References

Exercise, the menstrual cycle, and reproduction. Infertility ReprodMed ClinicsN Am 1998 9 667-87. 2 Warren MP, Shangold MM. Sports Gynecology Problems and Care of the Athletic Female. Cambridge, MA Blackwell Science, 1997. 3 Constantini NW, Warren MP. Physical activity, fitness, and reproductive health in women clinical observations. In Bouchard C, Shephard RJ, Stephens T, eds. Physical Activity, Fitness and Health International Proceedings and Consensus Statement....

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...

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...

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,...

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...

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 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...

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...

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...

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...

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 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 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 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 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...

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...

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...

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

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...

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...

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 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...

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...

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...

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....

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...

Foot pressure transducers

Force platforms as described above can be used to measure both static and dynamic plantar forces provided that the platform is capable of producing independent measures of both vertical and shear forces. In many applications, both clinical and athletic, it is desirable to have a continuous recording of the pressure distribution under the foot. Forces acting under the foot in various foot pathologies such as diabetic neuropathy, leprosies, injury and deformation are naturally different from...

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 ....

History and physical examination

A thorough and detailed physical examination of the knee is more useful than any other diagnostic test to aid the examining physician in determining the etiology of a patient's presenting complaints. The presenting complaints for the majority of knee injuries are fairly specific in the majority of cases and a clinician should have a general idea of what to expect on physical examination after reviewing a thorough history on a patient. The initial part of the history should start with the...

How is inflammation involved in muscle injury

It has been shown that after a bout of eccentric exercise, muscle maximum force generation continues to decline for several days. These data suggest that the initial mechanical events of exercise trigger subsequent events which result in further muscle injury. Tidball summarized in an excellent review the events following muscle injury cells 5 . Mononucleated cells are activated by injury, and then provide the chemotac-tic signal to circulating inflammatory cells. Three subsequent stages of...

How to measure energy turnover

Figure 2.4.2 illustrates the various methods that can be used for studies of the various compartments in energy turnover in humans. Energy turnover in the body comprises a conversion of energy between various forms mechanical energy as represented by physical exercise or muscular work heat production, which is also called thermogenesis. Sooner or later energy conversions result in heat production, i.e. dietary-induced thermogenesis Direct calorimetry (e.g. room, suit) Ergometers (e.g. bicycle,...

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...

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...

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...

Introduction

Injury to the head is a major cause of serious disability and fatality and tends to have a greater long-term effect than injuries to the extremities. Acute head injury is also commonly referred to as traumatic brain injury (TBI). The most common causes of TBI are automotive and contact sports-related accidents. Head and facial injuries in contact sports have been around since the first pugilists and wrestlers began competing thousands of years ago. The specter of serious head injury in athletes...

Lateral peroneal compartment syndrome

Isolated chronic compartment syndrome in the peroneal muscles is rarely seen. But several authors state that when there is an anterior compartment syndrome, the lateral peroneal compartment is simultaneously affected. Therefore standard surgery has been fas-ciotomy of both the anterior and lateral compartments of the leg 6 . The necessity of the strategy has been questioned, and one study 15 has shown that the results after fasciotomy of the anterior compartment alone were as good as when...

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...

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...

Meniscal injuries

Injuries to the menisci are common in sports, with an incidence between 6 and 10 10000 per year 50 . They are frequently the culprits for keeping athletes out of activity and for creating early osteoarthritis. The menisci are known to serve a crucial role in the complex biomechanics of knee joint function. The fact that meniscal injury and meniscectomy may result in early osteoarthritis of the knee serves as an impetus to advance our knowledge of this structure with regard to basic...

Mental health

Epidemiologic studies have shown associations between physical activity and symptoms of depression 98-101 , clinical depression 102 and general well-being. Most studies have used self-report questions for the assessment of both physical activity and mental health. These questions are useful to identify persons with perceived mental stress, but there is a poor relationship between questionnaire variables and clinical diagnoses of stress and depression 103 . Subjects with mood disturbances have...

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)...

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 .

Myocarditis

One reason why clinicians advise against performing vigorous exercise during acute infections is the potential for supervening myocarditis 7,8 . Acute exercise during ongoing viral myocarditis causes increased viral replication, inflammation and necrosis in the myocardium. Thus, swimming during the initial phase of coxsackie virus B3 infection in immunologically immature (2-week-old suckling) mice increased mortality 9 . Many of the affected mice died of congestive heart failure while swimming,...

Osteoporosis and related fractures

Osteoporosis is characterized by low bone mass and microarchitectural deterioration of bone tissue. These changes lead to enhanced bone fragility and increased risk of fractures. Osteoporosis as such without fracture is usually symptomless and the diagnostic criterion is bone mass. The most commonly used indicator of bone mass is areal bone mineral density (BMD, g m2), which can be measured accurately by dual-energy X-ray absorptiometry (DXA). Bone density accounts for 75-85 of the variance in...

Osteoporosis Introduction

The effects of exercise on the skeleton are generally thought to be positive, and numerous studies have indicated that physical activity increases bone mass in humans. Particularly for women, physical activity is recommended for preventing the development of osteoporosis, and regular, vigorous, weight-bearing activity of 1 h or more each week is associated with an increase in bone mineral density (BMD) within a normal population 38 . However, research also indicates that too much physical...

Overload injuries and degenerative changes

Athletes who include a large portion of weight-lifting in their strengthening exercises may trigger pain in the AC joint. This type of pain and AC problem appears under various names weight lifter's shoulder, lateral osteolysis of the clavicle and AC arthritis (Fig. 6.6.35). Overload problems in the AC joint have been described by several authors and not only in weight lifters 147 150 . When athletes other than lifters suffer from AC arthritis, this could simply be due to overambitious training...

Overuse injuries Introduction

Tendon overuse injury, often called tendinitis, is a common problem in both sports and industry. Data from the Bureau of Labor Statistics (1988) indicate that tendon overuse injuries account for 48 of reported occupational illness. Also, in a large European sports clinic, a quarter of all athletes treated for knee disorders were diagnosed with tendon overuse injury 83 . Clinically, the treatment of tendon disease has been largely empirical. Typical treatment protocols include combination of...

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...

Pathways involved in the spreading of the mechanical signal to neighboring cells

Mechanical strain causes membrane perturbations, stimulation of integrin clustering resulting in increased secretion of growth factors (Fig. 1.8.2). The most important growth factors associated with cellular responses to mechanical stimuli are transforming growth factor b (TGF-b), insulin-like growth factors (IGFs), fibroblast growth factor (FGF) and EGF. TGF-b, basic FGF, and IGF-I are present in high concentrations during distraction osteogenesis and localized to osteoblastic and a small...

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,...

Physical activity and bone mass

Physical activity can influence bone mass by causing compressive or bending loads on bone. If these are sufficiently strong, they can cause a temporary deformation, strain, in bone. As a result, primary and secondary responses occur that stimulate bone formation. The purpose of the increased bone formation can be thought to act as part of a homeostatic mechanism that aims to keep deformation of bone due to mechanical loading within narrow limits in order to avoid damage of the bone structure....

Physical activity and prevention of osteoporotic fractures

The lifetime risk of having at least one osteoporotic fracture is greater than 50 for women. This includes a lifetime risk of approximately 32 for vertebral fractures, 16 for hip fractures, 15 for wrist frac tures and 8 for humerus fractures 46 . Most vertebral fractures occur without trauma, solely as a result of osteoporosis. Most wrist and hip fractures are caused by a combination of mild or moderate trauma, usually a fall from a standing level, and osteoporosis. Thus, prevention of falls or...

Physical examination of the patellofemoral joint

The examination of the patello-femoral joint 15 starts with an overview of the mechanical axis of the extremity compared with the non-affected side. The q-angle (the intersection of the center line of the patellar tendon and the line from the center of the patella to the anterior superior iliac spine) is measured. The normal q-angle is reported to range between 10 and 15 with the knee in full extension. An increase in the q-angle may cause an increase in the peak patellofemoral pressure and may...

Physiologic agents

There are two possible strategies for revealing doping with an agent which naturally occurs or may occur in some physiologic conditions in the human body. The more laborious way to find the solution is to make quantitative determinations of the agent itself, e.g. growth hormone (GH), and of a number of potential 'markers' of its effects. In the case of GH such markers could be e.g. insulin-like growth factor (IGF-I) and IGF binding proteins. Measurements should be made in the blood and urine....

Posterior compartment syndrome

This pain syndrome is mainly seen in middle-distance and endurance runners as well as in orienteers. Symptoms appear during and after running and may progress to a chronic compartment syndrome located at the gastrocnemius-soleus muscle complex. Intracompartmental pressure measurements can confirm the diagnosis, and in case of elevated pressure, fasciotomy is the ultimate treatment. The common crural fascia can be opened posteriorly at one or both sides. In some cases pain of the posterior...

Prevention of osteoporosis and fractures later in life

PA, and especially exercise which poses high strain on the bones, is associated with an elevation in bone mass and bone mineral density during childhood and adolescence 22,23 . It has been estimated that a level of PA achievable by a large proportion of children and adolescents may increase peak bone mass by approximately 7-8 24 . If the activity-related increase of bone mineral density during adolescence is maintained through adulthood, this increase might be sufficient to prevent premature...

Principles of MR imaging

MR imaging is founded on the principle that certain nuclear species, such as hydrogen, possess inherent magnetic properties. When placed in a high-strength external magnetic field these nuclei will precess, which is a resonance phenomenon, according to the axis of the external field. In order to obtain diagnostic information from these precessing protons, radiofrequency pulses are sent into the patient, which convert these nuclei to a higher energy state, by 'flipping' them from the...

Prospective studies in women

Quite a few prospective studies have investigated physical training and BMD in pre- and post-menopausal women. Most studies of premenopausal women show some positive influence of physical training on bone. It appears that higher loads, such as those produced by greater impact, lead to greater bone mass. The activities through which these loads can be achieved need to be identified. Clearly, high-impact gymnastic training is not practical for most women, but a combination of stepping and jumping...

Questions

For the following statements, please answer true (a) or false (b). 1 Physical activity can prevent type 2 diabetes and reduce the burden ofcardiovascular disease. 2 Resistive training increases capillary density in skeletal muscle. 3 An intact insulin signaling cascade is necessary for exercise to stimulate glucose uptake in type 2 diabetes. 4 Physical training improves glycemic control in type 1 diabetes. 5 Physical training improves insulin sensitivity and induces potentially antiatherogenic...

Scintigraphy radionuclide bone scan

Scintigraphy is a modality that detects the distribution in the body of a radioactive agent injected into the vascular system. Following an intravenous injection of ra-diopharmaceutical agent, the patient is placed under a scintillation camera, which detects the distribution of radioactivity in the body by measuring the interaction of g rays emitted from the body with sodium iodide crystals in the head of the camera. The photoscans are obtained in multiple projections and may include either the...

Selenium

Selenium functions as an antioxidant alone in the detoxification of heavy metals in the body and as a cofactor of the antioxidant enzyme glutathione per-oxidase. Dietary selenium deficiency increases tissue oxidative damage and it seems that selenium has a sparing effect on tissue levels of vitamin E. However in experimental studies selenium deficiency does not impair endurance capacity in rats and supplementation in humans has no effect on physical performance 82 . Selenium has also been shown...

Sensation of dyspnea

Respiratory muscle oxygen consumption was once thought to increase disproportionately at high levels of ventilation, and thus contribute to a limitation of maximal oxygen intake, but more recent estimates suggest that patterns of breathing are adopted mainly to minimize dyspnea 101 . Because exercise is a voluntary activity, conscious humans stop exercise when the sensation of excessive effort and weakness in exercising muscle or of dyspnea becomes intolerable. A number of sensations related to...

Shoulder impingement

Basically there are three forms of impingement in the shoulder 1 primary impingement, in which the subacromial space is overcrowded and there is too little space for the supraspinatus and biceps tendons 2 secondary impingement, in which the rotator cuff is subject to microtrauma or overuse during motion, because of glenohumeral instability and 3 internal impingement, in which the undersurface of the rotator cuff collides with the superior rim of the glenoid. This is...

Skeletal muscle

Skeletal muscle is the largest organ in the body and has numerous functions most of which are impaired as a result of the aging process. Its prime role is to produce force and generate movement. It generates power during movement and also acts to brake movement. The force-generating ability of a muscle is primarily determined by its physiologic cross-sectional area. Measures of muscle strength made under isometric (static) conditions have shown that in both large and small muscles, in both men...

SLAP lesions

In the late 1980s and early 1990s, Synder and cowork-ers began to describe a lesion of the superior labral complex that included the biceps tendon 6 . This pathologic finding was called a SLAP (superior labrum anterior to posterior) lesion. Following review of over 700 shoulder arthroscopies, 20 patients had varying degrees of this SLAP lesion. The most common mechanism of injury was a fall on an outstretched arm that was forward and elevated, similar to the injury mechanism in posterior...

Spinal stenosis

Encroachment of the spinal canal, usually by hyper-trophic bone, produces signs of neural claudication, and is particularly problematic in the elderly runner or orienteering athlete (> 60 years). Symptoms may present at an earlier age when associated with previous fracture or spinal surgery. Symptoms and signs. Leg aching and numbness with or without back pain and morning stiffness. Reduced walking or running distance. Pain is normally reduced by forward flexion. In patients with a central...

Spondylolysisspondylolisthesis

Spondylolysis is defined as a defect in the vertebral isthmus (lysis) or most commonly the pars inter-articularis. Multiple factors may be involved in its genesis. In athletes, a stress fracture is considered to cause the defect, predominately located at the L5 level. Biomechanically, torsion against resistance, hyperextension and rotation are possible causative movements. Previous studies have described that spondylolisthesis is found in about 80 of spondy-lolytic lesions, but the frequency...

Sports medicine kit

A list of the most essential equipment and supplies which should be available for assessment and treatment of injuries during training and games is found in the box below. A presence of a large number of the items mentioned for general treatment is not necessarily based on scientific evidence for their effect, but is based on practical experience from team doctors and physiotherapists. Current list of permitted and prohibited Local anesthetic, local glucocorticoid Strapping tape 12 mm, 25 mm,...

Summary

Overall, exercise is extremely beneficial to women. It reduces adiposity while improving cardiovascular fitness, physical endurance, work capacity, muscle mass, muscle strength, flexibility, neuromuscular coordination and cognitive function. However, overtraining, energy deficit and or disordered eating can result in reproductive dysfunction for athletes. Untreated amenorrhea may result in an increase in the incidence of stress fractures, scoliosis and thin body mass, and greatly increases the...

The esophagus

Exercise has been reported to cause heartburn associated with gastroesophageal reflux (GER) 23,24 and chest pain of esophageal origin. However, chest pain, whenever it occurs in the setting of exertion, demands an evaluation for cardiac cause prior to specific esophageal evaluation. Esophageal motility changes occur with exercise. However, it is difficult to quantify physiologic manometric changes in the face of movement artifact induced by running and many studies have used a cycling model....

The frequency of lower leg injuries

Lower leg overuse injuries comprise approximately 10 of all overuse injuries in athletes. In younger athletes, the incidence is lower than in older. In runners, lower leg injuries account for approximately 20 of all injuries 2,3 . James et al. 4 evaluated 232 lower leg pain conditions in 180 runners, of which 13 were lower leg overuse injuries. Some of these (6 ) were stress fractures of the tibia and or fibula. The frequency of different pain syndromes of the lower leg varies according to...

The inguinal canal and associated structures

A number of lower abdominal lesions giving rise to groin pain in connection with athletic activities have been described. They have been named sports hernia, sportsman's hernia, incipient hernia, Gilmore's groin, pubic pain, athletic pubalgia and others. The lesions seem to be non-specific and difficult to describe pathoanatomically. The pathologic findings at surgery have been described in subjective terms as 'loose-feeling inguinal floor', 'thinning of the fascia', 'tendency to bulge',...

The risk to the individual

The risks of deleterious effects of physical activity in an infected person vary considerably, depending both on the location, degree and cause of the infection and on the intensity and type of physical activity. Vigorous or prolonged physical activity as well as intensive mental stress can lower the defense against infection. Furthermore, a subclinical complication of infection, e.g. myocarditis, can be aggravated by physical exertion. The risk level is generally higher in a competing...

Triquetrum impaction fractures

Fractures of the triquetrum are seen in athletes however, there is no consistent association with any particular sport 3 . They tend to happen as a result of a fall or blunt trauma to the dorsum of the hand. Others have suggested impaction of the triquetrum against the ulnar styloid 3,84 . Patients present with dorsal ulnar wrist pain. Placement of the wrist in the position of dorsiflexion and ulnar deviation will reproduce the pain. Another consideration with this injury is associated carpal...

Type I

It includes only partial injury to the joint and ligaments. Clinically there may be some swelling and always pain and tenderness Fig. 6.6.32 The uninjured acromioclavicular joint with intact capsule, joint ligaments and coracoclavicular ligaments. Fig. 6.6.32 The uninjured acromioclavicular joint with intact capsule, joint ligaments and coracoclavicular ligaments. over the AC joint. X-ray is normal. This injury usually heals uneventfully, even though...

Type of injury

Sports-related injuries are commonly categorized into (i) macrotrauma trauma sustained during a direct sudden event, and (ii) microtrauma trauma sustained from repetitive, often low-impact, activity. Macro-trauma often occurs in sports involving some form of impact, such as a contact sport (ice hockey or football) or a high-velocity sport (downhill skiing). Knee injuries involving anterior cruciate ligament tear, joint dislocation, rupture of muscle or soft tissue injury are common examples of...