Symptoms In Athletes Research Articles

Sports-Related Concussion in Helmeted vs. Unhelmeted Athletes: Who Fares Worse?

In the management of sports-related concussion, little is known about the effect of wearing or not wearing a helmet (i. e., helmet status) on the acute outcomes of concussed athletes. We endeavored to assess acute neurocognitive and symptom changes after SRC in helmeted vs. unhelmeted athletes. In a retrospective study, 1 025 athletes from 2 regional databases sustained a SRC. Athletes were matched by age, gender, number of prior concussions, and days to post-concussion test, yielding a final cohort of 138 athletes. For each group of 69, differences in post-concussion neurocognitive and symptom scores were compared using group mean differences as well as reliable change index (RCI) scores set at the 80% confidence interval. With gender, prior concussions, and days to post-concussion test similar in each group, using group mean change scores and RCI methodology, we found no significant differences between the helmeted and unhelmeted groups in 4 neurocognitive tests and one total symptom score. In a cohort of carefully matched athletes from 2 regional concussion centers, helmet status was unrelated to neurocognitive scores and total symptoms in athletes after suffering a SRC. These findings suggest that acute outcomes in helmeted vs. unhelmeted sports are quite similar.

The Effect of Preinjury Sleep Difficulties on Neurocognitive Impairment and Symptoms After Sport-Related Concussion

Background: Researchers have reported that sleep duration is positively related to baseline neurocognitive performance. However, researchers have yet to examine the effect of preinjury sleep difficulties on postconcussion impairments. Purpose: To compare neurocognitive impairment and symptoms of athletes with preinjury sleep difficulties to those without after a sport-related concussion (SRC). Study Design: Cohort study; Level of evidence, 3. Methods: The sample included 348 adolescent and adult athletes (age, mean ± SD, 17.43 ± 2.34 years) with a diagnosed SRC. The sample was divided into 2 groups: (1) 34 (10%) participants with preinjury sleep difficulties (sleeping less as well as having trouble falling asleep; SLEEP SX) and (2) 231 (66%) participants without preinjury sleep difficulties (CONTROL). The remaining 84 (24%) participants with minimal sleep difficulties (1 symptom) were excluded. Participants completed the Immediate Postconcussion Assessment and Cognitive Test (ImPACT) and Postconcussion Symptom Scale (PCSS) at baseline and 3 postinjury intervals (2, 5-7, and 10-14 days after injury). A series of repeated-measures analyses of covariance with Bonferroni correction, controlling for baseline non–sleep-related symptoms, were conducted to compare postinjury neurocognitive performance between groups. Follow-up exploratory t tests examined between-group differences at each time interval. A series of analyses of variance were used to examine total PCSS score, sleep-related, and non–sleep-related symptoms across time intervals between groups. Results: Groups differed significantly in PCSS scores across postinjury intervals for reaction time (P < .001), with the preinjury SLEEP SX group performing worse than controls at 5-7 days (mean ± SD, 0.70 ± 0.32 [SLEEP SX], 0.60 ± 0.14 [CONTROL]) and 10-14 days (0.61 ± 0.17 [SLEEP SX]; 0.57 ± 0.10 [CONTROL]) after injury. Groups also differed significantly on verbal memory performance (P = .04), with the SLEEP SX (68.21 ± 18.64) group performing worse than the CONTROL group (76.76 ± 14.50) 2 days after injury. The SLEEP SX group reported higher total symptom (P = .02) and sleep-related symptom (P = .02) scores across postinjury time intervals. Conclusion: Preinjury sleep difficulties may exacerbate neurocognitive impairment and symptoms after concussion. The findings may help clinicians identify athletes who are at risk for worse impairments after a concussion due to preinjury sleep difficulties.

An Explorative Study on Major Stressors and Its Connection to Depression and Chronic Stress among German Elite Athletes

Although research shows that chronic stress and specific stressful events (e.g. injury, failure) are associated with depressive symptoms in athletes, connections between chronic, major stressors and depressive symptoms are yet unknown. Therefore, the goal of the study was to gain new findings between major stressors and their relations to depressive symptoms and chronic stress. A total of 134 elite athletes provided data in an online survey. In addition to quantitative measurements (current depressive symptoms, and level of chronic stress), possible stressors were assessed qualitatively with an open ended question. By using content analysis to explore stressors, three different types of stressors were categorized: Double burden, sport specific demands, and conditions. Further statistical analysis found these stressors to be associated with dropout intentions, depression and chronic stress. Athletes, who reported sport specific demands (such as high training loads) as major stressors indicated higher levels of chronic stress and depressive symptoms than athletes without major stressors. Further research investigating sources of stress and its association to depressive syndromes in athletes could benefit from considering sport specific factors.

Hip Pain in Athletes - When It is Not the Labrum.

Hip pain is a relatively common complaint in sports. It is tempting to blame the athlete's symptoms on labral pathology. However, there is a high incidence of asymptomatic labral disease. Therefore, even when a labral tear is present, it may not be the underlying cause of the patient's pain. Clinicians should familiarize themselves with the large differential diagnosis for hip and pelvis pain to include nonmusculoskeletal pathology. This article reviews nonlabral causes of hip pain in athletes. For ease of classification, the hip is divided into anterior, lateral, and posterior regions.

Preinjury History of Migraine Headache: Effects on Neurocognitive Performance and Symptoms in Athletes With Concussion

Preinjury History of Migraine Headache: Effects on Neurocognitive Performance and Symptoms in Athletes With Concussion

Metabolomics of salivary fatigue markers in soccer players after consecutive games.

Strenuous and consecutive exercise leads to fatigue symptoms in athletes. Metabolomics is a comprehensive method to assess metabolites that involves the measurements of the overall metabolic signature of biological samples. Using metabolomic analysis, we investigated the identification of salivary fatigue markers in soccer players after 3 consecutive days of a game program. One hundred twenty-two male soccer players participated in 3 consecutive days of a game program. To detect fatigued athletes, we measured indices of traditional fatigue symptoms, i.e., heart rate, body mass and mood, before and after the program. We detected 37 fatigued players throughout the program. Before and after the program, the saliva in these players was analyzed using capillary electrophoresis and time-of-flight mass spectrometry (CE-TOFMS) and a multivariate statistical technique, principal component analysis, was used to process the data. CE-TOFMS was used to identify 144 metabolites in the saliva of fatigued players. A significant metabolomic difference was observed before and after 3 consecutive days of a soccer game program. Interestingly, metabolites were all increased after the program (P < 0.001). The identified metabolites, including 3-methylhistidine, glucose 1- and 6-phosphate, taurine, and some amino acids, were involved in skeletal muscle catabolism, glucose metabolism, lipid metabolism, amino acid metabolism, and energy metabolism. Our work demonstrated some salivary metabolites were significantly increased in the fatigued players after consecutive days of short soccer matches. We propose that the detected salivary metabolites may be new fatigue markers in athletes.

The Recognition and Evaluation of Patterns of Compensatory Injury in Patients With Mechanical Hip Pain

Context:In active individuals with femoroacetabular impingement (FAI), the resultant reduction in functional range of motion leads to high impaction loads at terminal ranges. These increased forces result in compensatory effects on bony and soft tissue structures within the hip joint and hemipelvis. An algorithm is useful in evaluating athletes with pre-arthritic, mechanical hip pain and associated compensatory disorders.Evidence Acquisition:A literature search was performed by a review of PubMed articles published from 1976 to 2013.Level of Evidence:Level 4.Results:Increased stresses across the bony hemipelvis result when athletes with FAI attempt to achieve supraphysiologic, terminal ranges of motion (ROM) through the hip joint required for athletic competition. This can manifest as pain within the pubic joint (osteitis pubis), sacroiliac joint, and lumbosacral spine. Subclinical posterior hip instability may result when attempts to increase hip flexion and internal rotation are not compensated for by increased motion through the hemipelvis. Prominence of the anterior inferior iliac spine (AIIS) at the level of the acetabular rim can result in impingement of the anterior hip joint capsule or iliocapsularis muscle origin against the femoral head-neck junction, resulting in a distinct form of mechanical hip impingement (AIIS subspine impingement). Iliopsoas impingement (IPI) has also been described as an etiology for anterior hip pain. IPI results in a typical 3-o’clock labral tear as well as an inflamed capsule in close proximity to the overlying iliopsoas tendon. Injury in athletic pubalgia occurs during high-energy twisting activities in which abnormal hip ROM and resultant pelvic motion lead to shearing across the pubic symphysis.Conclusion:Failure to recognize and address concomitant compensatory injury patterns associated with intra-articular hip pathology can result in significant disability and persistent symptoms in athletes with pre-arthritic, mechanical hip pain.Strength-of-Recommendation Taxonomy (SORT):B

The million dollar question: When should an athlete retire after concussion?

Management of acute concussions is guided by consensus statement, and the return-to-play process begins when an athlete's symptoms and examination return to baseline. This process may be relatively clear if symptoms resolve within the normal time frame following a first or second concussion. This decision-making process is more complicated in an athlete with prolonged unresolved symptoms, multiple concussions both with and without prolonged recovery, or a structural brain injury. In these situations, determining when to retire an athlete after concussion is a complex decision, without available evidence-based guidelines. This article will discuss absolute and relative contraindications to returning an athlete to contact sport following a concussion in three separate scenarios: following potentially life-threatening brain injury, persistent clinical symptoms or signs of prolonged postconcussion syndrome, and multiple concussions but without residual symptoms or signs.

Osgood Schlatter Disease—An ultrasound grading system with practical application

Athletes who sustain a knee joint injury, namely to the anterior cruciate ligament and/or meniscus, are at an increased risk of subsequent osteoarthritis (OA) – the so-called ‘young people with old knees’. Surgical intervention does not appear to reduce this increased risk. There is no good evidence that moderate sporting activity in thepresenceofnormal jointspredisposes toOA.Whether high-level participation in sport, particularly impact type sports, is associatedwithOA is unclear as it is difficult to disentangle the confounding effect of joint injury. Attention to strategies that prevent joint injury in athletes, such as neuromuscular exercise, is therefore paramount to reduce the burden of OA. Optimal management is needed to minimize the onset and extent of joint symptoms in athletes following joint injury. Clinicians should counsel the athlete about their increased likelihood of future OA as this allows athletes to make informed decisions about return to sport as well as plan future management. Prevention and management of OA in athletes includes use of load-reducing strategies such as variable stiffness shoes, bracing, activity modification, muscle strengthening and weight control although these have not been tested in clinical trials in athletes. There are currently no pharmacologic agents with convincing structural disease-modifying efficacy for people with existing joint damage and most have been tested in midto late-term OA rather than early OA. There are no high quality clinical trials investigating the effects of platelet-rich plasma therapy in treatment of knee OA. Evidence for a possible structuremodifying effect of glucosamine, the most commonly used dietary supplement for OA, is still controversial.

Maximising joint health: Preventing and managing knee osteoarthritis in the athlete

Athletes who sustain a knee joint injury, namely to the anterior cruciate ligament and/or meniscus, are at an increased risk of subsequent osteoarthritis (OA) – the so-called ‘young people with old knees’. Surgical intervention does not appear to reduce this increased risk. There is no good evidence that moderate sporting activity in thepresenceofnormal jointspredisposes toOA.Whether high-level participation in sport, particularly impact type sports, is associatedwithOA is unclear as it is difficult to disentangle the confounding effect of joint injury. Attention to strategies that prevent joint injury in athletes, such as neuromuscular exercise, is therefore paramount to reduce the burden of OA. Optimal management is needed to minimize the onset and extent of joint symptoms in athletes following joint injury. Clinicians should counsel the athlete about their increased likelihood of future OA as this allows athletes to make informed decisions about return to sport as well as plan future management. Prevention and management of OA in athletes includes use of load-reducing strategies such as variable stiffness shoes, bracing, activity modification, muscle strengthening and weight control although these have not been tested in clinical trials in athletes. There are currently no pharmacologic agents with convincing structural disease-modifying efficacy for people with existing joint damage and most have been tested in midto late-term OA rather than early OA. There are no high quality clinical trials investigating the effects of platelet-rich plasma therapy in treatment of knee OA. Evidence for a possible structuremodifying effect of glucosamine, the most commonly used dietary supplement for OA, is still controversial.

Efficacy of Amantadine Treatment on Symptoms and Neurocognitive Performance Among Adolescents Following Sports-Related Concussion

To evaluate the efficacy of amantadine in the treatment of symptoms and neurocognitive performance in adolescents following sports-related concussion. A clinical sample of 25 male (n = 11) and female (n = 14) adolescent subjects with an age-, sex-, and concussion history-matched group of 25 male (n = 11) and female (n = 14) control subjects. Outpatient concussion clinic. Retrospective, case-control design. Treatment group consisted of patients treated with 100 mg of amantadine twice daily (200 mg total per day) following a period of rest. Matched controls were evaluated and treated conservatively without medication at the same concussion program prior to the start of the current amantadine protocol. Immediate Postconcussion Assessment and Cognitive Test computerized neurocognitive test battery and symptom report. Results support significantly greater improvements from pre- to posttest in reported symptoms, verbal memory, and reaction time performance for the amantadine group than the matched controls. There were no significant differences for visual memory or visual motor processing speed. This study provides empirical support for amantadine as an effective pharmacologic treatment of certain concussion-related cognitive deficits and symptoms in athletes with protracted recovery of more than 3 weeks.

Symptom Severity Predicts Prolonged Recovery after Sport-Related Concussion, but Age and Amnesia Do Not

To identify predictors of prolonged symptoms in athletes who sustain concussions. This was a multicenter prospective cohort study of patients in 2 sport concussion clinics. Possible predictors of prolonged symptoms from concussion were compared in 2 groups, those whose symptoms resolved within 28 days and those whose symptoms persisted beyond 28 days. Candidate predictor variables were entered into a logistic regression model that was used to generate aORs. A total of 182 patients met the inclusion criteria during the study period. The mean patient age was 15.2 ± 3.04 years. More than one-third of the patients (n = 65) underwent computerized neurocognitive testing on their initial visit. On univariate analyses, Post-Concussion Symptom Scale (PCSS) score and all composite scores on computerized neurocognitive testing were apparently associated with prolonged symptom duration. Sex, age, loss of consciousness at time of injury, and amnesia at time of injury were not associated with prolonged symptom duration. After adjusting for potential confounding, only total PCSS score was associated with the odds of suffering prolonged symptoms. Further efforts to develop clinical tools for predicting which athletes will suffer prolonged recoveries after concussion should focus on initial symptom score.

The Athlete's Wrist: Ulnar-Sided Pain

Ulnar-sided wrist pain is one of the most common symptoms in athletes of baseball, racket sports, golf, and wrestling where there is frequent use of the hands as well as in soccer and running, where hand use is minimal. Compared with all wrist injuries, ulnar-sided wrist injury is a relatively serious condition for athletes because it plays an important role in performing a strong grip and in the rotation of the forearm. Ulnar-sided wrist pain in athletes can be related to acute trauma or chronic overuse. Acute trauma can lead to bone fractures and sprains/tears of ligaments. Repetitive mechanical stresses to tendons, ligaments, and the joint structures can lead to tendinitis or osteoarthrosis. Diagnosis of the ulnar-sided wrist pain is challenging both for hand surgeons and radiologists because of the small and complex anatomy. In the present article, we discuss mechanisms of wrist injury, sports-specific ulnar-sided wrist injuries, and the differential diagnosis of ulnar-sided wrist pain.

Posterior Circumflex Humeral Artery Injury with Distal Embolisation in Professional Volleyball Players: A Discussion of Three Cases

Presented are three cases of volleyball players with ischaemia of the hand due to arterial emboli originating from an injured posterior circumflex humeral artery (PCHA). An operative treatment with ligation of the PCHA was performed in all patients because of the proximity of the occlusion to the axillary artery. After a rehabilitation programme, all patients could return to their previous level of competition.During overhead motion, the PCHA is prone to injury in its position overlying the humeral head and its course through the quadrilateral space. Recognition of the vascular origin of these symptoms in athletes is important to prevent serious ischaemic complications. Signs of ischaemia might be subtle and may be misdiagnosed as musculoskeletal injuries. Therefore, the examining physician must have a high index of suspicion and awareness about these injuries is important.

Prevalence of Allergy and Upper Respiratory Tract Symptoms in Runners of the London Marathon

The prevalence of self-reported upper respiratory tract (URT) symptoms in athletes has been traditionally associated with opportunistic infection during the temporal suppression of immune function after prolonged exercise. There is little evidence for this, and a competing noninfectious hypothesis has been proposed, whereby the exercise-induced immune system modulations favor the development of atopy and allergic disease, which manifests as URT symptoms. The aim of this study was to examine the association between allergy and URT symptoms in runners after an endurance running event. Two hundred eight runners from the 2010 London Marathon completed the validated Allergy Questionnaire for Athletes (AQUA) and had serum analyzed for total and specific immunoglobulin E response to common inhalant allergens. Participants who completed the marathon and nonrunning controls who lived in the same household were asked to complete a diary on URT symptoms. Forty percent of runners had allergy as defined by both a positive AQUA and elevated specific immunoglobulin E. Forty-seven percent of runners experienced URT symptoms after the marathon. A positive AQUA was a significant predictor of postmarathon URT symptoms in runners. Only 19% of nonrunning controls reported symptoms. The prevalence of allergy in recreational marathon runners was similar to that in elite athletes and higher than that in the general population. There was a strong association between a positive AQUA and URT symptoms. The low proportion of households in which both runners and nonrunners were symptomatic suggests that the nature of symptoms may be allergic or inflammatory based rather than infectious. Allergy is a treatable condition, and its potential effect on performance and health may be avoided by accurate clinical diagnosis and management. Both athletes' and coaches' awareness of the potential implications of poorly managed allergy needs to be raised.

Endofibrose de l’artère iliaque externe diagnostiquée par écho-doppler post-effort

Arterial endofibrosis is a disease of recent discovery which concerns high-performance athletes, predominantly competitive cyclists. The preferential location is the external iliac artery. The symptoms are diverse (pain, edema, paresthesia), always linked to an effort. The diagnosis may be delayed due to atypical symptoms in athletes. Complementary tests are measure of the systolic pressure index after exercise, duplex ultrasound, CT angiography, MR angiography and arteriography. We report a case of endofibrosis where late diagnosis was established with postexercise duplex ultrasound, while CT angiography and arteriography failed to reveal characteristic abnormalities.

Nutritional Intake and Gastrointestinal Problems during Competitive Endurance Events

There is little information about the actual nutrition and fluid intake habits and gastrointestinal (GI) symptoms of athletes during endurance events. This study aimed to quantify and characterize energy, nutrient, and fluid intakes during endurance competitions and investigate associations with GI symptoms. A total of 221 endurance athletes (male and female) were recruited from two Ironman triathlons (IM Hawaii and IM GER), a half-Ironman (IM 70.3), a MARATHON, a 100/150-km CYCLE race. Professional cyclists (PRO) were investigated during stage racing. A standardized postrace questionnaire quantified nutrient intake and assessed 12 GI symptoms on a scale from 0 (no problem) to 9 (worst it has ever been) in each competition. Mean CHO intake rates were not significantly different between IM Hawaii, IM GER, and IM 70.3 (62 ± 26, 71 ± 25, and 65 ± 25 g·h(-1), respectively), but lower mean CHO intake rates were reported during CYCLE (53 ± 22 g·h(-1), P = 0.044) and MARATHON (35 ± 26 g·h(-1), P < 0.01). Prevalence of serious GI symptoms was highest during the IM races (∼31%, P = 0.001) compared with IM 70.3 (14%), CYCLE (4%), MARATHON (4%), and PRO (7%) and correlated to a history of GI problems. In all data sets, scores for upper and lower GI symptoms correlated with a reported history of GI distress (r = 0.37 and r = 0.51, respectively, P < 0.001). Total CHO intake rates were positively correlated with nausea and flatulence but were negatively correlated with finishing time during both IM (r = -0.55 and r = -0.48, P < 0.001). The present study demonstrates that CHO intake rates vary greatly between events and individual athletes (6-136 g·h(-1)). High CHO intake during exercise was related not only to increased scores for nausea and flatulence but also to better performance during IM races.

BILATERAL ADDUCTOR ABCESS FOLLOWING GRION INJURY

Pubic pain is a common symptom in athletes and in soccer players.Its cause can be difficult to determine. We report a case in a14-year-old boy who presented with bilateral adductor muscle abcesses following a trivial injury to the groin. The etiology, radiological findingsand treatment, along with literature review are discussed. Introduction: The main causes of pubic pain after sports are thought to be sportsrelated microtrauma to the pubic rami or symphysis and lesions of the oblique, rectus or adductor muscles or their tendons1,2. Osteitis pubisrefers to a painful inflammation of the periosteum, bone, cartilage and ligamentous structures of the anterior half of the pelvis. Pubicosteomyelitis is an uncommon entity, accounting for less than 1% of all cases of Heamatogenous osteomyelitis. We report a case of bilateraladductor muscle abcess six week after a trivial injury in sports.

Síndrome do impacto posterior do tornozelo: um diagnóstico que deve ser lembrado pelo reumatologista. Relato de dois casos

The ankle is a common site of painful symptoms in athletes and nonathletes. Posterior ankle pain can be the end result of several pathologies, and a diagnostic challenge for rheumatologists. The posterior ankle impingement syndrome, also known as os trigonum syndrome and posterior tibiotalar compression syndrome, is a clinical disorder characterized by acute or chronic posterior ankle pain triggered by forced plantar flexion, which causes chronic repetitive microtrauma. Pathology of the os trigonum-talar process is the most common cause of this syndrome, but there are other causes, such as tenosynovitis of the flexor hallucis longus, ankle osteochondritis, subtalar joint disease, and fracture. Diagnosis is based on clinical history and physical examination, and complemented by findings on plain radiography (RX), ultrasound (US), scintigraphy, computed tomography (CT), and magnetic resonance imaging (MRI). It is worth noting that RX has low cost and good sensitivity, US can provide guidance to therapeutic infiltrations, and MRI allows the assessment of surrounding soft tissues.

Nutrient and Fluid Intake and Gastrointestinal Problems during Prolonged Endurance Events

There is little information about the actual nutrition and fluid intake habits, and gastrointestinal (GI) symptoms of athletes during endurance events. PURPOSE: To characterize nutrient intakes during endurance competitions and investigate links to GI symptoms, performance and race characteristics (type, length, weather). Method: 221 endurance athletes (male and female) were recruited from two Ironman triathlons (IM Hawaii and IM GER), a half-Ironman (IM70.3), a MARATHON, a 100/150 km CYCLE race. Professional cyclists (PRO) were investigated during stage-racing. A standardized post-race questionnaire quantified nutrient intake and assessed 12 GI symptoms on a scale from 0 (no problem) to 9 (worst it has ever been). RESULTS: Mean CHO intake rates were not significantly different between IM Hawaii, IM GER and IM70.3 (62±26, 71±25 g/h and 65±25 g/h, respectively), but these rates were significantly greater than CYCLE (53±22 g/min, p=0.041) and MARATHON (35±26 g/min; p<0.01). Prevalence of serious GI symptoms were highest during the IM races (∼31%; p<0.01) compared with IM70.3 (14%), CYCLE (4%), MARATHON (4%) and PRO (7%), and correlated to a previous history of GI problems (p<0.01) and heat index (p<0.01). Training experience was linked to lower prevalence of GI distress (r=-0.373; p=0.008). Total CHO intake rates were positively correlated with nausea and flatulence, but negatively correlated with finishing time during both IM (r=-0.55 and r=-0.48; p<0.001), with a ∼20% higher (p=0.06) CHO intake rate in PRO compared to amateurs. CONCLUSION: The present study demonstrated that CHO intake rates vary greatly between events and individual athletes (6-136 g/h). High CHO intake rates were not associated with higher average scores for upper or lower GI symptoms, but appeared to be a risk factor for nausea and flatulence. However, high CHO intake rates were significantly correlated with faster finishing times. Reported GI symptoms during events were linked to a reported history of GI distress. Altogether the findings suggest a need for more individualized nutritional advice that optimizes CHO and fluid delivery to enhance performance, whilst minimizing GI discomfort. This study was supported by a Research Grant from Nestec Ltd., Nestlé Nutrition, Vevey, Switzerland.