeral capsule and ligaments may be loaded during contraction of the rotator cuff...

Ligaments physiology and repair

Athletic activities can result in a wide variety of joint injuries through either direct trauma or repetitive stress 61 . Although the predilection for specific injuries varies with the sport (e.g. elbow instability in baseball players, shoulder dislocations in football players and wrestlers, knee injuries in basketball players), all injuries can be debilitating and often involve ligamentous structures. Ligaments are structures that are known to play an important role in mediating normal joint...

Management

Chronic Achilles tendon disorders should be divided into conditions affecting the tendon insertion, the free tendon, the proximal tendon-muscle transition, and the paratenon. In clinical practice, there is often a combination of paratenon and tendon involvement. It is logical that there is some degree of relationship between paratenon and tendon disorders. There is a lack of controlled studies on operative and non-operative treatment of chronic Achilles tendon disorders. Clement et al. 40...

Maximal aerobic power

In elite athletes from endurance sports values for maximal aerobic power (V02 ) of > 6.5 L min or > 90 mL min kg body weight are frequently obtained. These extremely high values are primarily due to a large maximal cardiac output (Qmax). Values of more than 40 L min have been measured 8 . Since the arteriovenous oxygen difference (a-v 02diff) during maximal exercise in these well-trained athletes does not differ from that in less trained individuals but is somewhat larger than in untrained...

Medical issues

Eating disorders may cause serious medical problems and can even be fatal. Whereas most complications of anorexia nervosa occur as a direct or indirect result of starvation, complications of bulimia nervosa occur as a result of binge eating and purging 116 . Hsu 107 , Johnson et al. 128 , and Mitchell 129 provide information on the medical problems encountered in eating-disordered patients. Anorexia nervosa has a standard mortality rate up to six times higher than that of the general population...

Methods of detection

The requirements of the IOC for the accreditation of doping laboratories include sophisticated instrumentation. Most of the methods are based on gas chro-matography and sensitive and selective detectors. Development of analytic techniques and instrumentation has been fast in recent years allowing ever better resolution, identification and detection of smaller and smaller amounts of analytes with sufficient certainty. High-resolution and tandem mass spec-trometry, liquid chromatography combined...

MHC isoform composition fiber type conversion

When a nerve impulse reaches the muscle fiber, the muscle membrane is depolarized and calcium is released to the interior of the cell from specialized intra-cellular organelles (sarcoplasmatic reticulum), in turn triggering a transient process of cyclic attachment and detachment of cross-bridges between actin and myosin molecules within the muscle fiber. As a result of this cross-bridge cycling, the actin and myosin filaments perform a sliding movement relative to each other while generating...

Minerals

Minerals and trace elements constitute about 4 of the body. The dominant part is calcium phosphate in the skeleton, representing almost 2-3 of body mass, while the trace elements constitute less than 0.02 . As the latter play an essential role in the metabolic function of the body, trace elements represent essential nutrients which must be consumed regularly, albeit in small amounts. Today 21 minerals and trace elements have been identified as essential, but recommended daily allowances (RDA)...

Multiple choice questions

1 The population-attributable risk of coronary heart disease is given in a table. This measure is a the decrease in risk a subject will get if he she changed the level of a risk factor to the level recommended in the table b the number of deaths that would be prevented if a successful campaign were carried out c the number of deaths that theoretically could be prevented if all subjects had the most favorable behavior d the percentage that would survive if the risk factor levels were above the...

Muscle fatigue and metabolism

The cause of muscle fatigue (i.e. inability to maintain a defined exercise intensity) is considered to be multifactorial. The classic hypothesis is that muscle fatigue is caused by failure of the energetic processes to generate ATP at a sufficient rate. The evidence for this hypothesis is that interventions which increase the power (i.e. aerobic training, hyperoxia, blood doping) or capacity (i.e. CHO loading, creatine supplementation, glucose supplementation) of the energetic processes result...

Musculocutaneous nerve overload

The nerve can be compressed between the lateral border of the biceps aponeurosis and the brachial fascia during repetitive elbow extension combined with forearm pronation. Symptoms are burning hyperesthesia in the lateral forearm, and tenderness and weakness of the biceps muscle. Examination reveals atrophy of biceps and reduced sensation on the lateral forearm. Treatment consists of rest and with persisting symptoms decompression with resection of a wedge of the biceps aponeurosis 56 .

Myocardial vascularization and perfusion

In a comparison of the cross-sectional area of proximal coronary arteries from endurance-trained and sedentary humans it has been suggested that coronary vascular volume may be increased by training 31 . It remains unresolved whether in humans endurance training increases coronary vascular dimensions beyond the vascular proliferation that accompanies normal training-induced cardiac hypertrophy. On the basis of studies in rats, endurance training has been shown to increase myocardial capillary...

Natural history of MCL injury

Healing of the MCL has been found to be a long and complex process that is subject to local and external influences. Generally, the process involves several discrete but overlapping phases the acute inflammatory or reactive response phase, the repair phase, and finally the tissue remodeling phase. In the acute inflammatory phase, the cellular and tissue responses to injury occur within approximately the first 72 h following a given insult. Capillary damage results in enhanced permeability of...

Nerve disorders

Nerve disorders can be common in certain athletic endeavors such as cycling, baseball, karate, rugby and handball 3 . Problems in these athletes may include carpal tunnel syndrome, cyclist's palsy, gymnast palsy and Wartenberg's syndrome. The cause of these disorders is believed to be mechanical compression secondary to local tissue edema, blunt trauma, adjacent joint synovitis or equipment constraints which results in compression and vascular compromise of the nerve. This mechanical...

Occurrence of stress fractures

Breithaupt reported in 1855 metatarsal stress fractures in soldiers after long marches. A stress fracture is a dynamic, metabolic process of bone, in which remodelling dominates over repair, and is related to overuse impact. The character of the load and the degree of training seems to be of importance for the occurrence of stress fractures. Of 324 consecutive patients with stress fractures 84 were athletes at district or national elite level, while the remaining 15 were sedentary individuals 8...

Optimal nutrition for physical training and competition a challenge for nutritional science

In order to perform optimally during daily training as well as during competition, it is essential that an ath lete's habitual diet contains enough of both required nutrients and fluid. An optimal nutrient and fluid status is also important to avoid injuries and to optimize the immune system. Not only nutrient composition, but also timing and frequency of food and fluid intake are critical for optimal performance. One of the reasons for the common idea that athletes need special diets might be...

Pathophysiology

In secondary impingement, there is nothing 'in the way' in the subacromial space, nothing that the humeral head naturally can collide with. The humeral head is brought into a position where it can collide with the acromion because of hypermobility of the head. The pathogenesis of secondary impingement seems to be glenohumeral instability with insufficiency of both the passive and dynamic stabilizers (lengthening of the glenohumeral ligaments and the anterior capsule, and dyscoordination and...

Peripheral vascular adaptations

Regular physical activity results in peripheral vascular adaptations which enhance perfusion and flow capacity. Thus it has been shown that total leg blood flow during strenuous exercise increases in parallel with the rise in maximal aerobic power. In addition, the muscle arteriovenous oxygen difference is significantly greater after conditioning. Such adaptations may arise from structural modifications of the vasculature and alterations in the control of vascular tone 64,65 . The increase in...

Peripheral vessel diseases

In patients with intermittent claudication, arterial insufficiency in the legs, the major goal is to improve the ability to walk. Exercise training programs have great impact on functional capacity. Pain-free walking time may increase almost 200 and maximal walking time may be more than doubled in patients participating in an exercise program, and walking speed may increase substantially with an exercise program. A treadmill training program improves functional status during daily activities,...