High-level Athlete Research Articles

The epidemiology of abnormal hemoglobins in Mediterranean high-level athletes

The aim of this study was to determine the prevalence and nature of hemoglobin (Hb) defects in a Mediterranean high-level (HL) athlete population. Five hundred and ninety-four HL male and female athletes were recruited during the annual follow-up of the members of Tunisian national teams. Hematological data, Hb electrophoresis, and DNA analysis were assessed using conventional techniques. Sporting discipline, type of sport, and performance levels were assessed using a questionnaire. The results showed that 32 HL athletes had abnormal Hb (5.4%): beta-thalassemia (2.2%), alpha-thalassemia (0.5%), HbAS (1.5%), HbAC (0.5%), and rare Hb variants (0.7%). Of the 32 defect carriers, all but one (a alpha-thalassemia) were heterozygous. All the detected hemoglobinopathies but one (an Hb Hope) had already been reported in the country. The prevalence of Hb defect in the HL athletes was similar to that described in the general Tunisian population (P > 0.05). The percentage of Hb defect in the athletes was not dependent on gender, or performance level (P > 0.05). Within each type of sport the percentages of athletes with normal and abnormal Hb were similar (P > 0.05). The hematological data revealed the diversity of anemia, microcytosis, and hypochromia in thalassemic HL athletes. We concluded that HL athletes in Tunisia were a representative sample of the general Tunisian population regarding the prevalence and nature of benign abnormal Hb. The hematological data of the thalassemia carriers exhibited high variability and raised the question of genetic and sporting counseling, as well as biological follow-up for these carriers.

The International Olympic Committee (IOC) Consensus Statement on periodic health evaluation of elite athletes March 2009

The Olympic Games is the largest sport event in the world. In Beijing, 10 500 athletes competed, selected from a large group of elite athletes in 204 countries. Sports participation...

The International Olympic Committee (IOC) Consensus Statement on Periodic Health Evaluation of Elite Athletes: March 2009

The International Olympic Committee (IOC) Consensus Statement on Periodic Health Evaluation of Elite Athletes: March 2009

Knee Motion and Muscle Activity Before and After ACL Rupture

PURPOSE: to describe knee kinematics and muscle activity before and after an anterior cruciate ligament (ACL) rupture METHODS: A 37 year old male high level athlete was evaluated in the motion analysis lab after tearing his right ACL. Kinematic and EMG data were collected for both limbs during gait. 22.5 months after surgery he ruptured his left ACL. Kinematic and EMG data were collected again for both limbs. Variables of interest were knee flexion angles at peak knee flexion and muscle co-contraction values. Kinematic data were collected with a eight camera 3-D motion analysis system. Muscle activity was recorded using a 16 channel EMG system. EMG data were recorded for the medial and lateral hamstrings (MH and LH), vastus medialis and vastus lateralis (VM and VL), and medial and lateral gastrocnemius (MG and LG). Co-contraction indices were derived for each muscle pair (VMMH, VMMG, VLLH and VLLG) during weight acceptance and during mid-stance. Using descriptive tests, we compared kinematic and EMG data on the left leg prior to injury to data collected after left ACL rupture. RESULTS: During weight acceptance, co-contraction values for the quadricepshamstrings pairs increased (VL/LH: 62%; VM/MH: 38%), while the values for the quadriceps-gastrocnemius pairs decreased (VL/LG: 62%; VM/MG: 78%) after the ACL rupture. The peak knee flexion angle increased by 4.1 degrees after the left ACL rupture. All co-contraction values increased during mid-stance after the ACL rupture (VL/LH: 372%; VL/LG: 5%; VM/MH: 200%; VM/MG: 198%). CONCLUSIONS: Our hypotheses were partially supported as greater co-contraction values were seen after ACL rupture in the quadriceps:hamstrings pairs throughout gait and quadriceps:gastroc pairs during mid-stance. However the decreased co-contraction in the quadriceps:gastroc pairs and increase in the peak knee flexion angle were not expected. The increase in the quadriceps-hamstring co-contraction and decrease in the quadricepsgastrocnemius co-contraction may allow the quadriceps to pull more forcefully on the tibia as the hamstrings help to stabilize the tibia posteriorly while the gastrocs decrease their posterior force on the femur. During mid-stance, the large increase in the amount of cocontractions may reduce the risk of hyperextension as the knee moves into extension. NIH & FPT funding

Talocrural Dislocation With Associated Weber Type C Fibular Fracture in a Collegiate Football Player: A Case Report

To present the case of a talocrural dislocation with a Weber type C fibular fracture in a National Collegiate Athletic Association Division I football athlete. The athlete, while attempting to make a tackle during a game, collided with an opponent, who in turn stepped on the lateral aspect of the athlete's ankle, resulting in forced ankle eversion and external rotation. On-field evaluation showed a laterally displaced talocrural dislocation. Immediate reduction was performed in the athletic training room to maintain skin integrity. Post-reduction radiographs revealed a Weber type C fibular fracture and increased medial joint clear space. A below-knee, fiberglass splint was applied to stabilize the ankle joint complex. Subtalar dislocation, Maisonneuve fracture, malleolar fracture, deltoid ligament rupture, syndesmosis disruption. The sports medicine staff immediately splinted and transported the athlete to the athletic training room to reduce the dislocation. The athlete then underwent an open reduction and internal fixation procedure to stabilize the injury: 2 syndesmosis screws and a fibular plate were placed to keep the ankle joint in an anatomically reduced position. With the guidance of the athletic training staff, the athlete underwent an accelerated physical rehabilitation protocol in an effort to return to sport as quickly and safely as possible. Most talocrural dislocations and associated Weber type C fibular fractures are due to motor vehicle accidents or falls. We are the first to describe this injury in a Division I football player and to present a general rehabilitation protocol for a high-level athlete. Sports medicine practitioners must recognize that this injury can occur in the athletic environment. Prompt reduction, early surgical intervention, sufficient resources, and an accelerated rehabilitation protocol all contributed to a successful outcome in the patient.

Relations entre orientations motivationnelles et burnout : une étude chez des adolescents du pôle espoir handball

Introduction The aim of this study was to examine the links between the goal orientation and the burnout. Participants were 248 boys’ players and 213 girls’ players aged 15,68 years. Synthesis of the facts The results showed that the ego and task oriented adolescents are more self-determined, are less anxious, more self-confidence, and perceive a more important achievement in comparison to other groups of athletes. Conclusion A high level athlete oriented at the same time on ego and task goals has more favourable psychological characteristics that can reduce the risk of burnout.

Acute, Exertional Medial Compartment Syndrome of the Foot in a High-Level Athlete

Acute, Exertional Medial Compartment Syndrome of the Foot in a High-Level Athlete

Femoroacetabular impingement in 45 professional athletes: associated pathologies and return to sport following arthroscopic decompression

Femoroacetabular impingement (FAI) occurs when an osseous abnormality of the proximal femur (cam) or acetabulum (pincer) triggers damage to the acetabular labrum and articular cartilage in the hip. Although the precise etiology of FAI is not well understood, both types of FAI are common in athletes presenting with hip pain, loss of range-of-motion, and disability in athletics. An open surgical approach to decompressing FAI has shown good clinical outcomes; however, this highly invasive approach inherently may delay or preclude a high level athlete’s return to play. The purpose of this study was to define associated pathologies and determine if an arthroscopic approach to treating FAI can allow professional athletes to return to high-level sport. Hip arthroscopy for the treatment of FAI allows professional athletes to return to professional sport. Between October 2000 and September 2005, 45 professional athletes underwent hip arthroscopy for the decompression of FAI. Operative and return-to-play data were obtained from patient records. Average time to follow-up was 1.6 years (range: 6 months to 5.5 years). Forty two (93%) athletes returned to professional competition following arthroscopic decompression of FAI. Three athletes did not return to play; however, all had diffuse osteoarthritis at the time of arthroscopy. Thirty-five athletes (78%) remain active in professional sport at an average follow-up of 1.6 years. Arthroscopic treatment of FAI allows professional athletes to return to professional sport.

L'arrêt du sport intensif : révélation d'addictions ?

This study aims to show the impact of ending intensive sport activities on the psychic life of two former high level sportsmen and this under a psychoanalytical point of view. The question is to know whether ending intensive sport activities can be at the origin of an addiction of replacement (knowing meanwhile that the sportsman cannot accept the loss of his high level athlete statute) and whether the depression and the drop in self-esteem at the end of a sportsman's career are inevitable. The ending of a sportsman's career also puts an end to his quasi-pathological identity research, research which could be compared to a borderline behaviour. Moreover, a high level sportsman is more vulnerable at the end of his career and can be much more inclined to become dependent on drugs or on other addictions. During his career two distinct worlds surround him: the sporting family of adoption and the family unit. We can therefore question whether the sportsman dissociates these two families on a psychical level in order not to fall into a depression or into another dependence. Stopping sport activities is thus synonymous with a total loss of oneself; and this can therefore involve an anguish of separation and a probable fall into a social vacuum and into addiction.

Plyometric and agility training into the regimen of a patient with post-surgical anterior knee pain

Objectives The objective of this case report is to present an approach to clinical outcome assessment for a high-level athlete with post-surgical anterior knee pain. Additionally systematic dosage and patient response to plyometric and agility training exercises is presented. Design Case report. Case description A 23-year-old athlete, 12 weeks post-surgery, with left knee pain and swelling preventing participation in practice and competition. The athlete attended therapy for 8 weeks. In the final 4 weeks, agility drills and plyometric exercises were introduced into the rehabilitation regimen. Main outcome measures Outcome measures used were the Lower Extremity Functional Scale (LEFS), Knee Outcome Survey, vertical jump, T-test agility test, and 40-yard sprint test. Results During the “return-to-sports” phase of rehabilitation, the patient had meaningful changes on the LEFS, Knee Outcome Survey, vertical jump, T-test agility test, and 40-yard sprint. All changes were either greater than the standard error, or the minimally detectable changes, of the tools used to measure outcome in this case. Conclusions Using a combination of validated outcome tools and novel field tests, meaningful changes in impairment and function were demonstrated during a controlled introduction of advanced conditioning techniques.

Osteoarthritis of the knee and hip and activity: a systematic international review and synthesis (OASIS)

The goal of this study was to determine which activities in four domains, daily life, exercises, sports and occupational activities, should be recommended, in favor or against, for the patient suffering from knee or hip OA. Methods Scientific literature was searched in Medline, Embase and Cochrane databases for articles in French or English, reporting original data. The articles were evaluated with standardized epidemiological criteria. Seventy-two articles were retained. Recommendations were graded according to the level of scientific evidence (A high, B moderate, C clinical consensus) and were formulated for primary care. Conclusions and recommendations For activity of daily life (ADL), the OASIS group states with a moderate level of scientific evidence, that ADL are a risk factor for knee OA and that risk increases with intensity and duration of activity. The group concludes that healthy subjects as well as OA patients in general can pursue a high level of physical activity, provided the activity is not painful and does not predispose to trauma (grade B). Radiographic or clinical OA is not a contraindication to promoting activity in patients who have a sedentary lifestyle (grade C). For exercises and other structured activities pursued with a goal of health improvement, the group states with a high level of scientific evidence that they have a favourable effect on pain and function in the sedentary knee OA patient. The OASIS group recommends the practice of exercises and other structured activities for the sedentary patient with knee OA (grade A). Static exercises are not favored over dynamic exercises, availability, preference and tolerance being the criteria for the choice of an exercise (grade A). As results deteriorate when exercises are stopped, they should be performed at a frequency of between one and three times per week (grade B). Professional assistance can be useful in improving initial compliance and perseverance (grade B). There is no scientific argument to support halting exercise in case of an OA flare-up (grade C). For sports and recreational activity, the group states with a high degree of scientific evidence, that these activities are a risk factor for knee and hip OA and that the risk correlates with intensity and duration of exposure. The group also states, with a high degree of scientific evidence, that the risk of OA associated with sport is lesser than that associated with a history of trauma and overweight. No firm conclusion could be drawn about the possible protective role of sports such as cycling, swimming or golf. The OASIS group recommends that athletes should be informed that joint trauma is a greater risk factor than the practice of sport (Grade A). The high level athlete should be informed that the risk of OA is associated with the duration and intensity of exposure (Grade B). The OA patient can continue to engage regularly in recreational sports as long as the activity does not cause pain (Grade C). The OA patient who practices a sport at risk for joint trauma should be encouraged to change sport (Grade C). For occupational activity, the OASIS group states with a high level of scientific evidence that there is a relationship between occupational activity and OA of the knee and hip. The precise nature of biomechanical stresses leading to OA remains unclear but factors such as high loads on the joint, unnatural body position, heavy lifting, climbing and jumping may contribute to knee and hip OA. The group recommends that taking an occupational history should always be part of managing the OA patient (Grade B). In the knee or hip OA patient, work-related activity that produces or maintains pain should be avoided (Grade B). Physicians should be alerted by the early knee and hip signs and symptoms in workers exposed to stresses that are known or supposed to favour knee or hip OA (Grade C).

Lateral Meniscus Repair in a Professional Ice Hockey Goaltender: A Case Report With a 5-Year Follow-up

Case report of a professional ice hockey goaltender who underwent an arthroscopically assisted lateral meniscus repair. Rehabilitation of isolated meniscal repairs is not well documented in the literature. There is little knowledge about the healing time and the choice of rehabilitation exercises to be applied to a repaired meniscus. The objective of this case report is to describe a criterion-based, supervised, sport-specific rehabilitation protocol for a high-level athlete with a lateral meniscus repair from the first postoperative day until return to competitive sport, including a 5-year follow-up. The criterion-based protocol used with this athlete was based on a sport-specific neuromuscular rehabilitation approach. Data collected included range of motion, strength, neuromuscular control, and magnetic resonance images. This high-level athlete was able to return to sport 103 days after surgery and no reinjury of the lateral meniscus occurred up to 5 years after surgery. The sport-specific, criterion-based, supervised rehabilitation program described in this case report showed a safe return to sport and a good long-term outcome.

Mesure de l'incapacité fonctionnelle de l'épaule chez le sportif : revue systématique

Objectives. – To identify all available shoulder disability questionnaires and to examine those that could be used for athlete. Methods. – We systematically reviewed the literature in Medline using the keywords shoulder, function, scale, index, score, questionnaire, disability, quality of life, assessment, and evaluation. We searched for scales used for athletes with the keywords scale name AND (sport OR athlete). Data were completed by using the “Guide des Outils de Mesure et d’Evaluation en Médecine Physique et de Réadaptation” textbook. Analysis took into account the clinimetric quality of the instruments and the number of items specifically related to sports. Results. – A total of 37 instruments have been developed to measure disease-, shoulder-specific or upper extremity specific outcome. Older instruments were developed before the advent of modern measurement methods. They usually combined objective and subjective measures. Recent instruments were designed with use of more advanced methods. Most are self-administered questionnaires. Fourteen scales included items assessing sport activity. Four of these scales have been used to assess shoulder disability in athlete. Six scales have been used to assess such disability but do not have specific items related to sports. Conclusion. – There is no gold standard for assessing shoulder outcome in the general population and no validated outcome instruments specifically for athletes. We suggest the use of ASES, WOSI and WORC scales for evaluating shoulder function in the recreational athletes. The DASH scale should be evaluated in this population. The principal criterion in evaluating shoulder function in the high level athlete is a return to the same level of sport performance. Further studies are required to identify measurement tools for shoulder disability that have a high predictive value for return to sport.

Reflex extension loss after anterior cruciate ligament reconstruction due to femoral “high noon” graft placement

We describe a rare case of a painful reflex extension loss due to femoral malplacement of an anterior cruciate ligament (ACL) graft in a female high-level athlete. The graft was placed on the femoral site in the “high noon” position combined with a slight medial tibial tunnel placement. The resulting anterior-posterior cruciate ligament impingement near extension caused a persistent functional extension deficit of 20°. Under anesthesia, the extension loss diminished, and thus it was hypothesized that the ACL-PCL impingement during extension activates a proprioceptive reflex leading to a functional extension loss while the patient is awake. After sacrifice of the graft and subsequent replacement of the ACL, full range of motion was achieved within 2 months. After a 3-year postinjury history of 3 arthroscopies and 2 ACL reconstructions, the athlete reached her preinjury activity level again. This rare cause of a reflex extension loss due to femoral high noon graft placement has not been described previously and should be included as a differential diagnosis when evaluating patients with an extension deficit after ACL reconstruction.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 17, No 4 (April), 2001: pp 408–411

The Treatment of Posterior Subluxation in Athletes

Posterior instability in athletes is a diagnostic and therapeutic challenge. Athletes have recurrent posterior subluxations rather than true dislocations, and they have pain rather than instability, which makes the diagnosis difficult. The pathology is usually capsular laxity rather than a true reverse Bankart lesion. There is not one diagnostic test, including computed tomography (CT) arthrogram, magnetic resonance imaging (MRI), or arthroscopy, that will always help with the diagnosis. Most athletes respond to conservative care with an exercise program designed to strengthen the posterior deltoid, the infraspinatus, and the teres minor; but, there is still a select group of athletes that cannot perform their sport after an extensive rehabilitation program. The surgical options for these athletes are varied, and the results in most cases are less than ideal. A posterior capsulorrhaphy was performed to treat this problem. This was initially performed with a staple, but this technique has been abandoned for a suture capsulorrhaphy to avoid staple problems. The 40 athletes treated operatively that had adequate follow-up evaluation reflected a 40% failure rate. Most of the failures were related to ligamentous laxity and unrecognized multidirectional instability not treated at the time of surgery. There may be subtle differences between a patient with posterior subluxation and multidirectional instability; these must be differentiated before operation. Also, the higher the competitive level of athlete, the worse the overall results. The high-level athlete must be informed that even if his or her shoulder is stabilized, the functional results may not allow him or her to continue at the same competitive level.

HAND AND WRIST INJURIES IN THE PREADOLESCENT AND ADOLESCENT ATHLETE

In this time when physical prowess has been elevated to such a high level, the prepubescent and adolescent athlete have increased demands for performance placed on their immature musculoskeletal system. Although improved skills may result the athlete is exposed to more injury. Prompt, appropriate treatment of the injury with a controlled return to participation may prevent reinjury and disability. To this end, athletes, parents, coaches, trainers, and team physicians must maintain a close rapport for the benefit of the athlete. Language: en

Hand and Wrist Injuries in the Preadolescent and Adolescent Athlete

In this time when physical prowess has been elevated to such a high level, the prepubescent and adolescent athlete have increased demands for performance placed on their immature musculoskeletal system. Although improved skills may result the athlete is exposed to more injury. Prompt, appropriate treatment of the injury with a controlled return to participation may prevent reinjury and disability. To this end, athletes, parents, coaches, trainers, and team physicians must maintain a close rapport for the benefit of the athlete.

Zinc Metabolism in the Athlete: Influence of Training, Nutrition and Other Factors

Serum zinc was measured four times (October, January, March and May) in six young male athletes during a nine-month sporting season in relation to eleven other parameters. A significant decrease in serum zinc was observed after five months of intensive training (all values remaining in the normal range). This cannot be explained by changes in dietary habits, plasma protein concentrations, hormonal changes nor by the existence of minor infectious or inflammatory pathologies. The dietary intakes seemed adequate. These results support the hypothesis that zinc status may be slightly altered in the high-level athlete.