Younger Athlete Research Articles

Rotator Cuff Injuries in Tennis Players

This review presents epidemiology, etiology, management, and surgical outcomes of rotator cuff injuries in tennis players. Rotator cuff injuries in tennis players are usually progressive overuse injuries ranging from partial-thickness articular- or bursal-sided tears to full-thickness tears. Most injuries are partial-thickness articular-sided tears, while full-thickness tears tend to occur in older-aged players. The serve is the most energy-demanding motion in the sport, and it accounts for 45 to 60% of all strokes performed in a tennis match, putting the shoulder at increased risk of overuse injury and rotator cuff tears. Studies have shown deficits in shoulder range of motion and scapular dyskinesia to occur even acutely after a tennis match. First-line treatment for rotator cuff injuries in any overhead athlete consists of conservative non-operative management with appropriate rest, anti-inflammatory drugs, followed by a specific rehabilitation program. Operative treatment is usually reserved for older-aged players and to those who fail to return to play after conservative measures. Surgical options include rotator cuff debridement with or without tendon repair, biceps tenodesis, and labral procedures. Unlike rotator cuff repairs in the general population, repairs in the elite tennis athlete have less than ideal rates of return to sport to the same level of performance. Rotator cuff injuries are a common cause of pain and dysfunction in tennis players and other overhead athletes. The etiology of rotator cuff tears in tennis players is multifactorial and usually results from microtrauma and internal impingement in the younger athlete leading to partial tearing and degenerative full-thickness tears in older players. Surgical treatment is pursued in athletes who are still symptomatic despite an extensive course of non-operative treatment as outcomes with regard to returning to sport to the same pre-injury level are modest at best. Debridement alone is usually preferred over rotator cuff repairs for partial tears in younger players due to potential over-constraining of the shoulder joint and decreased rates of return to sport after rotator cuff repairs.

Caloric Regulation Linked Thermogenesis in Acute Submaximal Intensity Exercise Model as The Effect of Audio Frequency Exposure

Thermogenesis is an essential physiological mechanism in both bodies thermal and energy balance. Thermal balance is significantly associated with body heat homeostasis linked thermogenesis-caloric regulation. The caloric or energy balance was reported under facultative thermogenesis within skeletal muscle stimulated by exercise. Importantly, decreased energy expenditure, imbalance energy intake, and loss of energy was developed for types of obesity. Recently, music tempo and frequency are proposed as the new raw model of exercise treatment against the progression of overweight in the population. Thus, our preliminary pre-post test randomized study aimed to investigate the physical-physiological connection between thermogenesis, caloric regulation, acute- maximal and submaximal intensity exercise model and musical frequency/tempo on the body thermal homeostasis and physiological performance in the younger athlete. This study involved 45 participants with homogeneity in age, height, weight, heartbeat, and physical fitness. Interestingly, co-treatment high intensity, moderate intensity exercise and moderate intensity exercise with middle musical tempo/frequency decreased body temperature without relevant alteration on caloric production. Furthermore, this exercise model significantly induced caloric production and energy expenditure in a similar pattern with the placebo. Also, musical-moderate intensity exercise exposure enhanced muscle thermogenesis without effect to overheat condition during the treatment. The circulating level of physiological-physical stress marker (cortisol) significantly decreased post musical exposure. Hence, the development of physical combination therapy for individual onset obesity progress to metabolic syndrome can contribute to the prevention of metabolic disease. This combination model may offer an alternative solution to combating overweight and obesity through musical-exercise co-treatment. However, further studies are emerging to widely establish this model for global communities.

Quantitative Volumetric Imaging and Clinical Outcome Characterization of Symptomatic Concussion in 10- to 14-Year-Old Adolescent Athletes

Prior work suggests that younger athletes may be more vulnerable to postconcussive syndrome. We investigated measures of clinical outcome and quantitative volumetric imaging in 10- to 14-year-old adolescent athletes to better understand the impact of concussion on this younger population. Outpatient clinics. Ten- to 14-year-old symptomatic pediatric sports concussion patients and typically developing active controls. Prospective, observational multiclinic study. Demographics, magnetic resonance imaging, clinical assessments (neurocognitive function, postconcussive symptoms, mental health symptoms, quality of life). Neuropsychological performance was comparable between groups while symptoms of mental health were discriminating and comprised the top regression model describing factors related to overall health behavior impairment. Concussion patients had smaller total brain volume as well as total intracranial volume in comparison with controls even though there was no difference on measures of natural development (age, height, weight, education, gender, and handedness). Findings indicate that 10- to 14-year-old concussion patients symptomatic at 1 month more likely exhibit mental health symptoms impairing health behavior than cognitive dysfunction. There may be a vulnerability for those with smaller brain volumes at the time of the exposure. The study provides new data to support further investigation into risk factors for prolonged symptoms in this younger athlete population.

Kicks Inc.: Background Information

Kicks Inc., a manufacturer and distributor of athletic apparel and shoes, had plans to launch a new tennis shoe line within the year and was seeking an up-and-coming young athlete to be its spokesperson. Sebastian Martinez had emerged as an ideal candidate, and contract discussions were underway. Six issues need to be resolved to the satisfaction of the six parties involved—the athlete, the athlete's mother, the athlete's father, the athlete's agent, the Kicks brand manager, and an International Tennis Federation representative. This case provides the general information regarding the nature of the issues and the broad interests of the various parties involved. This general background case is supported by individual role cases for each of the six parties. This case and its supporting role cases can be used to (1) develop an understanding of the underlying bases upon which coalitions can be formed; (2) develop an appreciation for the added dimensionality of preparation in multiparty situations; (3) develop an appreciation for the process choices that need to be made; and (4) compare and contrast appropriate approaches to bilateral versus multilateral negotiations. Excerpt UVA-QA-0739 Rev. Nov. 19, 2010 Background Information The Tennis Shoe Industry Kicks Inc. had plans to launch a new tennis shoe line within the year and was searching for an up-and-coming athlete to be the face of its marketing campaign. Kicks, a manufacturer and distributor of athletic apparel and shoes, had had success in other sport-specific shoes, but this was the first time it had produced a tennis shoe. In the tennis shoe industry, Kicks competed against multi-billion-dollar companies, including Nike and Adidas, and traditional tennis-focused companies, including Prince and Wilson. Nike tended to win endorsement deals with the world's top-10 players, although they came at a high price, well beyond Kicks's financial means. In 2009, Roger Federer (number one in the world at the time and 15-time Grand Slam champion), had 10-year deals with Nike, Rolex, Wilson, Gillette, and Mercedes. The appearance fees and sponsorships from these companies added $ 28 million to Federer's yearly earnings; the contract with Nike alone provided Federer with more than $ 10 million annually. These endorsements were a significant portion of a professional tennis player's income. Almost all players had clauses in their endorsement contracts, particularly with apparel, shoe, and racket deals, which outlined bonuses based on year-end rankings and tournament wins. In 2009, the top-10 earners in tennis made an aggregate $ 165 million; prize money from tournament wins only accounted for $ 38 million, and corporate money provided the remaining $ 127 million. Although Kicks was looking for a younger athlete—not necessarily with the statistics of Federer, who was considered an all-time tennis great—the company still had to be prepared to offer its chosen athlete an enticing compensation package if it were to sign with a future star and market its shoe well. . . .

Nutritional Considerations for Performance in Young Athletes.

Nutrition is an integral component to any athletes training and performance program. In adults the balance between energy intake and energy demands is crucial in training, recovery, and performance. In young athletes the demands for training and performance remain but should be a secondary focus behind the demands associated with maintaining the proper growth and maturation. Research interventions imposing significant physiological loads and diet manipulation are limited in youth due to the ethical considerations related to potential negative impacts on the growth and maturation processes associated with younger individuals. This necessary limitation results in practitioners providing nutritional guidance to young athletes to rely on exercise nutrition recommendations intended for adults. While many of the recommendations can appropriately be repurposed for the younger athlete attention needs to be taken towards the differences in metabolic needs and physiological differences.

Operative and Nonoperative Treatment Options for ACL Tears in the Adult Patient: A Conceptual Review

Injury to the anterior cruciate ligament (ACL) is common among athletic individuals. Both nonoperative and operative treatment options exist. The optimal treatment of an adult with an ACL tear depends on several patient-specific factors, including age, occupation, and desired activity level. In less active patients with sedentary jobs, nonoperative management, consisting of physical therapy, bracing, and activity modification can yield successful results. In active patients who want to resume participation in jumping, cutting, or pivoting sports, patients who have physically demanding occupations, or patients who fail a trial of nonoperative management, ACL reconstruction is recommended. Reconstruction utilizing autograft tissue is preferred over allograft, especially in the younger athlete, but allograft tissue is a reasonable option in the older (aged < 40 years) and less active adult, as well. Successful results have been achieved with both patellar tendon and hamstring grafts. The optimal treatment in adult patients with ACL tears should be based on careful consideration of the patient's goals for return to activity, knee-specific comorbidities, such as coexistent meniscal pathology or osteoarthritis, and his or her willingness to follow a detailed rehabilitation regimen. Our article provides an overview of current nonoperative and operative treatment options for adults with ACL tears, considers the outcomes of both nonoperative and operative strategies, and provides general recommendations as to the ideal management for a given patient.

The “LIFT” Lesion: Lateral Inverted Osteochondral Fracture of the Talus

The purpose of this study was to assess a series of lateral inverted osteochondral fractures of the talus. Over a 17-year period, 10 patients with an acute lateral inverted osteochondral fracture of the talus after an inversion injury to the ankle were identified. Diagnosis was made by physical examination, radiographs, magnetic resonance imaging, and/or computed tomography scan. Arthroscopy was initially performed on all patients. All patients had an inverted osteochondral fragment. In 8 of 10 patients the fragment was reattached in an open manner in conjunction with lateral ligament reefing. The fragment was excised in 2 patients. The mean age of the patients was 17.2 years. They were evaluated with the Single Assessment Numeric Evaluation, American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale, modified Weber score, Berndt and Harty score, and Short Form 36 version 2 score. Physical and radiographic examination was also performed. The mean time to follow-up was 112.3 months (9.3 years). The mean American Orthopaedic Foot and Ankle Society score improved from 18.9 preoperatively to 86.9 postoperatively (P ≤ .0001). The mean Single Assessment Numeric Evaluation and modified Weber scores were 81.6 and 81.5, respectively. On the Berndt and Harty scale, 6 patients had a good to excellent rating; 3, fair; and 1, poor. The mean Short Form 36 version 2 scores corresponded to national averages for healthy populations. Mean loss of motion for dorsiflexion and plantarflexion was 6.8° and 3.0°, respectively, when compared with the contralateral side. All patients showed some osteophyte formation on follow-up radiographs. An inverted osteochondral fracture of the lateral talus (lateral, inverted, fracture, talus [LIFT lesion]) can occur after a twisting injury to the ankle. Clinical suspicion should be high, especially in the younger athlete. This injury can be successfully managed with a combined arthroscopic and open approach. Level IV, therapeutic case series.

A Review and Proposed Treatment Approach for the Young Athlete at High Risk for the Female Athlete Triad

As sports medicine and health care professionals we have a responsibility to promote health and well-being in all the athletes we treat. The child or adolescent athlete who struggles with one or more aspects of the female athlete triad (Triad) may be at particular risk. This condition occurs on a spectrum and includes three interrelated components: energy availability, menstrual regularity and bone density. The domains of healthy nutrition, exercise and well-being form a cohesive foundation for skill development and may prevent development of the Triad interrelated aspects. By developing specific skills in each area, a younger athlete can earn a “safety badge” for safe sports participation which supports resilience and balance. Specific guidelines and expectations for the athlete in these three areas are outlined and can improve communication and treatment outcomes. Helping the athlete and family understand the importance of skill acquisition in these areas will promote treatment cohesion. Prevention through education of health care providers, the athletic community and parents is the key to success. The younger athlete should be evaluated for signs of the Triad during pre-participation physicals, yearly exams or any time one of the Triad interrelated aspects is present.

Summary and Agreement Statement of the 2nd International Conference on Concussion in Sport, Prague 2004

In November 2001, the 1st International Symposium on Concussion in Sport was held in Vienna, Austria to provide recommendations for the improvement of safety and health of athletes who suffer concussive injuries in ice hockey, football (soccer), and other sports. The 2nd International Symposium on Concussion in Sport was organised by the same group and held in Prague, Czech Republic in November 2004. It resulted in a revision and update of the Vienna consensus recommendations, which are presented here.

Potential Risk of Rerupture in Primary Achilles Tendon Repair in Athletes Younger than 30 Years of Age

Background Complete Achilles tendon ruptures are found more often in athletes who participate in sports involving explosive acceleration or maximal effort. In most studies, the consensus for athletes is surgery. This form of treatment has been shown to exhibit the best functional performance with a lower rerupture rate. Hypothesis Achilles tendon ruptures in a young population (<30 years) have a higher rerupture rate than similar injuries in an older age group (31-50 years), in which the injury is more common. Study Design Cohort study; Level of evidence, 4. Methods Retrospective study was carried out by chart review. Magnetic resonance images were obtained comparing appearance of repair in young and old patients at 8 to 12 weeks after operation. Results There were a total of 4 reruptures in the 89 Achilles tendon repairs. This was an overall rerupture rate of 4.5%, which was consistent with the literature. When the reruptures were critically analyzed, it was noted that the 4 reruptures of the repaired tendon occurred in a young population. Of the 89, there was a subgroup of athletes (n = 24) who were 30 years of age or younger at the time of injury. The incidence of rerupture for these individuals was 16.6%. In the remaining athletes (n = 65) older than 30 years, the incidence of rerupture was zero. There were no significant differences (P=. 05) in all parameters measured (average days in a boot, average days to active range of motion, average time to full weight-bearing, average days to bike or use a stair climbing machine, average return to sports) between age groups except in the time from injury to surgery (7.1 days, for athletes = 30 years vs 2.65 days for athletes >31 years). Conclusions The results of Achilles tendon repair with an early weightbearing and an early range of motion rehabilitation program are good. However, caution may need to be taken in the younger athlete (= 30 years) during rehabilitation. Clinical Relevance Although the authors recommend aggressive rehabilitation for Achilles tendon repairs, caution should be observed in the younger athlete.

Nonsurgical sports medicine: preparticipation exam through rehabilitation

Contents:List of Tables and FiguresIntroduction1. The Preparticipation Physical Examination 2. Preexisting Medical Conditions 3. Infectious Diseases 4. Ergogenic Agents 5. Injuries to the Head and Spine 6. Upper-Extremity Injuries 7. Lower-Extremity Injuries 8. Overuse Syndromes 9. The Older and Younger Athlete 10. The Female Athlete 11. Environmental Conditions and Exercise 12. Medical Coverage of Athletic EventsAppendix A. Algorithms for Decision Making in Management of Injuries 1. Head Injury 2. Neck Injury 3. Shoulder Injury 4. Knee Injury 5. Ankle Injury Appendix B. Most Common Injuries by Sport Index

Treatment of shoulder pain in thesenior athlete

As our population ages, seniors participating in sports or fitness programs are being seen more frequently in orthopedic practices for the complaint of shoulder pain. While evaluation and treatment of the senior athlete is similar to evaluation and treatment of the younger athlete, the senior cohort presents some specific challenges. Diagnosis is more difficult: underlying disease processes including cervical spondylosis, cardiac and neoplastic diseases are more common. Physical examination is important, because magnetic resonance scans may present many abnormalities not all of which are symptomatic. We reserve magnetic resonance scanning for patients in whom the diagnosis is in question, or for those who fail conservative measures. Surgical treatment is complicated by the quality of tissue to repair. Proper rehabilitation, for both nonsurgical and operative treatment is essential and should be physician directed. Finally, many senior athletes have unrealistic expectations of treatment underscoring the need, for good patient-physician communication.

The diagnosis and treatment of cervical radiculopathy

To provide a comprehensive review of the presentation, evaluation, differential diagnosis, treatment and return-to-play criteria which can be useful to the clinician caring for athletes with cervical radiculopathy. A review of the literature on cervical radiculopathy and sports injuries of the cervical spine was performed. This information was used in conjunction with the author's clinical experience to present a literature based approach to the diagnosis and treatment of cervical radiculopathy in athletic individuals. There was limited scientific literature on the evaluation and treatment of cervical radiculopathy in athletes. Many studies reported on the evaluation and treatment of the "burner" or "stinger" in the younger athlete which may represent a cervical radiculopathy in many of these cases. A nonoperative treatment plan using a logical step-wise approach is successful in the vast majority of these patients. Using the history and a detailed physical examination, along with imaging and other diagnostic studies when necessary, a proper diagnosis of cervical radiculopathy can be made. Once a discrete diagnosis is made, then a systematic approach to the treatment and rehabilitation can be implemented to optimize a safe return to competition.

Sudden cardiac death and the 'athlete's heart'

<h3>Objectives:</h3> To review the current literature pertaining to the cardiovascular adaptations to exercise and the impact on the physical examination, the electrocardiogram, and the echocardiogram, and to distinguish those physiologic changes from pathologic conditions associated with sudden cardiac death in athletes. <h3>Data Synthesis:</h3> Specific cardiovascular adaptations occur in response to regular physical exercise. The extent of these changes depend on the type and duration of exercise as well as the gender of the athlete. These cardiac adaptations are morphologically different from those conditions associated with sudden cardiac death. In the athlete younger than 35 years, hypertrophic cardiomyopathy is the most common cardiac condition associated with sudden death. Right ventricular dysplasia, idiopathic left ventricular hypertrophy, coronary anomalies, premature atherosclerosis, and Marfan syndrome compose the majority of the remaining causes of sudden cardiac death in athletes. In the athlete older than 35 years, coronary atherosclerosis is the leading cause of sudden death followed by those conditions responsible for sudden death in the younger athlete. Despite this, regular exercise before or following a myocardial infarction provides a protective effect with respect to overall mortality, cardiovascular mortality, and fatal reinfarction rates. <h3>Conclusions:</h3> Cardiovascular adaptation to regular physical exercise leads to morphologic changes in the myocardium that influence the cardiac examination, the electrocardiogram, and the echocardiogram. Knowledge and recognition of those changes can allow the clinician to distinguish normal physiologic changes from cardiac abnormality. Proper detection of athletes at high risk for sudden cardiac death and abstention from vigorous physical activity in these athletes may prevent sudden death. (Arch Intern Med. 1955;155:1473-1480)

Sudden Cardiac Death and the `Athlete's Heart'

To review the current literature pertaining to the cardiovascular adaptations to exercise and the impact on the physical examination, the electrocardiogram, and the echocardiogram, and to distinguish those physiologic changes from pathologic conditions associated with sudden cardiac death in athletes. Specific cardiovascular adaptations occur in response to regular physical exercise. The extent of these changes depend on the type and duration of exercise as well as the gender of the athlete. These cardiac adaptations are morphologically different from those conditions associated with sudden cardiac death. In the athlete younger than 35 years, hypertrophic cardiomyopathy is the most common cardiac condition associated with sudden death. Right ventricular dysplasia, idiopathic left ventricular hypertrophy, coronary anomalies, premature atherosclerosis, and Marfan syndrome compose the majority of the remaining causes of sudden cardiac death in athletes. In the athlete older than 35 years, coronary atherosclerosis is the leading cause of sudden death followed by those conditions responsible for sudden death in the younger athlete. Despite this, regular exercise before or following a myocardial infarction provides a protective effect with respect to overall mortality, cardiovascular mortality, and fatal reinfarction rates. Cardiovascular adaptation to regular physical exercise leads to morphologic changes in the myocardium that influence the cardiac examination, the electrocardiogram, and the echocardiogram. Knowledge and recognition of those changes can allow the clinician to distinguish normal physiologic changes from cardiac abnormality. Proper detection of athletes at high risk for sudden cardiac death and abstention from vigorous physical activity in these athletes may prevent sudden death.

The surgical treatment of shoulder impingement in the athlete older than 40 years

Shoulder impingement is a common cause of shoulder pain in the athlete older than 40 years. Although shoulder instability and cuff tendinitis remain common in the younger athlete, rotator cuff degeneration and bone abnormalities are largely responsible for shoulder pain in the older athlete who participates with sports. A history of subacromial pain with movement, aggravated by overhead activities and interfering with sleep, is classic. Impingement signs are positive, although rotator cuff strength is variable and depends on the extent of rotator cuff damage. Conservative treatment consists of activity modification rather than complete rest and is centered around a home rehabilitation program designed to maintain or improve shoulder movement and strength. Surgical treatment consists of two parts. The space within the coracoacromial arch is increased with acromioplasty and, if needed, acromioclavicular joint resection. Arthroscopic or open techniques can be used. Tendon surgery is related to the amount of tendon damage, the activity level of the patient, and the amount of bone abnormality. A postoperative rehabilitation program is critical

Swimming and the Older Athlete

Swimming is an organized, fast-growing sport and competitive swimmers are now found in abundance in all age groups. Including those athletes who do not compete in formal events (masters swimming program) and those participating in outside events (long-distance, channel swimming, triathlons, and so on), it may be one of the largest participant sports in this country. Injuries to the elite collegiate competitive swimmers have been well-documented. Considerations and injuries to the masters-level swimmer closely mirror those found in the younger athlete, but these injuries reflect the impact of tissue aging (degenerative disease). The preparticipation history and physical examination become more important. We are hopeful that this article will contribute to greater safety and enjoyment among all older swimmers.

Knee Problems in Children and Adolescents

It is important to recognize that there are differences in the spectrum of knee injuries that occur in childhood and adolescence and to always keep these in mind when examining the younger athlete. Constant vigilance for hip pathology presenting as knee pain is also necessary in this age group. As the tendency becomes greater for practitioners to become more specialized in treatment modalities (for example, arthroscopic surgeons, knee surgeons, and so forth), the likelihood of making preventable errors in the case of young athletes increases. The comprehensive care of the athlete and his or her injury is paramount, and one should be wary of the pressure to treat the youngster as one might the college or professional athlete in order to return him or her to sports more quickly. Serious injuries require time to heal and even more time for the patient to convalesce and undergo rehabilitation.

The Prevention of Sports Injuries in High School Students Through Strength Training

ABSTRACTThe introduction of variable resistance exercise (weight training) to athletic training for purposes of improving athletic performance is well known. The effect of such training on athletic injury in the younger athlete has not yet been well documented. A study was undertaken of injury rate