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Bascharon R, Sethi NK, Estevez R, Gordon M, Guevara C, Twohey E, deWeber K. Transgender competition in combat sports: Position statement of the Association of ringside physicians. PHYSICIAN SPORTSMED 2024; 52:317-324. [PMID: 38038979 DOI: 10.1080/00913847.2023.2286943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 11/20/2023] [Indexed: 12/02/2023]
Abstract
The Association of Ringside Physicians (ARP) is committed to the concept of fair competition. It advocates for two equally skilled and matched athletes to keep bouts fair, competitive, entertaining, and, most importantly, safe for all combatants. Numerous studies have proven that transgender women may have a competitive athletic advantage against otherwise matched cis-gender women. Likewise, transgender men may suffer a competitive disadvantage against cis-gender men. These differences - both anatomic and physiologic - persist despite normalization of sex hormone levels and create disparities in competitive abilities that are not compatible with the spirit of fair competition. More importantly, allowing transgender athletes to compete against cisgender athletes in combat sports, which already involve significant risk of serious injury, unnecessarily raises the risk of injury due to these differences. Hence the ARP does not support transgender athlete competition against cisgender athletes in combat sports.
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Affiliation(s)
- Randa Bascharon
- Orthopedic and Sports Medicine Institute of Las Vegas, Las Vegas, NV, US
| | - Nitin K Sethi
- New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, USA
| | - Ryan Estevez
- Lakeland Regional Health Medical Center, Lakeland, FL, US
| | - Mark Gordon
- Memorial Hospital Pembroke, Pembroke Pines, FL, US
| | - Carlo Guevara
- Oral and Maxillofacial Surgery, Broward Health , Lauderdale, FL, USA
| | - Eric Twohey
- Mayo Clinic Department of Physical Medicine and Rehabilitation, Rochester, MN, US
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Ayaz A, Zaman W, Radák Z, Gu Y. Green strength: The role of micronutrients in plant-based diets for athletic performance enhancement. Heliyon 2024; 10:e32803. [PMID: 38975163 PMCID: PMC11225853 DOI: 10.1016/j.heliyon.2024.e32803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 06/05/2024] [Accepted: 06/10/2024] [Indexed: 07/09/2024] Open
Abstract
This review examines the correlation between plant-based diets and athletic performance, with a specific emphasis on the vital aspect of optimizing micronutrients for athletes. In light of the increasing prevalence of plant-based nutrition among athletes due to its perceived advantages in terms of health, ethics, and the environment, this study investigates the ability of these diets to satisfy the demanding nutritional requirements essential for achieving optimal performance and facilitating recovery. The article emphasizes the significance of essential micronutrients such as iron, vitamin B12, calcium, vitamin D, zinc, and omega-3 fatty acids and also addressing the challenges with their absorption and bioavailability from plant sources. The review consolidates existing scientific knowledge to propose strategies for improving micronutrient consumption, comparing the effects of supplements against whole foods, and highlighting the significance of enhancing bioavailability. The proposal supports the implementation of personalized meal planning, with the assistance of sports nutritionists or dietitians, and is substantiated by case studies showcasing the success of plant-based athletes. Future research directions examine the long-term effects of plant-based diets on micronutrient status and athletic performance, as well as developing nutritional trends and technology. The review concludes that plant-based diets can meet athletes' nutritional demands and improve peak performance while aligning with personal and ethical values with strategic planning and professional guidance. This study intends to help athletes, coaches, and nutritionists understand plant-based nutrition for enhanced athletic performance.
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Affiliation(s)
- Asma Ayaz
- Faculty of Sports Science, Ningbo University, Ningbo, 315211, China
| | - Wajid Zaman
- Department of Life Sciences, Yeungnam University, Gyeongsan, 38541, Republic of Korea
| | - Zsolt Radák
- Research Institute of Sport Science, University of Physical Education, 1123, Budapest, Hungary
- Faculty of Sport Sciences, Waseda University, Tokorozawa, 359-1192, Japan
| | - Yaodong Gu
- Faculty of Sports Science, Ningbo University, Ningbo, 315211, China
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Weijer VC, van Dijk JW, van Dam L, Risvang L, Bons J, Raastad T, van Loon LJ, Jonvik KL. Do Paralympic athletes suffer from brittle bones? Prevalence and risk factors of low bone mineral density in Paralympic athletes. Bone Rep 2024; 21:101767. [PMID: 38694186 PMCID: PMC11061701 DOI: 10.1016/j.bonr.2024.101767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 04/15/2024] [Accepted: 04/17/2024] [Indexed: 05/04/2024] Open
Abstract
Background Bone health may be a concern in Paralympic athletes, given the presence of multiple risk factors predisposing these athletes to low bone mineral density (BMD). Objective: We aimed to assess the prevalence of low BMD among Paralympic athletes participating in various sport disciplines, and to identify potential risk factors for low BMD. Methods Seventy Paralympic athletes, of whom 51 % were wheelchair-dependent, were included in this cross-sectional study. BMD of the whole-body, lumbar spine, total hip, and femoral neck were assessed by dual-energy x-ray absorptiometry. Comparisons between groups were conducted by one-way ANOVA, and regression analyses were conducted to identify potential risk factors for low BMD. Results The prevalence of low BMD (Z-score < -1.0) was highest at femoral neck (34 %), followed by total hip (31 %), whole-body (21 %), and lumbar spine (18 %). Wheelchair-dependent athletes had significantly lower BMD Z-scores compared to the non-wheelchair-dependent athletes at whole-body level (-0.5 ± 1.4 vs 0.2 ± 1.3; P = 0.04), total hip (-1.1 ± 1.2 vs 0.0 ± 1.1; P < 0.01), and femoral neck (-1.0 ± 1.3 vs -0.1 ± 1.2; P < 0.01). At the lumbar spine, low BMD was completely absent in wheelchair basketball and tennis players. Regression analyses identified body mass, wheelchair dependence, and type of sport, as the main risk factors for low BMD. Conclusions In this cohort of Paralympic athletes, low BMD is mainly present at the hip, and to a lesser extent at the whole-body and lumbar spine. The most prominent risk factors for low BMD in Paralympic athletes are related to mechanical loading patterns, including wheelchair use, the type of sport, and body mass.
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Affiliation(s)
- Vera C.R. Weijer
- School of Sport and Exercise, HAN University of Applied Sciences, Nijmegen, the Netherlands
- Department of Human Biology, NUTRIM, Maastricht University Medical Centre+, the Netherlands
| | - Jan-Willem van Dijk
- School of Sport and Exercise, HAN University of Applied Sciences, Nijmegen, the Netherlands
| | - Lotte van Dam
- School of Sport and Exercise, HAN University of Applied Sciences, Nijmegen, the Netherlands
| | - Linn Risvang
- Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway
| | - Judith Bons
- Central Diagnostic Laboratory, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Truls Raastad
- Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway
| | - Luc J.C. van Loon
- School of Sport and Exercise, HAN University of Applied Sciences, Nijmegen, the Netherlands
- Department of Human Biology, NUTRIM, Maastricht University Medical Centre+, the Netherlands
| | - Kristin L. Jonvik
- Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway
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Raiser SN, Schroeder AN, Lawley RJ, Tenforde AS. Bone health and the masters runner. PM R 2024; 16:363-373. [PMID: 38532664 DOI: 10.1002/pmrj.13175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 02/13/2024] [Accepted: 02/25/2024] [Indexed: 03/28/2024]
Abstract
Masters runners are often defined as those ages 35 years and older who train and compete in running events. These runners represent a growing population of the overall running community and experience running-related injuries including bone stress injuries (BSIs). Similar to younger runners, health considerations in masters runners include the goal to optimize bone health with focus on mitigating age-associated loss of bone strength and preventing BSIs through a combination of ensuring appropriate physical activity, optimizing nutrition, and correcting faulty biomechanics. Importantly, BSIs in masters runners may include characteristics of both overuse injury from insufficient recovery and failure of bone weakened by age-related loss of bone (insufficiency fractures). This narrative review covers the limited available research on strategies to optimize bone health in masters runners. Applying knowledge on masters athletes and extrapolating from other populations, we propose strategies on treatment and prevention of BSIs. Finally, the review highlights gaps in knowledge that require further age-specific discoveries to advance treatment and prevention.
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Affiliation(s)
- Sara N Raiser
- Department of Physical Medicine & Rehabilitation, University of Virginia, Charlottesville, Virginia, USA
| | - Allison N Schroeder
- Department of Orthopedics, University Hospitals and Case Western Reserve University, Cleveland, Ohio, USA
| | - Richard J Lawley
- Department of Physical Medicine & Rehabilitation, Loyola University Medical Center, Maywood, Illinois, USA
| | - Adam S Tenforde
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
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Sebastiá-Rico J, Martínez-Sanz JM, Sanchis-Chordà J, Alonso-Calvar M, López-Mateu P, Romero-García D, Soriano JM. Supplement Consumption by Elite Soccer Players: Differences by Competitive Level, Playing Position, and Sex. Healthcare (Basel) 2024; 12:496. [PMID: 38391871 PMCID: PMC10887827 DOI: 10.3390/healthcare12040496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 02/13/2024] [Accepted: 02/17/2024] [Indexed: 02/24/2024] Open
Abstract
Soccer is a sport practiced all over the world and whose practice begins in young athletes. Currently, the consumption of nutritional supplements is essential to achieve the maximum performance of players. The aim of this study was to describe the consumption of sports supplements (CSS) by elite soccer players and its association with their competitive level, playing position, and sex. A comparative descriptive and non-experimental study was performed during the 2021-2022 competitive season. A total of 70 elite players completed one online questionnaire about their CSS. We found that sports drinks (55.7%), sports bars (50.0%), whey protein (48.6%), caffeine (47.1%), and creatine (60.0%) were the most consumed supplements by the total sample. Relative to the categories, the CSS was higher in the senior teams for both men and women. Regarding playing positions, caffeine was more consumed by midfielders and forwards (p = 0.013). Finally, in relation to sex, significant differences were found in the consumption of sports confectionery (p = 0.036), whey protein (p = 0.002), β-alanine (p = 0.013), and melatonin (p = 0.016). Soccer club SS questionnaires gather data to understand patterns, assess effectiveness and risks, and aid research. In conclusion, differences were found in the CSS according to competitive level, sex, and playing position.
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Affiliation(s)
- Jaime Sebastiá-Rico
- Area of Nutrition, University Clinic of Nutrition, Physical Activity and Physiotherapy (CUNAFF), Lluís Alcanyís Foundation-University of Valencia, 46020 Valencia, Spain
- Food & Health Lab, Institute of Materials Science, University of Valencia, 46980 Paterna, Spain
| | | | | | - Miguel Alonso-Calvar
- Area of High Conditional Performance, Academia Valencia CF SAD, 46980 Paterna, Spain
| | - Pedro López-Mateu
- Area of Medical Services, Academia Valencia CF SAD, 46980 Paterna, Spain
| | | | - Jose M Soriano
- Food & Health Lab, Institute of Materials Science, University of Valencia, 46980 Paterna, Spain
- Joint Research Unit of Endocrinology, Nutrition and Clinical Dietetics, Health Research Institute La Fe-University of Valencia, 46026 Valencia, Spain
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Zweifler LE, Sinder BP, Stephan C, Koh AJ, Do J, Ulrich E, Grewal J, Woo C, Batoon L, Kozloff K, Roca H, Mishina Y, McCauley LK. Parathyroid hormone and trabectedin have differing effects on macrophages and stress fracture repair. Bone 2024; 179:116983. [PMID: 38013019 PMCID: PMC10932746 DOI: 10.1016/j.bone.2023.116983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 10/25/2023] [Accepted: 11/23/2023] [Indexed: 11/29/2023]
Abstract
Stress fractures occur as a result of repeated mechanical stress on bone and are commonly found in the load-bearing lower extremities. Macrophages are key players in the immune system and play an important role in bone remodeling and fracture healing. However, the role of macrophages in stress fractures has not been adequately addressed. We hypothesize that macrophage infiltration into a stress fracture callus site promotes bone healing. To test this, a unilateral stress fracture induction model was employed in which the murine ulna of four-month-old, C57BL/6 J male mice was repeatedly loaded with a pre-determined force until the bone was displaced a distance below the threshold for complete fracture. Mice were treated daily with parathyroid hormone (PTH, 50 μg/kg/day) starting two days before injury and continued until 24 h before euthanasia either four or six days after injury, or treated with trabectedin (0.15 mg/kg) on the day of stress fracture and euthanized three or seven days after injury. These treatments were used due to their established effects on macrophages. While macrophages have been implicated in the anabolic effects of PTH, trabectedin, an FDA approved chemotherapeutic, compromises macrophage function and reduces bone mass. At three- and four-days post injury, callus macrophage numbers were analyzed histologically. There was a significant increase in macrophages with PTH treatment compared to vehicle in the callus site. By one week of healing, treatments differentially affected the bony callus as analyzed by microcomputed tomography. PTH enhanced callus bone volume. Conversely, callus bone volume was decreased with trabectedin treatment. Interestingly, concurrent treatment with PTH and trabectedin rescued the reduction observed in the callus with trabectedin treatment alone. This study reports on the key involvement of macrophages during stress fracture healing. Given these observed outcomes on macrophage physiology and bone healing, these findings may be important for patients actively receiving either of these FDA-approved therapeutics.
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Affiliation(s)
- Laura E Zweifler
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, United States of America
| | - Benjamin P Sinder
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, United States of America
| | - Chris Stephan
- Department of Orthopedic Surgery, University of Michigan, Ann Arbor, MI, United States of America
| | - Amy J Koh
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, United States of America
| | - Justin Do
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, United States of America
| | - Emily Ulrich
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, United States of America
| | - Jobanpreet Grewal
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, United States of America
| | - Cecilia Woo
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, United States of America
| | - Lena Batoon
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, United States of America
| | - Kenneth Kozloff
- Department of Orthopedic Surgery, University of Michigan, Ann Arbor, MI, United States of America
| | - Hernan Roca
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, United States of America.
| | - Yuji Mishina
- Department of Biologic and Materials Science, University of Michigan School of Dentistry, Ann Arbor, MI, United States of America
| | - Laurie K McCauley
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, United States of America; Department of Pathology, University of Michigan, Medical School, Ann Arbor, MI, United States of America
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Lyu FF, Ramoo V, Chui PL, Ng CG. Perceptions Toward Exercise or Mindful Exercise Participation Among Patients With Primary Osteoporosis: A Qualitative Study. Clin Nurs Res 2024; 33:40-50. [PMID: 37970808 DOI: 10.1177/10547738231198561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Exercise is significantly beneficial for patients with osteoporosis. However, physiological and psychological factors such as pain and kinesiophobia prevent patients from participating in exercise. Therefore, it is important to understand how these patients perceive participation in exercise. This qualitative study was conducted in China using conventional content analysis. Using a purposeful sampling method, 17 patients with primary osteoporosis were recruited. Data were collected through a semi-structured interview and managed using ATLAS.ti 21. Nine generic categories were developed from 26 subcategories and two main categories were identified: Barriers and facilitators, support systems, network resources, positive emotions, and reactions were the facilitators for exercise in this study. In addition, mindful exercise was positively viewed by the patients. Inefficient awareness, weak support systems, and burdens were identified as barriers. To improve compliance in clinical practice, targeted exercise protocols should be developed for patients based on these perceptions.
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Affiliation(s)
- Fang Fei Lyu
- Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
- Yunnan University of Traditional Chinese Medicine, Kunming, Yunnan, China
| | - Vimala Ramoo
- Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Ping Lei Chui
- Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Chong Guan Ng
- Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
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Pasqualini I, Huffman N, Keller SF, McLaughlin JP, Molloy RM, Deren ME, Piuzzi NS. Team Approach: Bone Health Optimization in Orthopaedic Surgery. JBJS Rev 2023; 11:01874474-202312000-00007. [PMID: 38100611 DOI: 10.2106/jbjs.rvw.23.00178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
» Bone health optimization (BHO) has become an increasingly important consideration in orthopaedic surgery because deterioration of bone tissue and low bone density are associated with poor outcomes after orthopaedic surgeries.» Management of patients with compromised bone health requires numerous healthcare professionals including orthopaedic surgeons, primary care physicians, nutritionists, and metabolic bone specialists in endocrinology, rheumatology, or obstetrics and gynecology. Therefore, achieving optimal bone health before orthopaedic surgery necessitates a collaborative and synchronized effort among healthcare professionals.» Patients with poor bone health are often asymptomatic and may present to the orthopaedic surgeon for reasons other than poor bone health. Therefore, it is imperative to recognize risk factors such as old age, female sex, and low body mass index, which predispose to decreased bone density.» Workup of suspected poor bone health entails bone density evaluation. For patients without dual-energy x-ray absorptiometry (DXA) scan results within the past 2 years, perform DXA scan in all women aged 65 years and older, all men aged 70 years and older, and women younger than 65 years or men younger than 70 years with concurrent risk factors for poor bone health. All women and men presenting with a fracture secondary to low-energy trauma should receive DXA scan and bone health workup; for fractures secondary to high-energy trauma, perform DXA scan and further workup in women aged 65 years and older and men aged 70 years and older.» Failure to recognize and treat poor bone health can result in poor surgical outcomes including implant failure, periprosthetic infection, and nonunion after fracture fixation. However, collaborative healthcare teams can create personalized care plans involving nutritional supplements, antiresorptive or anabolic treatment, and weight-bearing exercise programs, resulting in BHO before surgery. Ultimately, this coordinated approach can enhance the success rate of surgical interventions, minimize complications, and improve patients' overall quality of life.
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Affiliation(s)
| | - Nickelas Huffman
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Sarah F Keller
- Department of Rheumatology and Immunology, Cleveland Clinic, Cleveland, Ohio
| | | | - Robert M Molloy
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Matthew E Deren
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Nicolas S Piuzzi
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio
- Department of Biomedical Engineering, Cleveland Clinic Foundation, Cleveland, Ohio
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Gremillion MJ, Martinez A, Ghanta RB, Borici N, Kushare I. An assessment of the diagnosis, treatment, and outcomes of lower extremity stress fractures in pediatric and adolescent populations. PHYSICIAN SPORTSMED 2023; 51:572-581. [PMID: 36328959 DOI: 10.1080/00913847.2022.2143247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 10/28/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To present one of the first descriptive case series of pediatric and adolescent lower extremity stress injuries, their management, and outcomes in athletes and non-athletes. METHODS The IRB-approved retrospective study included patients under 18 years at a tertiary children's hospital who were diagnosed with a lower extremity stress fracture/reaction. Demographic data, mechanism of injury, physical exam, radiographic findings, treatment, & outcomes were collected. Descriptive statistical analysis was conducted. RESULTS Ninety-seven patients with stress injuries on clinical exams and on radiographs or MRI were included. The average age when diagnosed was 11.7 years (range 1.1-18 years) and the most common injuries were to the tibia (n = 33, 28.4%) and the least common involved were the cuneiforms (n = 4, 3.4%). Patients under the age of 14 were more likely to experience cuboid and calcaneal stress injuries (mean age 5.5 and 8.3 years respectively). Nineteen patients (19.6%) had high-risk stress fractures, with the average age of 14.9 years versus 11.6 for those with low risk (p-value = 0.01) and return to activity time being 15 weeks compared to 10.5 (p-value = 0.027). The most common forms of treatment were controlled ankle motion (CAM), walker boots (58.6%), and physical therapy (PT) (38.1%). The mean Lower Extremity Function Score of the patient population was 73.8, indicating no clinically important difference from full functionality. CONCLUSION Lower extremity stress injuries in this cohort were most seen in the tibia, although patients younger than 14 had a high number of cuboid and calcaneal stress injuries. Those with high-risk stress fractures were older and took longer to recover from when compared to low-risk injuries. Treatment is commonly conservative, with CAM boots and PT being the most frequently utilized interventions and serving as a successful approach to treatment, with patients returning to activity at an average of 11.4 weeks, which is comparable to similar studies.
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Affiliation(s)
| | | | - Ramesh B Ghanta
- Department of Orthopedic Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Neritan Borici
- Baylor College of Medicine, Houston, TX, USA
- Department of Orthopedic Surgery, Texas Children's Hospital, Houston, TX, USA
| | - Indranil Kushare
- Baylor College of Medicine, Houston, TX, USA
- Department of Orthopedic Surgery, Texas Children's Hospital, Houston, TX, USA
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Banerjee A, Basu B, Saha S, Chowdhury AR. Design and development of a patient-specific temporomandibular joint implant: Probing the influence of bone condition on biomechanical response. J Biomed Mater Res B Appl Biomater 2023; 111:2089-2097. [PMID: 37624362 DOI: 10.1002/jbm.b.35311] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 06/23/2023] [Accepted: 07/31/2023] [Indexed: 08/26/2023]
Abstract
Total temporomandibular joint (TMJ) replacement is widely recognized as an effective treatment for TMJ disorders. The long-term stability of TMJ implants depends on two important factors which are design concepts for fixation to anatomical locations in the mandible and bone conditions. Other factors include stress distribution, microstrain in the peri-implant, bone attributes like bone conditions leading to the clinical complications and failures. This study addresses these limitations by examining the influence of patient-specific design concepts and bone conditions on TMJ implant performance. Clinical evidences support the importance of implant design on healing ability. Previous studies have focused on achieving precise implant fit based on geometric considerations, however those published studies did not explore the impact of such. Against this perspective, the present study reports the extensive finite element analysis (FEA) results, while analyzing the impact of a newly designed patient-specific TMJ implant to address clinical complications associated with various bone conditions, particularly osteoporotic bone. In validating the FEA results, the performance of additively manufactured patient-specific TMJ implants was compared with designs resembling two commonly used clinically approved implant designs. By addressing the limitations of previous research and emphasizing the importance of bone conditions, the study provides valuable guidelines for the development of next-generation TMJ implants. These findings contribute to enhanced clinical outcomes and long-term success in the treatment of TMJ disorders.
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Affiliation(s)
- Anik Banerjee
- Department of Aerospace Engineering and Applied Mechanics, Indian Institute of Engineering Science and Technology, Shibpur, India
| | - Bikramjit Basu
- Laboratory for Biomaterials, Materials Research Centre Indian Institute of Science, Bangalore, India
| | - Subrata Saha
- Department of Restorative Dentistry, University of Washington, Seattle, Washington, USA
| | - Amit Roy Chowdhury
- Department of Aerospace Engineering and Applied Mechanics, Indian Institute of Engineering Science and Technology, Shibpur, India
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Zia T, Bangfan L, Nadeem A, Hussain A, Abdel-Maksoud MA, Zakri AM, Bashir MK, Ali M, Jabeen N, Jamil M, Al-Qahtani WH, Almanaa TN. Comprehensive multi-level expression profiling of key biomarkers in breast cancer patients. Am J Transl Res 2023; 15:6058-6070. [PMID: 37969199 PMCID: PMC10641354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 10/11/2023] [Indexed: 11/17/2023]
Abstract
OBJECTIVES In this comprehensive breast cancer (BC) study, we aimed to identify, validate, and characterize key biomarkers with significant implications in BC diagnosis, prognosis, and as therapeutic targets. METHODS Our research strategy involved a multi-level methodology, combining bioinformatic analysis with experimental validation. RESULTS Initially, we conducted an extensive literature search to identify BC biomarkers, selecting those with reported accuracies exceeding 20% in specificity and sensitivity. This yielded nine candidate biomarkers, which we subsequently analyzed using Cytoscape to identify a few key biomarkers. Based on the degree method, we denoted four key biomarkers, including progesterone receptor (PGR), epidermal growth factor receptor (EGFR), estrogen receptor 1 (ESR1), and Erb-B2 Receptor Tyrosine Kinase 2 (ERBB2). Expression analysis using The Cancer Genome Atlas (TCGA) dataset revealed that PGR and EGFR exhibited significant (p-value < 0.05) down-regulation in BC samples when compared to controls, while ESR1 and ERBB2 showed up-regulation. To strengthen our findings, we collected clinical BC tissue samples from Pakistani patients and performed expression verification using real-time quantitative polymerase chain reaction (RT-qPCR). The results aligned with our initial TCGA dataset analysis, further validating the differential expression of these key biomarkers in BC. Furthermore, we utilized receiver operating characteristic (ROC) curves to demonstrate the diagnostic use of these biomarkers. Our analysis underscored their accuracy and sensitivity as diagnostic markers for BC. Survival analysis using the Kaplan-Meier Plotter tool revealed a prognostic significance of PGR, ESR1, EGFR, and ERBB2. Their expression levels were associated with poor overall survival (OS) of BC patients, shedding light on their roles as prognostic indicators in BC. Lastly, we explored DrugBank to identify drugs that may reverse the expression patterns , and estradiol, decitabine, and carbamazepine were singled out. CONCLUSION Our study gives valuable insight into BC biomarkers, for diagnosis and prognosis. These findings have implications for BC management using personalized and targeted therapeutic approaches for BC patients.
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Affiliation(s)
- Tayyaba Zia
- School of Public Management, Yanshan UniversityQinhuangdao 066000, Hebei, China
| | - Liu Bangfan
- School of Public Administration, Yanshan UniversityQinhuangdao 066000, Hebei, China
| | - Amun Nadeem
- Department of Pathology, Gujranwala Medical College Teaching Hospital and DHQ Teaching HospitalGujranwala 52250, Punjab, Pakistan
| | - Abid Hussain
- APMO Nishter HospitalMultan 60000, Punjab, Pakistan
| | - Mostafa A Abdel-Maksoud
- Department of Botany and Microbiology, College of Science, King Saud UniversityP.O. Box 2455, Riyadh 11451, Saudi Arabia
| | - Adel M Zakri
- Department of Plant Production, College of Food and Agricultural Sciences, King Saud UniversitySaudi Arabia
| | - Muhammad Kazim Bashir
- Shaukat Khanum Memorial Cancer Hospital and Research CentreLahore 13014, Punjab, Pakistan
| | - Mubarak Ali
- Animal Science Institute, National Agricultural Research CenterIslamabad 54000, Pakistan
| | - Norina Jabeen
- Department of Rural Sociology, University of Agriculture FaisalabadFaisalabad 38000, Punjab, Pakistan
| | - Muhammad Jamil
- PARC Arid Zone Research CentreDera Ismail Khan 29050, Pakistan
| | - Wahidah H Al-Qahtani
- Department of Food Sciences & Nutrition, College of Food and Agricultural Sciences, King Saud UniversitySaudi Arabia
| | - Taghreed N Almanaa
- Department of Botany and Microbiology, College of Science, King Saud UniversityP.O. Box 2455, Riyadh 11451, Saudi Arabia
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Álvarez-Herms J, González A, Corbi F, Odriozola I, Odriozola A. Possible relationship between the gut leaky syndrome and musculoskeletal injuries: the important role of gut microbiota as indirect modulator. AIMS Public Health 2023; 10:710-738. [PMID: 37842270 PMCID: PMC10567981 DOI: 10.3934/publichealth.2023049] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 08/03/2023] [Accepted: 08/07/2023] [Indexed: 10/17/2023] Open
Abstract
This article aims to examine the evidence on the relationship between gut microbiota (GM), leaky gut syndrome and musculoskeletal injuries. Musculoskeletal injuries can significantly impair athletic performance, overall health, and quality of life. Emerging evidence suggests that the state of the gut microbiota and the functional intestinal permeability may contribute to injury recovery. Since 2007, a growing field of research has supported the idea that GM exerts an essential role maintaining intestinal homeostasis and organic and systemic health. Leaky gut syndrome is an acquired condition where the intestinal permeability is impaired, and different bacteria and/or toxins enter in the bloodstream, thereby promoting systemic endotoxemia and chronic low-grade inflammation. This systemic condition could indirectly contribute to increased local musculoskeletal inflammation and chronificate injuries and pain, thereby reducing recovery-time and limiting sport performance. Different strategies, including a healthy diet and the intake of pre/probiotics, may contribute to improving and/or restoring gut health, thereby modulating both systemically as local inflammation and pain. Here, we sought to identify critical factors and potential strategies that could positively improve gut microbiota and intestinal health, and reduce the risk of musculoskeletal injuries and its recovery-time and pain. In conclusion, recent evidences indicate that improving gut health has indirect consequences on the musculoskeletal tissue homeostasis and recovery through the direct modulation of systemic inflammation, the immune response and the nociceptive pain.
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Affiliation(s)
- Jesús Álvarez-Herms
- Department of Genetics, Physical Anthropology and Animal Physiology, University of the Basque Country UPV/EHU, 48080 Leioa, Spain
- Phymo Lab, Physiology, and Molecular laboratory, Spain
| | - Adriana González
- Department of Genetics, Physical Anthropology and Animal Physiology, University of the Basque Country UPV/EHU, 48080 Leioa, Spain
| | - Francisco Corbi
- Institut Nacional d'Educació Física de Catalunya (INEFC), Centre de Lleida, Universitat de Lleida (UdL), Lleida, Spain
| | - Iñaki Odriozola
- Health Department of Basque Government, Donostia-San Sebastián, Spain
| | - Adrian Odriozola
- Department of Genetics, Physical Anthropology and Animal Physiology, University of the Basque Country UPV/EHU, 48080 Leioa, Spain
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Thapa M, Neupane A, Shrestha SKD, Nepal P, Upadhyaya A, Niraula P, Shrestha RK, Sunuwar DR. Factors affecting nutritional knowledge, attitude, practices and dietary intake among national players in Kathmandu, Nepal: a cross-sectional study. BMC Sports Sci Med Rehabil 2023; 15:73. [PMID: 37391783 DOI: 10.1186/s13102-023-00691-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 06/27/2023] [Indexed: 07/02/2023]
Abstract
INTRODUCTION Good nutrition knowledge and nutrient intake have been regarded as significant determinants in enhancing athletes' performance and overall health status. This study aimed to assess knowledge, attitude, and practices of nutrition and dietary intake among athletes. METHODS A cross-sectional study was conducted from January to April 2022 among national athletes from two sports clubs in Kathmandu Metropolitan City, Nepal. A semi-structured questionnaire was used to collect the data. Anthropometric measurements and dietary intake were recorded. Bivariate and multivariate binary logistic regression was used to estimate the crude odds ratios (cOR), and adjusted odds ratios (aOR) with 95% confidence intervals (CIs). RESULTS A total of 270 players were included in this study (mean age, 25 years; 49.6% male, 50.4% female). Almost half of the athletes had good nutrition knowledge [54.1% (146/270)], attitude [56.7% (153/270)], and practices [50% (135/270)] scores. The mean energy, carbohydrate, protein, and fat intake were 35.0 kcal/kg/day, 5.6, 0.9, and 0.9 g/kg/day, respectively. Likewise, mean calcium and iron intake were 370, and 12.5 mg, respectively. In the multivariate model, families with monthly household income less than 50,000 Nepalese rupees ($400) (adjusted Odds Ratio/aOR = 2.58; 95% CI: 1.12 to 5.96), and those who did not receive diet plan (aOR = 3.14; 95% CI: 1.25 to 7.84) were more likely to have poor nutrition knowledge. Players who did not check food labelling (aOR = 1.44; 95% CI: 0.78 to 2.63) were more likely to have negative attitude towards nutrition. Players who did not ever attend nutrition class (aOR = 3.54; 95% CI: 1.46 to 8.54) and those who did not consume different food during off and on the season of sports (aOR = 2.36; 95% CI: 1.39 to 4.01) were more likely to have poor nutrition practice. CONCLUSIONS Half of the athletes' nutritional knowledge, attitudes, and practices score were satisfactory. Nutrient intake among athletes was suboptimal. Nutrition intervention programs are critical to improve nutritional knowledge, attitude and practice related to dietary intake among national athletes in Nepal.
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Affiliation(s)
- Madhu Thapa
- Department of Nutrition and Dietetics, College of Applied Food & Dairy Technology, Purbanchal University, Lalitpur, Nepal
- Department of Nutrition and Dietetics, Nepal Armed Police Force Hospital, Kathmandu, Nepal
| | - Arjun Neupane
- Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | | | - Prabin Nepal
- Department of Orthopedic, Nepal Armed Police Force Hospital, Kathmandu, Nepal
| | | | | | - Ram Kumar Shrestha
- Department of Nutrition and Dietetics, College of Applied Food & Dairy Technology, Purbanchal University, Lalitpur, Nepal
| | - Dev Ram Sunuwar
- Department of Nutrition and Dietetics, Nepal Armed Police Force Hospital, Kathmandu, Nepal.
- Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, USA.
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Costa D, Brito R, Afonso S, Ramalhão N, Cantista P. Humeral Fracture in a Young CrossFit Practitioner. Cureus 2023; 15:e39781. [PMID: 37398834 PMCID: PMC10313087 DOI: 10.7759/cureus.39781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2023] [Indexed: 07/04/2023] Open
Abstract
CrossFit (CrossFit Inc, Washington, DC) is a recent, high-intensity strength and conditioning sport that is growing in popularity worldwide. Potential risks and injuries have been described in previous reports. Distal humeral fractures without direct trauma were related to sports like baseball or wrestling. However, they have never been reported in a CrossFit athlete. We present the first case of distal humeral fracture associated with a CrossFit workout, during a gymnastic movement. Our patient had no relevant medical history but the investigation revealed reduced vitamin D levels and low bone density. The patient was surgically treated and he completed the rehabilitation program. He returned to sports practice 12 weeks after the surgery.
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Affiliation(s)
- Diogo Costa
- Physical Medicine and Rehabilitation, Centro Hospitalar Universitário de Santo António, Porto, PRT
| | - Rui Brito
- Physical Medicine and Rehabilitation, Centro Hospitalar Universitário de Santo António, Porto, PRT
| | - Sara Afonso
- Physical Medicine and Rehabilitation, Centro Hospitalar Universitário de Santo António, Porto, PRT
| | - Nuno Ramalhão
- Physical Medicine and Rehabilitation, Centro Hospitalar Universitário de Santo António, Porto, PRT
| | - Pedro Cantista
- Physical Medicine and Rehabilitation, Centro Hospitalar Universitário de Santo António, Porto, PRT
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Kyte KH, Haakstad LAH, Hisdal J, Sunde A, Stensrud T. Bone health in Norwegian female elite runners: a cross-sectional, controlled study. BMJ Open Sport Exerc Med 2023; 9:e001472. [PMID: 36844436 PMCID: PMC9950887 DOI: 10.1136/bmjsem-2022-001472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2023] [Indexed: 02/24/2023] Open
Abstract
Objective The primary objective was to compare bone mineral density (BMD) in Norwegian female elite long-distance runners with a control group of inactive females. Secondary objectives were to identify cases of low BMD, to compare the concentration of bone turnover markers, vitamin D and symptoms of low energy availability (LEA) between the groups, and to identify possible associations between BMD and selected variables. Methods Fifteen runners and fifteen controls were included. Assessments included dual-energy X-ray absorptiometry measurement of BMD in the total body, lumbar spine and dual proximal femur. Blood samples included endocrine analyses and circulating bone turnover markers. The risk of LEA was assessed through a questionnaire. Results Runners had higher Z-scores in the dual proximal femur (1.30 (0.20 to 1.80) vs 0.20 (-0.20 to 0.80), p<0.021) and total body (1.70 (1.20 to 2.30) vs 0.90 (0.80 to 1.00), p<0.001). The lumbar spine Z-score was similar between groups (0.10 (-0.70 to 0.60) vs -0.10(-0.50 to 0.50), p=0.983). Three runners had low BMD (Z-score <-1) in the lumbar spine. Vitamin D and bone turnover markers showed no differences between the groups. Forty-seven per cent of the runners were at risk of LEA. Dual proximal femur BMD showed a positive correlation to estradiol and a negative correlation to LEA symptoms in runners. Conclusion Norwegian female elite runners had higher BMD Z-score in the dual proximal femur and total body compared with controls, while no difference was observed in the lumbar spine. The advantages of long-distance running on bone health seem to be site specific, and there is still a need for the prevention of LEA and menstrual disorders in this group.
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Affiliation(s)
- Karoline Holsen Kyte
- Institute of Clinical Medicine, University of Oslo Faculty of Medicine, Oslo, Norway,Department of Vascular Surgery, Oslo University Hospital, Aker, Oslo, Norway
| | - Lene A H Haakstad
- Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
| | - Jonny Hisdal
- Institute of Clinical Medicine, University of Oslo Faculty of Medicine, Oslo, Norway,Department of Vascular Surgery, Oslo University Hospital, Aker, Oslo, Norway
| | - Andrine Sunde
- Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
| | - Trine Stensrud
- Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
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Jówko E, Długołęcka B, Cieśliński I, Kotowska J. Polymorphisms in Genes Encoding VDR, CALCR and Antioxidant Enzymes as Predictors of Bone Tissue Condition in Young, Healthy Men. Int J Mol Sci 2023; 24:ijms24043373. [PMID: 36834780 PMCID: PMC9964706 DOI: 10.3390/ijms24043373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 01/30/2023] [Accepted: 02/02/2023] [Indexed: 02/11/2023] Open
Abstract
The aim of the study was to assess significant predictors of bone mineral content (BMC) and bone mineral density (BMD) in a group of young, healthy men at the time of reaching peak bone mass. Regression analyses showed that age, BMI and practicing combat sports and team sports at a competitive level (trained vs. untrained group; TR vs. CON, respectively) were positive predictors of BMD/BMC values at various skeletal sites. In addition, genetic polymorphisms were among the predictors. In the whole population studied, at almost all measured skeletal sites, the SOD2 AG genotype proved to be a negative predictor of BMC, while the VDR FokI GG genotype was a negative predictor of BMD. In contrast, the CALCR AG genotype was a positive predictor of arm BMD. ANOVA analyses showed that, regarding SOD2 polymorphism, the TR group was responsible for the significant intergenotypic differences in BMC that were observed in the whole study population (i.e., lower BMC values of leg, trunk and whole body were observed in AG TR compared to AA TR). On the other hand, higher BMC at L1-L4 was observed in the SOD2 GG genotype of the TR group compared to in the same genotype of the CON group. For the FokI polymorphism, BMD at L1-L4 was higher in AG TR than in AG CON. In turn, the CALCR AA genotype in the TR group had higher arm BMD compared to the same genotype in the CON group. In conclusion, SOD2, VDR FokI and CALCR polymorphisms seem to affect the association of BMC/BMD values with training status. In general, at least within the VDR FokI and CALCR polymorphisms, less favorable genotypes in terms of BMD (i.e., FokI AG and CALCR AA) appear to be associated with a greater BMD response to sports training. This suggests that, in healthy men during the period of bone mass formation, sports training (combat and team sports) may attenuate the negative impact of genetic factors on bone tissue condition, possibly reducing the risk of osteoporosis in later age.
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Affiliation(s)
- Ewa Jówko
- Department of Physiology and Biochemistry, Faculty of Physical Education and Health in Biała Podlaska, Józef Piłsudski University of Physical Education in Warsaw, 00-968 Warsaw, Poland
- Correspondence: ; Tel.: +48-608-074-393
| | - Barbara Długołęcka
- Department of Physiology and Biochemistry, Faculty of Physical Education and Health in Biała Podlaska, Józef Piłsudski University of Physical Education in Warsaw, 00-968 Warsaw, Poland
| | - Igor Cieśliński
- Department of Sports and Training Sciences, Faculty of Physical Education and Health in Biała Podlaska, Józef Piłsudski University of Physical Education in Warsaw, 00-968 Warsaw, Poland
| | - Jadwiga Kotowska
- Department of Physiology and Biochemistry, Faculty of Physical Education and Health in Biała Podlaska, Józef Piłsudski University of Physical Education in Warsaw, 00-968 Warsaw, Poland
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Ling X. ANALYSIS OF ALTERNATIVE STRATEGIES FOR PHYSICAL RECOVERY AND MUSCLE STRENGTH AFTER BASKETBALL TRAINING. REV BRAS MED ESPORTE 2023. [DOI: 10.1590/1517-8692202329012022_0158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Introduction: The need to increase muscle strength and optimize physical recovery is essential for athletes’ maximum performance in basketball competitions. However, alternative interventions are still little explored for the physical recovery process. Objective: Explore the effect of muscle strength training in basketball and alternative strategies for physical recovery. Methods: After basketball strength training, the control group adopted the traditional stretching method, while the experimental group combined yoga and music for a gradual warm-up and body relaxation. In this process, we measured changes in blood lactate content during exercise. Within 5 minutes, 15 minutes, and 30 minutes after exercise was used to analyze the effect of muscle recovery between the groups. Results: Muscle strength training can comprehensively improve performance indicators of all aspects of basketball. Still, many biochemical parameters of muscle strength, especially of the shoulder and back, showed no significant effect in the control group. The relative total work (TWP), average power (AP), and relative average power (APP) indicators showed a significant impact after the alternative intervention in the experimental group. Conclusion: Muscle strength training can effectively improve multiple qualities in athletes, providing gains in strength development and motor skills with an acceleration in the physical recovery stage. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.
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18
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Weinrich L, Dahne M, Lindner T, Stöckle U, Tsitsilonis S. Femoral Neck Stress Fracture of a Male, Healthy Marathon Runner - Case Report and Literature Review. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2022; 160:564-571. [PMID: 33782932 DOI: 10.1055/a-1401-0375] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
In the present report, a case of a healthy, 38-year-old male recreational marathon runner who presented in the emergency department is discussed. He was diagnosed with a stress fracture of the femoral neck and treated surgically using a dynamic hip screw (DHS). One year after surgery, the patient was able to return to most of his previous sports activities. In the present report, the existing literature on the subject is exhibited and the points of interest in terms of incidence, risk factors, diagnosis, classification, treatment, and long-term outcome are analyzed. We suggest operative treatment of stress fractures of the femoral neck even in cases of complete undisplaced ones. This way, the risk of a displacement is counteracted, and patients can quickly return to daily activities without having to withstand long-term immobilization.
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Affiliation(s)
- Luise Weinrich
- Centrum für Muskuloskeletale Chirurgie, Charité University Hospital Berlin, Germany
| | - Michael Dahne
- Centrum für Muskuloskeletale Chirurgie, Charité University Hospital Berlin, Germany
| | - Tobias Lindner
- Zentrale chirurgische Notaufnahme, Charité University Hospital Berlin, Germany
| | - Ulrich Stöckle
- Centrum für Muskuloskeletale Chirurgie, Charité University Hospital Berlin, Germany
| | - Serafeim Tsitsilonis
- Centrum für Muskuloskeletale Chirurgie, Charité University Hospital Berlin, Germany
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19
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Moraes MS, Fernandes RA, Moreno YMF, Pelegrini A, Silva DAS. Bone Density and Bone Geometry in University Athletes From Sports With Different Levels of Impact: Simultaneous Association With Multiple Factors. J Strength Cond Res 2022; 36:3113-3121. [PMID: 36026482 DOI: 10.1519/jsc.0000000000004132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
ABSTRACT Moraes, MS, Fernandes, RA, Moreno, YMF, Pelegrini, A, and Silva, DAS. Bone density and bone geometry in university athletes from sports with different levels of impact: simultaneous association with multiple factors. J Strength Cond Res XX(X): 000-000, 2022-The aim of this study was to use the bone loading unit (BLU) classification to compare bone density and bone geometry of sports with different levels of impact, simultaneously controlling the multiple factors that interfere with bone metabolism in athletes. Overall, 167 university athletes (92 men) participated in the study. Bone mineral density (BMD), strength index, cross-sectional area (CSA) at the moment of inertia, section modulus (Z), CSA, neck-shaft angle (NSA), and hip axis length (HAL) were measured. Sports were categorized by level of impact, high BLU (higher impact) and moderate/low BLU (lower impact). Covariates were fat mass, lean tissue mass, training volume, time of practice, dietary supplementation, use of oral contraceptives and menstrual status. Multiple linear regression with 5% significance level (p < 0.05) was used. In men, HAL was higher in sports with high BLU compared with those with moderate/low BLU (β: -0.21; R2: 0.30; p = 0.03). In women, NSA was higher in sports with moderate/low BLU compared with those with high BLU (β: 0.31; R2: 0.11; p = 0.02). There was no difference between BLU groups for BMD. These results persisted when the simultaneous interference of covariates was controlled. Thus, this study recommends BLU to classify sports and reinforces the importance of monitoring HAL and NSA in athletes in addition to the control of multiple factors that interfere with bone metabolism, because they influence physical performance and bone health during and after athletic life.
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Affiliation(s)
- Mikael S Moraes
- Research Center in Kinanthropometry and Human Performance, Federal University of Santa Catarina, Florianopolis, Brazil
| | - Rômulo A Fernandes
- Department of Physical Education, School of Sciences and Technology, São Paulo State University, São Paulo, Brazil
| | - Yara M F Moreno
- Department of Nutrition, Graduate Program in Nutrition, Federal University of Santa Catarina, Florianopolis, Brazil; and
| | - Andreia Pelegrini
- Health and Sport Sciences Center, Santa Catarina State University, Florianopolis, Brazil
| | - Diego A S Silva
- Research Center in Kinanthropometry and Human Performance, Federal University of Santa Catarina, Florianopolis, Brazil
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20
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Høeg TB, Olson EM, Skaggs K, Sainani K, Fredericson M, Roche M, Kraus E. Prevalence of Female and Male Athlete Triad Risk Factors in Ultramarathon Runners. Clin J Sport Med 2022; 32:375-381. [PMID: 34232162 DOI: 10.1097/jsm.0000000000000956] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 05/29/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To identify the prevalence of male and female athlete triad risk factors in ultramarathon runners and explore associations between sex hormones and bone mineral density (BMD). DESIGN Multiyear cross-sectional study. SETTING One hundred-mile ultramarathon. PARTICIPANTS Competing runners were recruited in 2018 and 2019. ASSESSMENT OF RISK FACTORS Participants completed a survey assessing eating behaviors, menstrual history, and injury history; dual-energy x-ray absorptiometry for BMD; and laboratory evaluation of sex hormones, vitamin D, and ferritin (2019 cohort only). MAIN OUTCOME MEASURE A Triad Cumulative Risk Assessment Score was calculated for each participant. RESULTS One hundred twenty-three runners participated (83 males and 40 females, mean age 46.2 and 41.8 years, respectively). 44.5% of men and 62.5% of women had elevated risk for disordered eating. 37.5% of women reported a history of bone stress injury (BSI) and 16.7% had BMD Z scores <-1.0. 20.5% of men had a history of BSI and 30.1% had Z-scores <-1.0. Low body mass index (BMI) (<18.5 kg/m 2 ) was seen in 15% of women and no men. The Triad Cumulative Risk Assessment classified 61.1% of women and 29.2% of men as moderate risk and 5.6% of both men and women as high risk. CONCLUSIONS Our study is the first to measure BMD in both male and female ultramarathon runners. Our male population had a higher prevalence of low BMD than the general population; females were more likely to report history of BSI. Risk of disordered eating was elevated among our participants but was not associated with either low BMD or low BMI.
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Affiliation(s)
- Tracy Beth Høeg
- Department of Physical Medicine & Rehabilitation School of Medicine, University of California-Davis, Sacramento, California.,Northern California Orthopaedic Associates, Grass Valley, California
| | - Emily Miller Olson
- Stanford Department of Orthopaedic Surgery, Stanford University, Palo Alto, California; and
| | - Kira Skaggs
- Stanford Department of Orthopaedic Surgery, Stanford University, Palo Alto, California; and
| | - Kristin Sainani
- Department of Epidemiology and Population Health, Stanford University, Stanford, California
| | - Michael Fredericson
- Stanford Department of Orthopaedic Surgery, Stanford University, Palo Alto, California; and
| | - Megan Roche
- Department of Epidemiology and Population Health, Stanford University, Stanford, California
| | - Emily Kraus
- Stanford Department of Orthopaedic Surgery, Stanford University, Palo Alto, California; and
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21
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Gama E, Kasuki L, Paranhos-Neto FP, Madeira M, Mendonça L, Schtscherbyna A, Farias M. Low Energy Availability Interferes With Exercise-Associated Bone Effects in Female Long-Distance Triathletes as Detected by HR-pQCT. J Clin Densitom 2022; 25:160-167. [PMID: 33608221 DOI: 10.1016/j.jocd.2021.01.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 01/20/2021] [Accepted: 01/26/2021] [Indexed: 12/27/2022]
Abstract
Female Athlete Triad, initially described as the association of disordered eating, amenorrhea and osteoporosis, was further redefined to focus on low energy availability (EA), which has a central role in development of hypoestrogenism and low bone mineral density (BMD). However, the contribution of each variable, that is, low EA and hypoestrogenism, for bone derangements is still an open question. To evaluate body composition and bone status in long-distance triathletes without hypoestrogenism, as compared to non-athletes, using DXA and HR-pQCT, and the influence of EA. Population comprised 23 triathletes who had completed at least one long-distance race in the previous year, and 17 non-athletic healthy controls. The athletes denied previous oligo-amenorrhea and had spontaneous regular menses or were on hormonal contraceptives. Control patients also had regular menses. Energy deficiency (low EA) was defined as energy intake below the recommended level for athletes, that is, 45 kcal/kg free fat mass/day. Only femoral neck BMD Z-score measured by DXA trended higher in athletes (p = 0.05), whereas high-resolution peripheral quantitative computed tomography detected significantly higher values of entire bone and trabecular bone area, cortical perimeter, trabecular vBMD and trabecular bone volume/tissue volume, and lower trabecular separation and trabecular inhomogeneity in athletes. No difference was found between athletes with spontaneous menses and those on hormone contraceptives in respect to all parameters. The effects of exercise on bone were not so pronounced in athletes with low EA, although they still had better bone parameters than controls. Stress fractures were reported by 4:12 athletes with low EA and by 2:11 athletes with adequate EA. Long-distance female triathletes without hypoestrogenism show higher values of cortical perimeter, bone area, volumetric density and trabecular microstructure, but low EA interferes with exercise-associated bone effects. These innovative findings reinforce the importance of adequate EA in female athletes to guarantee skeletal health.
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Affiliation(s)
- Emf Gama
- Division of Endocrinology, Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro (HUCFF-UFRJ), Rio de Janeiro, Rio de Janeiro, Brasil.
| | - L Kasuki
- Neuroendocrinology Research Center, Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro (HUCFF-UFRJ), Rio de Janeiro, Rio de Janeiro, Brasil
| | - F P Paranhos-Neto
- Division of Endocrinology, Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro (HUCFF-UFRJ), Rio de Janeiro, Rio de Janeiro, Brasil
| | - M Madeira
- Division of Endocrinology, Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro (HUCFF-UFRJ), Rio de Janeiro, Rio de Janeiro, Brasil
| | - Lmc Mendonça
- Division of Rheumatology of Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro (HUCFF-UFRJ), Rio de Janeiro, Rio de Janeiro, Brasil
| | - A Schtscherbyna
- Division of Endocrinology, Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro (HUCFF-UFRJ), Rio de Janeiro, Rio de Janeiro, Brasil
| | - Mlf Farias
- Division of Endocrinology, Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro (HUCFF-UFRJ), Rio de Janeiro, Rio de Janeiro, Brasil
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Xu AL, Beck JJ, Sweeney EA, Severson MN, Page AS, Lee RJ. Understanding the Cheerleader as an Orthopaedic Patient: An Evidence-Based Review of the Literature. Orthop J Sports Med 2022; 10:23259671211067222. [PMID: 35083360 PMCID: PMC8785319 DOI: 10.1177/23259671211067222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 09/27/2021] [Indexed: 11/24/2022] Open
Abstract
Cheerleading is a highly popular youth sport in the United States and has been increasingly recognized in recent years for its athleticism and competitive nature. The sport has changed dramatically since its inception. When the sport of cheerleading was first developed, its primary purpose was to entertain crowds and support other athletes. Today, cheerleaders are competitive athletes themselves. Cheerleaders, most of whom are in the pediatric age group, and their parents commonly approach orthopaedic surgeons and sports medicine physicians with questions regarding the risks associated with participation in the sport. Appropriate clinical guidance is especially important for athletes returning to the sport after an injury. However, unlike other popular sports (eg, football, basketball, and volleyball), the intricacies of cheerleading are not well-known to those outside the sport, including many health care providers. Previous studies have reported on the epidemiological patterns of injuries associated with cheerleading and how such aesthetic sports affect the body, finding that fractures and concussions are prevalent and that catastrophic injuries are more common than in most other sports. Here, we provide an evidence-based discussion of 10 pertinent topics regarding cheerleading and its risks to the musculoskeletal system. The purpose of this review is to provide a comprehensive resource for orthopaedic surgeons and sports medicine physicians who care for these athletes.
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Affiliation(s)
- Amy L. Xu
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland, USA
| | - Jennifer J. Beck
- Orthopaedic Institute for Children/UCLA, Santa Monica, California, USA
| | - Emily A. Sweeney
- Sports Medicine Center, Children’s Hospital Colorado, Aurora, Colorado, USA
- Department of Orthopaedic Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Megan N. Severson
- Carilion Clinic Orthopaedic Surgery, Roanoke, Virginia, USA
- Department of Orthopaedic Surgery, Virginia Tech-Carilion School of Medicine, Roanoke, Virginia, USA
| | - A. Stacie Page
- Department of Physical Medicine and Rehabilitation, The Johns Hopkins Hospital, White Marsh, Maryland, USA
| | - R. Jay Lee
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland, USA
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Mendes Junior AF, Tabet CG, Mendes SL, Abreu MDM, Figueirêdo NCD. Triathlete with Multiple Stress Fractures in the Lower Limbs: Case Report and Literature Review. Rev Bras Ortop 2021; 56:813-818. [PMID: 34900113 PMCID: PMC8651454 DOI: 10.1055/s-0041-1739404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 03/08/2021] [Indexed: 11/03/2022] Open
Abstract
Recurrent stress fractures rarely affect the same athlete. We present the case of a female triathlete who suffered multiple stress fractures in both tibias, the right fibula, and the left femoral neck. Conservative treatment was instituted in all episodes, with rest, reduced training load, and physical therapy rehabilitation. The relative energy deficiency in sport syndrome, along with an eating disorder, training overload, and osteopenia, was identified as a risk factor. Although rare, multiple stress fractures can occur in female triathletes. These patients must be screened for risk factors associated with biomechanics, nutrition, and training to develop an effective prevention and treatment program.
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Affiliation(s)
- Adriano Fernando Mendes Junior
- Ambulatório de Trauma do Esporte, Hospital Universitário, Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brasil
| | - Caio Gomes Tabet
- Programa de Residência Médica em Ortopedia e Traumatologia, Hospital Universitário, Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brasil
| | - Samuel Lopes Mendes
- Departamento de Ortopedia e Traumatologia, Santa Casa de Misericórdia de Juiz de Fora, Juiz de Fora, MG, Brasil
| | - Marcus da Matta Abreu
- Disciplinas de Medicina de Urgência e Emergência e Medicina do Esporte, Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brasil
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Moraes MS, Martins PC, Silva DAS. COMPARISON OF BONE PARAMETERS BY BODY REGION IN UNIVERSITY ATHLETES: SYSTEMATIC REVIEW. REV BRAS MED ESPORTE 2021. [DOI: 10.1590/1517-8692202127062020_0051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Introduction: Bone mineral density (BMD) and bone mineral content (BMC) vary depending on the type of sport practiced and the body region, and their measurement can be an effective way to predict health risks throughout an athlete’s life. Objective: To describe the methodological aspects (measurement of bone parameters, body regions, precision errors and covariates) and to compare BMD and BMC by body region (total body, upper limbs, lower limbs and trunk) among university athletes practicing different sports. Methods: A search was performed on the databases PubMed, Web of Science, Scopus, ScienceDirect, EBSCOhost, SportDiscus, LILACS and SciELO. Studies were selected that: (1) compared BMD and BMC of athletes practicing at least two different sports (2) used dual-energy X-ray absorptiometry (DXA) to assess bone parameters (3) focused on university athletes. The extracted data were: place of study, participant selection, participants’ sex, sport practiced, type of study, bone parameters, DXA model, software used, scan and body regions, precision error, precision protocol, covariates and comparison of bone parameters between different sports by body region. Results: The main results were: 1) BMD is the most investigated bone parameter; 2) total body, lumbar spine and proximal femur (mainly femoral neck) are the most studied body regions; 3) although not recommended, the coefficient of variation is the main indicator of precision error; 4) total body mass and height are the most commonly used covariates; 5) swimmers and runners have lower BMD and BMC values; and 6) it is speculated that basketball players and gymnasts have greater osteogenic potential. Conclusions: Swimmers and runners should include weight-bearing exercises in their training routines. In addition to body mass and height, other covariates are important. The results of this review can help guide intervention strategies focused on preventing diseases and health problems during and after the athletic career. Level of evidence II; Systematic Review.
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Clemente FM, González-Fernández FT, Ceylan HI, Silva R, Younesi S, Chen YS, Badicu G, Wolański P, Murawska-Ciałowicz E. Blood Biomarkers Variations across the Pre-Season and Interactions with Training Load: A Study in Professional Soccer Players. J Clin Med 2021; 10:5576. [PMID: 34884288 PMCID: PMC8658324 DOI: 10.3390/jcm10235576] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 11/18/2021] [Accepted: 11/24/2021] [Indexed: 02/07/2023] Open
Abstract
Background: Pre-season training in soccer can induce changes in biological markers in the circulation. However, relationships between chosen hematological and biochemical blood parameters and training load have not been measured. Objective: Analyze the blood measures changes and their relationships with training loads changes after pre-season training. Methodology: Twenty-five professional soccer players were assessed by training load measures (derived from rate of perceived exertion- known as RPE) during the pre-season period. Additionally, blood samples were collected for hematological and biochemical analyses. Results: For hematological parameters, significant increases were found for platelets (PLT) (dif: 6.42; p = 0.006; d = -0.36), while significant decreases were found for absolute neutrophils count (ANC) (dif: -3.98; p = 0.006; d = 0.11), and absolute monocytes count (AMC) (dif: -16.98; p = 0.001; d = 0.78) after the pre-season period. For biochemical parameters, there were significant increases in creatinine (dif: 5.15; p = 0.001; d = -0.46), alkaline phosphatase (ALP) (dif: 12.55; p = 0.001; d = -0.84), C-reactive protein (CRP) (dif: 15.15; p = 0.001; d = -0.67), cortisol (dif: 2.85; p = 0.001; d = -0.28), and testosterone (dif: 5.38; p = 0.001; d = -0.52), whereas there were significant decreases in calcium (dif: -1.31; p = 0.007; d =0.49) and calcium corrected (dif: -2.18; p = 0.015; d = 0.82) after the pre-season period. Moreover, the Hooper Index (dif: 13.22; p = 0.01; d = 0.78), and all derived RPE measures increased after pre-season period. Moderate-to-very large positive and negative correlations (r range: 0.50-0.73) were found between the training load and hematological measures percentage of changes. Moderate-to-large positive and negative correlations (r range: 0.50-0.60) were found between training load and biochemical measures percentage of changes. Conclusions: The results indicated heavy physical loads during the pre-season, leading to a decrease in immune functions. Given the significant relationships between blood and training load measures, monitoring hematological and biochemical measures allow coaches to minimize injury risk, overreaching, and overtraining.
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Affiliation(s)
- Filipe Manuel Clemente
- Escola Superior Desporto e Lazer, Instituto Politécnico de Viana do Castelo, Rua Escola Industrial e Comercial de Nun’Álvares, 4900-347 Viana do Castelo, Portugal;
- Instituto de Telecomunicações, Delegação da Covilhã, 1049-001 Lisboa, Portugal
| | - Francisco Tomás González-Fernández
- Department of Physical Activity and Sport Sciences, Pontifical University of Comillas, 07013 Palma, Spain;
- SER Research Group, Pontifical University of Comillas, 07013 Palma, Spain
| | - Halil Ibrahim Ceylan
- Physical Education and Sports Teaching Department, Kazim Karabekir Faculty of Education, Ataturk University, Erzurum 25240, Turkey;
| | - Rui Silva
- Escola Superior Desporto e Lazer, Instituto Politécnico de Viana do Castelo, Rua Escola Industrial e Comercial de Nun’Álvares, 4900-347 Viana do Castelo, Portugal;
| | - Saeid Younesi
- Research Unit for Sport and Physical Activity, Faculty of Sport Sciences and Physical Education, University of Coimbra, 3004-531 Coimbra, Portugal;
| | - Yung-Sheng Chen
- Department of Exercise and Health Sciences, University of Taipei, Taipei 11153, Taiwan;
| | - Georgian Badicu
- Department of Physical Education and Special Motricity, University Transilvania of Brasov, 500068 Brasov, Romania;
| | - Paweł Wolański
- Department of Physiology, Gdansk University of Physical Education and Sport, 80-336 Gdansk, Poland;
| | - Eugenia Murawska-Ciałowicz
- Department of Physiology and Biochemistry, University School of Physical Education, 51-612 Wrocław, Poland;
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Verhoef SJ, Wielink MC, Achterberg EA, Bongers MY, Goossens SMTA. Absence of menstruation in female athletes: why they do not seek help. BMC Sports Sci Med Rehabil 2021; 13:146. [PMID: 34814941 PMCID: PMC8609260 DOI: 10.1186/s13102-021-00372-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 11/08/2021] [Indexed: 11/18/2022]
Abstract
Background It is known that amenorrhea is highly prevalent among female athletes. However, a large percentage of them do not seek help if this complaint occurs. We performed this study to gain more insight into the reasons why female athletes do not seek help when experiencing amenorrhea and how care for these women could be improved. Method Qualitative focus group research. Female athletes were approached to take part in a focus group. They were asked about the main reasons for not reporting amenorrhea and how care for amenorrhea, in their opinion, would ideally be organised. The women were asked to make a list of their top five reasons for both subjects and discuss this among their peers. Results According to the participants, the five main reasons for not reporting the amenorrhea were: (1) normalizing of the subject, (2) the absence of menstruation is not perceived as a problem by the athletes themselves, (3) experienced shame and taboo, (4) prioritisation of sports performance, and (5) denial. Factors to improve care around menstrual cycle problems in female athletes were: (1) informing athletes, coaches, trainers and mentors, (2) informing doctors, (3) conducting more research on long-term consequences, (4) breaking the taboo on menstrual problems, and (5) having a multidisciplinary collaboration between different specialisms. Conclusion By informing athletes, coaches, trainers, and mentors about menstrual cycle problems in athletes, more awareness among those groups can be created. According to the athletes, more research is needed on the long-term consequences of amenorrhea in sports, to enable them to make a better assessment of their possible future health risks. Women experience a taboo on discussing menstrual problems; role models discussing the problem may help in decreasing the taboo. A multidisciplinary collaboration of health care providers may improve care around female athletes with menstrual problems.
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Affiliation(s)
- Saskia J Verhoef
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Universiteitssingel 40, 6229 ER, Maastricht, The Netherlands. .,Department of Obstetrics and Gynaecology, Máxima Medical Centre, PO Box 7777, 5500 MB, Veldhoven, The Netherlands.
| | - Merel C Wielink
- Department of Sports Medicine, Máxima Medical Centre, De Run 4600, 5504 DB, Veldhoven, The Netherlands
| | - Edwin A Achterberg
- Department of Sports Medicine, Máxima Medical Centre, De Run 4600, 5504 DB, Veldhoven, The Netherlands
| | - Marlies Y Bongers
- Department of Obstetrics and Gynaecology, Máxima Medical Centre, PO Box 7777, 5500 MB, Veldhoven, The Netherlands.,Research School Grow, Maastricht University, Universiteitssingel 40, 6229 ER, Maastricht, The Netherlands
| | - Simone M T A Goossens
- Department of Obstetrics and Gynaecology, Máxima Medical Centre, PO Box 7777, 5500 MB, Veldhoven, The Netherlands.,Eindhoven MedTech Innovation Center (E/MTIC), Horsten 1, 5612 AX, Eindhoven, The Netherlands
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Schmidt I, Albert J, Ritthaler M, Papastavrou A, Steinmann P. Bone fracture healing within a continuum bone remodelling framework. Comput Methods Biomech Biomed Engin 2021; 25:1040-1050. [PMID: 34730042 DOI: 10.1080/10255842.2021.1998465] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Bone fracture healing is a complex process which is still under research. Computer-aided patient-specific prediction of bone development, fracture risk, prevention and treatment approaches promises a significant milestone in clinical practice. With this long-term goal in mind, a novel model is presented and examined in this work in the context of continuum bone remodelling. Therein, a clear distinction is made between external mechanical stimulation and the biological healing process of an injured bone tissue. The model is implemented within a finite element framework and investigated for the example of a fractured proximal femur head. The results show promising perspectives for further application. Besides, the model offers the possibility of easily integrating other factors like age-dependency and the availability of nutrition. For the future, further studies with large clinical datasets are essential for validation.
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Affiliation(s)
- Ina Schmidt
- Faculty of Mechanical Engineering, Nuremberg Tech, Nuremberg, Germany
| | - Jacob Albert
- Institute of Applied Mechanics, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Marina Ritthaler
- Faculty of Mechanical Engineering, Nuremberg Tech, Nuremberg, Germany
| | - Areti Papastavrou
- Faculty of Mechanical Engineering, Nuremberg Tech, Nuremberg, Germany
| | - Paul Steinmann
- Institute of Applied Mechanics, University of Erlangen-Nuremberg, Erlangen, Germany
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Cheng J, Santiago KA, Abutalib Z, Temme KE, Hulme A, Goolsby MA, Esopenko CL, Casey EK. Menstrual Irregularity, Hormonal Contraceptive Use, and Bone Stress Injuries in Collegiate Female Athletes in the United States. PM R 2021; 13:1207-1215. [PMID: 33340255 PMCID: PMC8262270 DOI: 10.1002/pmrj.12539] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 12/02/2020] [Accepted: 12/14/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Menstrual irregularity (MI) is common in female athletes and is a component of the Female Athlete Triad (Triad). Many athletes with the Triad are started on hormonal contraceptives (HC) for MI, but this interferes with the ability to monitor menstrual cycle regularity and can mask other causes of MI. There are limited studies investigating the relationship between MI, HC use, and injury in female collegiate athletes. OBJECTIVE To examine the prevalence of and relationship between HC use, MI, and bone stress injuries in female collegiate athletes in the United States. DESIGN Cross-sectional study. SETTING Online survey. PARTICIPANTS 1020 U.S. female collegiate athletes (age ≥ 18 years). METHODS OR INTERVENTIONS Assessment of risk factors for menstrual irregularity and bone stress injuries was conducted via a one-time survey. MAIN OUTCOME MEASURES HC use, MI, history of stress fractures. RESULTS Current HC use prevalence was 65% (95% confidence interval [CI], 61.9%, 67.8%). Of all athletes, 47% reported past MI. Of the athletes who were not currently using HCs, 32% had current MI. Compared with athletes without past MI, more athletes with past MI reported current HC use (73% vs. 57%) and indicated menstrual cycle consistency as the primary reason for use (24% vs. 4%) (P < .001). Additionally, 25% of athletes reported a history of stress fractures, which was associated with lean/aesthetic sports participation (odds ratio [95% CI]: 1.9 [1.4, 2.5]; P < .001) and less oral contraceptive pill (OCP) use (0.7 [0.5, 1.0]; P = .043). Compared with OCPs, injectable HCs were associated with greater odds of a history of stress fractures (4.5[1.6, 12.3]; P = .004). CONCLUSIONS HC use was prevalent among this cohort of female collegiate athletes, and almost half of the athletes reported past MI. A goal of menstrual cycle regularity was cited by 24% of athletes as a primary reason to use HCs, which shows that more athlete education is needed to avoid masking MI and the Triad with HCs. Further studies elucidating the relationship between HC use, MI, and sports-related injury are warranted.
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Affiliation(s)
- Jennifer Cheng
- Department of Physiatry, Hospital for Special Surgery, New York, NY
| | | | - Zafir Abutalib
- Biostatistics Core, Hospital for Special Surgery, New York, NY
| | - Kate E. Temme
- Department of Physical Medicine and Rehabilitation, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Ann Hulme
- Department of Physical Medicine and Rehabilitation, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Marci A. Goolsby
- Department of Primary Care Sports Medicine, Hospital for Special Surgery, New York, NY
| | - Carrie L. Esopenko
- Department of Rehabilitation and Movement Sciences, Rutgers Biomedical Health Sciences, Newark, NJ
| | - Ellen K. Casey
- Department of Physiatry, Hospital for Special Surgery, New York, NY
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Lin YC, Tseng IJ, Lu YC, Yang SW, Wu CC, Lin YN, Chan WP. Muscle Mass and Gait Characteristics in Older Women Fallers vs. Non-Fallers. J Clin Med 2021; 10:jcm10173924. [PMID: 34501372 PMCID: PMC8432046 DOI: 10.3390/jcm10173924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 08/26/2021] [Accepted: 08/27/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Falling is a major public health concern of elderly people. We aimed to determine if lean mass and spatiotemporal gait parameters could predict the risk of falling in elderly women and also study the relationships between lean mass and gait characteristics. Methods: Twenty-four community women were prospectively recruited (mean age, 72.30 ± 5.31 years). Lean mass was measured using dual-energy fan-beam X-ray absorptiometry. Gait characteristics were assessed using spatiotemporal analysis. Fall risks were assessed using the Berg Balance Scale (BBS) and the Falls Efficacy Scale-International. Fall histories were recorded. Appropriate statistical analyses were applied to determine lean mass and gait characteristics in predicting the risk of fall and the associations between lean mass and gait characteristics. Results: There were 14 participants (58.33%) with fall histories. Patients with fall histories had a significantly narrower base of support and lower BBS score. However, only the base of support was significantly associated with fall risk (odds ratio, 0.415; p = 0.022). Lean mass was significantly negatively associated with proportion of swing phase and positively associated with proportions of stance and double-support phases. Conclusion: Fall risk among elderly women can be predicted using base of support, where a narrower base predicts a greater fall risk. Although the lean mass was not related to risk of fall, lean mass is still related to some gait characteristics.
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Affiliation(s)
- Yu-Ching Lin
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Keelung and Chang Gung University, Tayoun 33001, Taiwan;
| | - Ing-Jy Tseng
- School of Gerontology Health Management, College of Nursing, Taipei Medical University, Taipei 11031, Taiwan;
| | - Yi-Chien Lu
- Department of Radiology, Wan Fang Hospital, Taipei Medical University, Taipei 11696, Taiwan; (Y.-C.L.); (S.-W.Y.)
| | - Shao-Wei Yang
- Department of Radiology, Wan Fang Hospital, Taipei Medical University, Taipei 11696, Taiwan; (Y.-C.L.); (S.-W.Y.)
| | - Chia-Chi Wu
- Department of Pathology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan;
| | - Yen-Nung Lin
- Department of Physical Medicine and Rehabilitation, Wan-Fang Hospital, Taipei Medical University, Taipei 11696, Taiwan;
- Institute of Injury Prevention and Control, Taipei Medical University, Taipei 11031, Taiwan
| | - Wing P. Chan
- Department of Radiology, Wan Fang Hospital, Taipei Medical University, Taipei 11696, Taiwan; (Y.-C.L.); (S.-W.Y.)
- Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11696, Taiwan
- Correspondence: ; Tel.: +886-6(2)29307930 (ext. 1300); Fax: +886-6(2)29316809
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30
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Martins PC, Moraes MS, Silva DAS. How is the phase angle associated with total and regional bone mineral density in university athletes? . Physiol Meas 2021; 42. [PMID: 34225269 DOI: 10.1088/1361-6579/ac114b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 07/05/2021] [Indexed: 11/11/2022]
Abstract
Objective.To investigate how phase angle (PhA) is associated with total and regional bone mineral density (BMD) (femur and lumbar spine) in university athletes.Approach.This cross-sectional study was conducted in Florianópolis, Brazil, with 167 university athletes from different sports (92 males). The PhA was obtained through electrical bioimpedance and BMD was obtained through dual x-ray absorptiometry (DXA). Data on the covariables age, time involved in the sport, type of sport (low, medium and high impact), daily use of oral contraceptives, and vitamin D calcium and/or protein supplementation were obtained through anamnesis, while fat mass and fat- and bone-free mass were obtained through DXA. Simple linear regression and a 5% significance level were used.Main results. In female athletes, PhA was directly associated with total BMD (β: 2.20; 95% CI: 0.43; 3.96) and BMD in the femur (β0.85; 95% CI: -0.23; 1.94) and lumbar spine (β: 1.45; 95% CI: 0.44; 2.46), even after adjusting for the covariates. In male athletes, although PhA was directly associated with regional BMD (femur [β: 0.63; 95% CI: 0.04; 1.22] and lumbar spine [β: 0.64; 95% CI: -0.01; 1.31]) in simple linear regression, this association disappeared when the covariates were added.Significance. PhA was directly associated with total BMD and lumbar spine in female, but not male, athletes.
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Affiliation(s)
- Priscila Custódio Martins
- Núcleo de Pesquisa em Cineantropometria & Desempenho Humano. Centro de Desportos. Universidade Federal de Santa Catarina. Florianópolis, Santa Catarina, Brasil
| | - Mikael Seabra Moraes
- Núcleo de Pesquisa em Cineantropometria & Desempenho Humano. Centro de Desportos. Universidade Federal de Santa Catarina. Florianópolis, Santa Catarina, Brasil
| | - Diego Augusto Santos Silva
- Núcleo de Pesquisa em Cineantropometria & Desempenho Humano. Centro de Desportos. Universidade Federal de Santa Catarina. Florianópolis, Santa Catarina, Brasil
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Wazzani R, Pallu S, Bourzac C, Ahmaïdi S, Portier H, Jaffré C. Physical Activity and Bone Vascularization: A Way to Explore in Bone Repair Context? Life (Basel) 2021; 11:life11080783. [PMID: 34440527 PMCID: PMC8399402 DOI: 10.3390/life11080783] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 06/11/2021] [Accepted: 07/21/2021] [Indexed: 01/15/2023] Open
Abstract
Physical activity is widely recognized as a biotherapy by WHO in the fight and prevention of bone diseases such as osteoporosis. It reduces the risk of disabling fractures associated with many comorbidities, and whose repair is a major public health and economic issue. Bone tissue is a dynamic supportive tissue that reshapes itself according to the mechanical stresses to which it is exposed. Physical exercise is recognized as a key factor for bone health. However, the effects of exercise on bone quality depend on exercise protocols, duration, intensity, and frequency. Today, the effects of different exercise modalities on capillary bone vascularization, bone blood flow, and bone angiogenesis remain poorly understood and unclear. As vascularization is an integral part of bone repair process, the analysis of the preventive and/or curative effects of physical exercise is currently very undeveloped. Angiogenesis–osteogenesis coupling may constitute a new way for understanding the role of physical activity, especially in fracturing or in the integration of bone biomaterials. Thus, this review aimed to clarify the link between physical activities, vascularization, and bone repair.
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Affiliation(s)
- Rkia Wazzani
- Laboratoire APERE, Université de Picardie Jules Verne, CEDEX, F-80000 Amiens, France; (R.W.); (S.A.)
| | - Stéphane Pallu
- Laboratoire B3OA, Université de Paris, CEDEX, F-75010 Paris, France; (S.P.); (C.B.); (H.P.)
- UFR Science & Technique, Université d’Orléans, CEDEX, F-45100 Orléans, France
| | - Céline Bourzac
- Laboratoire B3OA, Université de Paris, CEDEX, F-75010 Paris, France; (S.P.); (C.B.); (H.P.)
| | - Saïd Ahmaïdi
- Laboratoire APERE, Université de Picardie Jules Verne, CEDEX, F-80000 Amiens, France; (R.W.); (S.A.)
| | - Hugues Portier
- Laboratoire B3OA, Université de Paris, CEDEX, F-75010 Paris, France; (S.P.); (C.B.); (H.P.)
- UFR Science & Technique, Université d’Orléans, CEDEX, F-45100 Orléans, France
| | - Christelle Jaffré
- Laboratoire APERE, Université de Picardie Jules Verne, CEDEX, F-80000 Amiens, France; (R.W.); (S.A.)
- Laboratoire B3OA, Université de Paris, CEDEX, F-75010 Paris, France; (S.P.); (C.B.); (H.P.)
- Correspondence:
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Bielik V, Kolisek M. Bioaccessibility and Bioavailability of Minerals in Relation to a Healthy Gut Microbiome. Int J Mol Sci 2021; 22:ijms22136803. [PMID: 34202712 PMCID: PMC8268569 DOI: 10.3390/ijms22136803] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/17/2021] [Accepted: 06/21/2021] [Indexed: 02/06/2023] Open
Abstract
Adequate amounts of a wide range of micronutrients are needed by body tissues to maintain health. Dietary intake must be sufficient to meet these micronutrient requirements. Mineral deficiency does not seem to be the result of a physically active life or of athletic training but is more likely to arise from disturbances in the quality and quantity of ingested food. The lack of some minerals in the body appears to be symbolic of the modern era reflecting either the excessive intake of empty calories or a negative energy balance from drastic weight-loss diets. Several animal studies provide convincing evidence for an association between dietary micronutrient availability and microbial composition in the gut. However, the influence of human gut microbiota on the bioaccessibility and bioavailability of trace elements in human food has rarely been studied. Bacteria play a role by effecting mineral bioavailability and bioaccessibility, which are further increased through the fermentation of cereals and the soaking and germination of crops. Moreover, probiotics have a positive effect on iron, calcium, selenium, and zinc in relation to gut microbiome composition and metabolism. The current literature reveals the beneficial effects of bacteria on mineral bioaccessibility and bioavailability in supporting both the human gut microbiome and overall health. This review focuses on interactions between the gut microbiota and several minerals in sport nutrition, as related to a physically active lifestyle.
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Affiliation(s)
- Viktor Bielik
- Department of Biological and Medical Science, Faculty of Physical Education and Sport, Comenius University in Bratislava, 81469 Bratislava, Slovakia
- Correspondence:
| | - Martin Kolisek
- Biomedical Center Martin, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 03601 Martin, Slovakia;
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Hamstra-Wright KL, Huxel Bliven KC, Napier C. Training Load Capacity, Cumulative Risk, and Bone Stress Injuries: A Narrative Review of a Holistic Approach. Front Sports Act Living 2021; 3:665683. [PMID: 34124660 PMCID: PMC8192811 DOI: 10.3389/fspor.2021.665683] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 04/14/2021] [Indexed: 01/09/2023] Open
Abstract
Bone stress injuries (BSIs) are a common orthopedic injury with short-term, and potentially long-term, effects. Training load capacity, influenced by risk factors, plays a critical role in the occurrence of BSIs. Many factors determine how one's body responds to repetitive loads that have the potential to increase the risk of a BSI. As a scientific community, we have identified numerous isolated BSI risk factors. However, we have not adequately analyzed the integrative, holistic, and cumulative nature of the risk factors, which is essential to determine an individual's specific capacity. In this narrative review, we advocate for a personalized approach to monitor training load so that individuals can optimize their health and performance. We define “cumulative risk profile” as a subjective clinical determination of the number of risk factors with thoughtful consideration of their interaction and propose that athletes have their own cumulative risk profile that influences their capacity to withstand specific training loads. In our narrative review, we outline BSI risk factors, discuss the relationship between BSIs and training load, highlight the importance of individualizing training load, and emphasize the use of a holistic assessment as a training load guide.
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Affiliation(s)
- Karrie L Hamstra-Wright
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, United States
| | - Kellie C Huxel Bliven
- Department of Interdisciplinary Health Sciences, Arizona School of Health Sciences, A.T. Still University, Mesa, AZ, United States
| | - Christopher Napier
- Menrva Research Group, Faculty of Applied Science, Schools of Mechatronic Systems Engineering and Engineering Science, Simon Fraser University, Vancouver, BC, Canada.,Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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Ricart B, Monteagudo P, Blasco-Lafarga C. Hypovitaminosis D in Young Basketball Players: Association with Jumping and Hopping Performance Considering Gender. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18105446. [PMID: 34069673 PMCID: PMC8160822 DOI: 10.3390/ijerph18105446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 05/12/2021] [Accepted: 05/15/2021] [Indexed: 11/23/2022]
Abstract
This study aimed to verify whether a group of young well-trained basketball players presented deficiencies in vitamin D concentration, and to analyze whether there was an association between vitamin D concentration and jumping and hopping performance. Gender differences were considered. Twenty-seven players from an international high-level basketball club (14 female, 16.00 ± 0.55 years; 13 male, 15.54 ± 0.52 years) participated in this cross-sectional study. Rate of force development was evaluated by means of the Abalakov test (bilateral: AbB; right leg: AbR; left leg: AbL); and the triple hop test (right leg: THR; left leg: THL). Blood samples were collected for the determination of serum 25-hydroxyvitamin D and nutritional status. Vitamin D insufficiency was found in both women (29.14 ± 6.08 ng/mL) and men (28.92 ± 6.40 ng/mL), with no gender differences regarding nutritional scores. Jumping and hopping performance was confirmed to be significantly larger in males (AbL, THR, and THL p < 0.005), whose CV% were always smaller. A positive correlation was found between AbB and vitamin D (r = 0.703) in males, whereas this correlation was negative (−0.611) for females, who also presented a negative correlation (r = −0.666) between THR and vitamin D. A prevalence of hypovitaminosis D was confirmed in young elite athletes training indoors. Nutritional (i.e., calciferol) controls should be conducted throughout the season. Furthermore, whilst performance seems to be affected by low levels of this vitamin in men, these deficiencies appear to have a different association with jumping and hopping in women, pointing to different performance mechanisms. Further studies accounting for differences in training and other factors might delve into these gender differences.
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Affiliation(s)
- Borja Ricart
- Sport Performance and Physical Fitness Research Group (UIRFIDE), Physical Education and Sports Department, University of Valencia, 46010 Valencia, Spain;
- Alqueria LAB, Valencia Basket, 46013 Valencia, Spain
- Correspondence: (B.R.); (P.M.)
| | - Pablo Monteagudo
- Sport Performance and Physical Fitness Research Group (UIRFIDE), Physical Education and Sports Department, University of Valencia, 46010 Valencia, Spain;
- Education and Specific Didactics Department, Jaume I University, 12071 Castellón, Spain
- Correspondence: (B.R.); (P.M.)
| | - Cristina Blasco-Lafarga
- Sport Performance and Physical Fitness Research Group (UIRFIDE), Physical Education and Sports Department, University of Valencia, 46010 Valencia, Spain;
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Sweeney E, Rodenberg R, MacDonald J. Overuse Knee Pain in the Pediatric and Adolescent Athlete. Curr Sports Med Rep 2021; 19:479-485. [PMID: 33156034 DOI: 10.1249/jsr.0000000000000773] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Overuse knee pain is common in young athletes. There are many potential overuse injuries which present with insidious onset of pain that can challenge sports medicine providers, including Osgood-Schlatter's disease, patellofemoral syndrome, osteochondritis dissecans, and stress fractures. The differential diagnosis of insidious onset knee pain also includes malignancies, infections, and rheumatologic issues. A thorough history and physical examination can guide the treating provider in making a diagnosis and appropriate treatment plan. Although not always necessary, imaging is often helpful in overuse knee pain, and laboratory workup may be necessary. Conservative treatment is often the first recommendation in the management of overuse knee pain in young athletes, and this may include activity modification, ice, anti-inflammatory medications, bracing, and physical therapy. This review summarizes common overuse knee injuries seen in pediatric and adolescent athletes.
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Shannon N, Cable B, Wood T, Kelly J. Common and Less Well-known Upper-limb Injuries in Elite Tennis Players. Curr Sports Med Rep 2021; 19:414-421. [PMID: 33031207 DOI: 10.1249/jsr.0000000000000760] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
A recent increase in epidemiology studies on injuries in elite tennis players has helped to shed light on the types of injuries these athletes sustain. This article reviews the common upper-limb injuries in elite players and includes less well known, but important, injuries. A search was conducted to identify current relevant studies involving elite tennis players. Injury frequency rates, injuries by regions, and types of injuries together with a list of commonly reported injuries in the upper limb were established. This list was then reviewed and refined by a sports medicine physician who cares for elite tennis players to include both those injuries of the upper limb that are common and those that are less well known but still important and frequently encountered. Common injuries include internal shoulder impingement, rotator cuff pathology, labral tears, elbow tendinopathies, as well as extensor carpi ulnaris tendinopathies and subluxation. Posterior shoulder instability, distal humeral bone stress, elbow medial collateral ligament, and nondominant wrist ulnar collateral ligament injuries are not commonly reported injuries, but they are of significant clinical importance.
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Affiliation(s)
| | - Brian Cable
- Clinical Orthopaedic Surgery, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA
| | - Timothy Wood
- Clinical Orthopaedic Surgery, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA
| | - John Kelly
- Clinical Orthopaedic Surgery, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA
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Moraes MS, Martins PC, Ferreira FE, Silva DA. Comparison of bone mineral density and bone mineral content in university athletes from different sports. J Sports Med Phys Fitness 2021; 62:654-660. [PMID: 33666077 DOI: 10.23736/s0022-4707.21.12297-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Bone parameters are influenced by multiple factors. However, when comparing sports, few studies have considered the simultaneous interference of these factors in bone parameters. OBJECTIVE To compare bone mineral density (BMD) and bone mineral content (BMC) between university athletes from different sports, according to sex. APPROACH Cross-sectional study with 71 male (M) and female (F) university athletes practicing indoor soccer (M = 14, F = 20), judo (M = 8, F = 6) and volleyball (M = 11, F = 12) aged 22.37 (± 3.71) years. Dependent variables were BMD and BMC corrected by height measured by dual energy X-ray absorptiometry. The sport practiced (indoor soccer, judo and volleyball) was the independent variable and covariates were fat mass, lean tissue mass, training volume, practice time and gynecological aspects (in females athletes) such as regular menstruation and use of oral contraceptives. Analysis of covariance was used, with p <0.05. RESULTS Female volleyball players [mean: 1.23; Standard Error (SE): 0.03] presented higher lumbar BMD values compared to judo athletes (mean: 1.08; SE: 0.05). In addition, lumbar BMC values of indoor soccer athletes (mean: 0.41; SE: 0.01) was higher compared to judo athletes (mean: 0.34; SE: 0.02). In males, no differences were observed among sports. CONCLUSIONS Sports performance technicians and professionals will be able to broaden the understanding of variations in BMD and BMC lumbar between judo, indoor soccer and volleyball athletes, which allows monitoring these parameters in the sports context and in the athlete's health.
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Affiliation(s)
- Mikael S Moraes
- Federal University of Santa Catarina, Research Center in Kinanthropometry and Human Performance, Florianópolis, Brazil -
| | - Priscila Custódio Martins
- Federal University of Santa Catarina, Research Center in Kinanthropometry and Human Performance, Florianópolis, Brazil
| | - Francisco E Ferreira
- Federal University of Santa Catarina, Research Center in Kinanthropometry and Human Performance, Florianópolis, Brazil
| | - Diego A Silva
- Federal University of Santa Catarina, Research Center in Kinanthropometry and Human Performance, Florianópolis, Brazil
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Knechtle B, Jastrzębski Z, Hill L, Nikolaidis PT. Vitamin D and Stress Fractures in Sport: Preventive and Therapeutic Measures-A Narrative Review. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:223. [PMID: 33804459 PMCID: PMC7999420 DOI: 10.3390/medicina57030223] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/22/2021] [Accepted: 02/24/2021] [Indexed: 01/13/2023]
Abstract
There are numerous risk factors for stress fractures that have been identified in literature. Among different risk factors, a prolonged lack of vitamin D (25(OH)D) can lead to stress fractures in athletes since 25(OH)D insufficiency is associated with an increased incidence of a fracture. A 25(OH)D value of <75.8 nmol/L is a risk factor for a stress fracture. 25(OH)D deficiency is, however, only one of several potential risk factors. Well-documented risk factors for a stress fracture include female sex, white ethnicity, older age, taller stature, lower aerobic fitness, prior physical inactivity, greater amounts of current physical training, thinner bones, 25(OH)D deficiency, iron deficiency, menstrual disturbances, and inadequate intake of 25(OH)D and/or calcium. Stress fractures are not uncommon in athletes and affect around 20% of all competitors. Most athletes with a stress fracture are under 25 years of age. Stress fractures can affect every sporty person, from weekend athletes to top athletes. Stress fractures are common in certain sports disciplines such as basketball, baseball, athletics, rowing, soccer, aerobics, and classical ballet. The lower extremity is increasingly affected for stress fractures with the locations of the tibia, metatarsalia and pelvis. Regarding prevention and therapy, 25(OH)D seems to play an important role. Athletes should have an evaluation of 25(OH)D -dependent calcium homeostasis based on laboratory tests of 25-OH-D3, calcium, creatinine, and parathyroid hormone. In case of a deficiency of 25(OH)D, normal blood levels of ≥30 ng/mL may be restored by optimizing the athlete's lifestyle and, if appropriate, an oral substitution of 25(OH)D. Very recent studies suggested that the prevalence of stress fractures decreased when athletes are supplemented daily with 800 IU 25(OH)D and 2000 mg calcium. Recommendations of daily 25(OH)D intake may go up to 2000 IU of 25(OH)D per day.
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Affiliation(s)
- Beat Knechtle
- Medbase St. Gallen Am Vadianplatz, 9000 St. Gallen, Switzerland
- Institute of Primary Care, University Hospital Zurich, University of Zurich, Pestalozzistrasse 24, 8091 Zürich, Switzerland
| | - Zbigniew Jastrzębski
- Department of Health and Life Sciences, Gdansk University of Physical Education and Sport, 80-336 Gdańsk, Poland;
| | - Lee Hill
- Division of Gastroenterology & Nutrition, Department of Pediatrics, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada;
| | - Pantelis T. Nikolaidis
- Exercise Physiology Laboratory, 18450 Nikaia, Greece;
- School of Health and Caring Sciences, University of West Attica, 12243 Athens, Greece
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Schwarz I, Houck DA, Shah V, Jolly AJ, Lindsay A, Bravman JT, Frank RM. Bone and body characteristics of freestyle and nonfreestyle skiers. J Sports Med Phys Fitness 2021; 62:74-80. [PMID: 33555668 DOI: 10.23736/s0022-4707.21.12055-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Freestyle skiers must optimize their aerial performance by maintaining the strength and coordination to propel themselves in the air and adapt to landings and take-offs on uneven surfaces. The purpose of this study is to investigate the differences in areal bone mineral density (aBMD) and body composition in freestyle skiers and nonfreestyle skiing controls. HYPOTHESIS We hypothesized that the unique demands and summation of forces experienced by freestyle athletes would manifest as greater femoral neck aBMD, lower percent body fat, and lower BMI than nonfreestyle skiing controls. LEVEL OF EVIDENCE Level 3, Retrospective Cohort Study. METHODS 18 freestyle skiers (14M 4F, [27.56 ± 5.22 years]) and 15 controls (7M 8F, [26.93 ± 3.54 years]) were measured with dual energy X-ray absorptiometry (DXA) to determine total body composition, hip and lumbar spine aBMD, and bone mineral composition (BMC). Height and weight were measured with an in-office stadiometer and scale. Questionnaires were used to determine physical activity and pertinent medical history. Between-group variations were analyzed with an analysis of variance (ANOVA) and stratified by sex. RESULTS Percent body fat, hip and lumbar spine aBMD, BMC, and area were all similar between freeski and nonfreeski athletes (p<0.05 for all). BMI was significantly lower in male freeski athletes (23.97kg/m2, 95% CI [22.75-25.18]) compared to nonfreestyle skiing controls (26.64kg/m2, 95% CI [24.43-28.86]) (p=0.03). CONCLUSIONS Freestyle skiers have a lower BMI than nonfreestyle skiers. All skiers in this study has similar percent body fat, aBMD, and BMC. This pilot study supports that there are unique musculoskeletal adaptations based on type of skiing. CLINICAL RELEVANCE Skiers endure a variety of intense physical forces yet remain understudied despite high orthopedic injury rates. This study serves to broaden the current sports health literature and explore the physical demands and subsequent physiology of freestyle skiers.
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Affiliation(s)
- Ilona Schwarz
- Division of Sports Medicine and Shoulder Surgery, Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA -
| | - Darby A Houck
- Division of Sports Medicine and Shoulder Surgery, Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Viral Shah
- Barbara Davis Center for Diabetes, University of Colorado, Denver, CO, USA
| | - Austin J Jolly
- Division of Renal Diseases and Hypertension, Department of Medicine University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Adam Lindsay
- Division of Sports Medicine and Shoulder Surgery, Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jonathan T Bravman
- Division of Sports Medicine and Shoulder Surgery, Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Rachel M Frank
- Division of Sports Medicine and Shoulder Surgery, Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA
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Liddle DG, Changstrom B, Senter C, Meirick P, Stern N, Putukian M, Shah S, Powell A, Dixit S, Eerkes K, Moran B, Barnes KP, Dal Molin C, Myers R, Waterbrook AL. Recommended Musculoskeletal and Sports Medicine Curriculum for Internal Medicine Residency Training. Curr Sports Med Rep 2021; 20:113-123. [PMID: 33560036 DOI: 10.1249/jsr.0000000000000811] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
ABSTRACT Patients present to primary care physicians with musculoskeletal complaints more often than they do for upper respiratory infections, hypertension, or diabetes. Despite this, instruction in musculoskeletal medicine for internal medicine residents represents less than 1% of their total didactic and clinical education time. We recognize the immense breadth of knowledge and skill required to train residents in the practice of internal medicine. This curriculum guideline defines a recommended training strategy, and supplies relevant resources, to improve musculoskeletal education among internal medicine residents to optimize patient care. This curriculum guideline was created by internists who are sports medicine specialists. Sports medicine physicians promote overall health and well-being while providing expertise in acute and chronic musculoskeletal conditions, as well as how disease affects exercise and using exercise as medicine for people with chronic disease.
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Affiliation(s)
- David G Liddle
- Intermountain Sports Medicine, Intermountain Healthcare, Logan Regional Orthopedics and Sports Medicine, Logan, UT
| | - Bradley Changstrom
- Department of Medicine, Division of Internal Medicine, University of Colorado, Denver, CO
| | - Carlin Senter
- Department of Orthopaedic Surgery, Division of Sports Medicine, University of California San Francisco, San Francisco, CA
| | | | | | - Margot Putukian
- Princeton University, McCosh Health Center, University Health Services, Preinceton, NJ
| | - Selina Shah
- Center for Sports Medicine, Walnut Creek, CA
| | - Amy Powell
- Department of Orthopaedic Surgery and Department of Internal Medicine, Division of General Internal Medicine, University of Utah, Salt Lake City, UT
| | - Sameer Dixit
- Department of Primary Care Sports Medicine, Hospital for Special Surgery, New York, NY
| | - Kevin Eerkes
- NYU Langone Health, Department of Internal Medicine, New York University, New York, NY
| | - Byron Moran
- Department of Orthopaedic Surgery, Division of Sports Medicine, College of Medicine, University of South Florida, Tampa, FL
| | - Kenneth P Barnes
- Department of Orthopaedic Surgery, Division of Sports Medicine, Moses H. Cone Memorial Hospital, Greensboro, NC
| | - Claudia Dal Molin
- Department of Internal Medicine and Department of Orthopaedic Surgery, Division of Sports Medicine, University of Maryland, Baltimore, MD
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Abstract
Vitamin D Deficiency in Sports Abstract. A deficiency in vitamin D is very common in the general population as well as in athletes. The aim of this overview is to assess the level of knowledge about the importance of vitamin D for athletes. A deficiency in vitamin D is present in up to 90 % of athletes. Risk groups are young athletes, female athletes, athletes with a limitation such as paraplegia, vegetarians, athletes with a resorption disorder such as celiac disease, athletes training and competing indoors (e.g. ice hockey, basketball, boxing, rhythmic gymnastics), and older athletes. Dark skin pigmentation, the use of sunscreen, the time of day of the training (early morning, late evening) and the geographical location influence the risk for a deficiency in vitamin D. Exposure to the sun and a balanced diet are often not enough to prevent a vitamin D deficiency.
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Affiliation(s)
- Beat Knechtle
- Medbase St. Gallen Am Vadianplatz, St. Gallen
- Institut für Hausarztmedizin, Universität Zürich, Zürich
| | | | - Pantelis T Nikolaidis
- Exercise Physiology Laboratory, Nikaia, Griechenland
- School of Health and Caring Sciences, University of West Attica, Athen, Griechenland
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Izquierdo M, Merchant RA, Morley JE, Anker SD, Aprahamian I, Arai H, Aubertin-Leheudre M, Bernabei R, Cadore EL, Cesari M, Chen LK, de Souto Barreto P, Duque G, Ferrucci L, Fielding RA, García-Hermoso A, Gutiérrez-Robledo LM, Harridge SDR, Kirk B, Kritchevsky S, Landi F, Lazarus N, Martin FC, Marzetti E, Pahor M, Ramírez-Vélez R, Rodriguez-Mañas L, Rolland Y, Ruiz JG, Theou O, Villareal DT, Waters DL, Won Won C, Woo J, Vellas B, Fiatarone Singh M. International Exercise Recommendations in Older Adults (ICFSR): Expert Consensus Guidelines. J Nutr Health Aging 2021; 25:824-853. [PMID: 34409961 DOI: 10.1007/s12603-021-1665-8] [Citation(s) in RCA: 368] [Impact Index Per Article: 122.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The human ageing process is universal, ubiquitous and inevitable. Every physiological function is being continuously diminished. There is a range between two distinct phenotypes of ageing, shaped by patterns of living - experiences and behaviours, and in particular by the presence or absence of physical activity (PA) and structured exercise (i.e., a sedentary lifestyle). Ageing and a sedentary lifestyle are associated with declines in muscle function and cardiorespiratory fitness, resulting in an impaired capacity to perform daily activities and maintain independent functioning. However, in the presence of adequate exercise/PA these changes in muscular and aerobic capacity with age are substantially attenuated. Additionally, both structured exercise and overall PA play important roles as preventive strategies for many chronic diseases, including cardiovascular disease, stroke, diabetes, osteoporosis, and obesity; improvement of mobility, mental health, and quality of life; and reduction in mortality, among other benefits. Notably, exercise intervention programmes improve the hallmarks of frailty (low body mass, strength, mobility, PA level, energy) and cognition, thus optimising functional capacity during ageing. In these pathological conditions exercise is used as a therapeutic agent and follows the precepts of identifying the cause of a disease and then using an agent in an evidence-based dose to eliminate or moderate the disease. Prescription of PA/structured exercise should therefore be based on the intended outcome (e.g., primary prevention, improvement in fitness or functional status or disease treatment), and individualised, adjusted and controlled like any other medical treatment. In addition, in line with other therapeutic agents, exercise shows a dose-response effect and can be individualised using different modalities, volumes and/or intensities as appropriate to the health state or medical condition. Importantly, exercise therapy is often directed at several physiological systems simultaneously, rather than targeted to a single outcome as is generally the case with pharmacological approaches to disease management. There are diseases for which exercise is an alternative to pharmacological treatment (such as depression), thus contributing to the goal of deprescribing of potentially inappropriate medications (PIMS). There are other conditions where no effective drug therapy is currently available (such as sarcopenia or dementia), where it may serve a primary role in prevention and treatment. Therefore, this consensus statement provides an evidence-based rationale for using exercise and PA for health promotion and disease prevention and treatment in older adults. Exercise prescription is discussed in terms of the specific modalities and doses that have been studied in randomised controlled trials for their effectiveness in attenuating physiological changes of ageing, disease prevention, and/or improvement of older adults with chronic disease and disability. Recommendations are proposed to bridge gaps in the current literature and to optimise the use of exercise/PA both as a preventative medicine and as a therapeutic agent.
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Affiliation(s)
- M Izquierdo
- Mikel Izquierdo, PhD, Department of Health Sciences, Public University of Navarra, Av. De Barañain s/n 31008 Pamplona (Navarra) Spain, Tel + 34 948 417876
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Millward D, Root AD, Dubois J, Cohen RP, Valdivia L, Helming B, Kokoskie J, Waterbrook AL, Paul S. Association of Serum Vitamin D Levels and Stress Fractures in Collegiate Athletes. Orthop J Sports Med 2020; 8:2325967120966967. [PMID: 33816638 PMCID: PMC8008136 DOI: 10.1177/2325967120966967] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 05/20/2020] [Indexed: 12/16/2022] Open
Abstract
Background Low vitamin D levels along with high-intensity athletic training may put an athlete at increased risk for a stress fracture. Purpose To assess whether supplementation with vitamin D is associated with a reduced risk of stress fractures in college athletes. We also assessed differences in vitamin D levels among athletes participating in outdoor versus indoor sports. Study Design Cohort study; Level of evidence, 2. Methods The study participants included 802 National Collegiate Athletic Association Division I intercollegiate athletes (497 men and 305 women) on a sports team for at least 1 semester from 2012 to 2018. All athletes who had a baseline vitamin D level in their medical record were included. Athletes with vitamin D levels <40 ng/mL were given vitamin D supplements. We assessed differences in the rate of stress fracture among those who maintained or improved vitamin D levels to ≥40 ng/mL and those who did not, as well as differences in average baseline vitamin D levels by sport type (indoor vs outdoor). Results The rate of stress fracture was 12% higher (95% CI, 6-19; P < .001) for those who remained low in vitamin D compared with those who were low at baseline but improved their vitamin D status to ≥40 ng/mL. The rate of stress fracture was also 12% higher (95% CI, 5-18; P < .001) for those who had low vitamin D levels compared with those who maintained normal levels. The mean baseline vitamin D values were significantly higher for men participating in outdoor sports versus indoor sports. For men, the mean vitamin D level was 5.7 ng/mL higher (95% CI, 0.9-10.5; P = .01) in outdoor athletes. For women, the mean vitamin D level was 3.7 ng/mL higher (95% CI, -0.58 to 8.03; P < .04) for outdoor versus indoor sports. Conclusion Study results indicated that correcting low serum vitamin D levels reduces the risk of stress fracture. This study also presented evidence that athletes who participate in indoor sports may be at greater risk for vitamin D deficiency than those who compete in outdoor sports.
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Toraishi M, Uenishi K, Iwamoto J, Otani T. Vitamin A intake is related to stress fracture occurrence in male collegiate long-distance runners. J Sports Med Phys Fitness 2020; 61:1509-1514. [PMID: 33269888 DOI: 10.23736/s0022-4707.20.11792-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Nutrient intake has an essential role in bone disorder prevention among long-distance runners. However, the influence of Vitamin A intake on the risk of stress fractures remains unknown. This prospective study aimed to investigate the association between Vitamin A intake, and stress fracture occurrence in male collegiate long-distance runners. METHODS Forty-one male long-distance runners were recruited from a top-class long-distance college running team whose complete survey data on bone mass, anthropometric measurements, blood and urine tests, food intake frequency, history of competing in long-distance races, and monthly running distance during 2009-2010 were available. The influence of factors related to stress fractures, including Vitamin A intake, at baseline and the occurrence of stress fractures during the 1-year period were investigated. RESULTS Four athletes experienced stress fractures during the study period (stress fracture group) and had significantly higher Vitamin A, calcium, and iron intake at baseline compared with that in the nonstress fracture group. In the stress fracture group, the mean daily Vitamin A intake was 2792 μg of retinol activity equivalents (RAE), which was higher than the upper intake limit for males aged 18-25 years in the Japanese Dietary Standard. Logistic regression analyses showed that only Vitamin A intake independently contributed to stress fracture occurrence. The odds ratio of developing stress fractures with a 100-μg RAE increase in Vitamin A intake was 1.22. CONCLUSIONS A result of the present study suggested that Vitamin A intake was associated with stress fracture occurrence in male collegiate long-distance runners.
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Affiliation(s)
- Mami Toraishi
- Graduate School of Health Management, Keio University, Kanagawa, Japan - .,Teikyo University Institute of Sports Science and Medicine, Tokyo, Japan -
| | - Kazuhiro Uenishi
- Laboratory of Physiological Nutrition, Kagawa Nutrition University, Saitama, Japan
| | - Jun Iwamoto
- Bone and Joint Disease Center, Keiyu Orthopedic Hospital, Gunma, Japan
| | - Toshiro Otani
- Graduate School of Health Management, Keio University, Kanagawa, Japan
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Książek A, Zagrodna A, Słowińska-Lisowska M. Assessment of the Dietary Intake of High-Rank Professional Male Football Players during a Preseason Training Week. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228567. [PMID: 33218191 PMCID: PMC7699180 DOI: 10.3390/ijerph17228567] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 11/16/2020] [Accepted: 11/17/2020] [Indexed: 12/18/2022]
Abstract
A well-balanced diet is one of the main factors that may play a supportive role in enhancing acute training stimuli in optimal training adaptation. The aim of the present study was to examine the energy and macro- and micronutrient intake including and excluding supplements among top-level Polish football players during one week of the general preparatory period. In addition, the study looked at whether athletes consume carbohydrates in recommended amounts, depending on the completed training sessions. A total of 26 professional football players were included in the study. The preseason dietary intake was assessed using a 7-day estimated food record. The energy value of the diet and the amounts of the dietary ingredients were assessed using the software Dieta 6.0. The average consumption of energy, vitamin B2, vitamin C, vitamin E, folate, and calcium was lower than recommendations, and average intake of sodium and potassium was higher than the norm in the diets of the athletes. The results of this study do not confirm the justification for adding protein preparations to diets of the studied players. Furthermore, football players dietary carbohydrate intake was relatively low in comparison to requirements based on training loads. Based on our results we conclude that further work is necessary to reinforce education about nutritional habits and adjust nutritional strategies to individual needs to enhance athletic performance.
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de Almeida-Neto PF, Arrais RF, de Matos DG, Cesário TM, Bulhões-Correia A, Silva LF, Aidar FJ, Santana EE, Silva Dantas PM, Cabral BG. The influence of biological maturation and neuromuscular performance on peak bone mineral density in children. J Sports Med Phys Fitness 2020; 61:829-835. [PMID: 33146496 DOI: 10.23736/s0022-4707.20.11497-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The growth and development cycle of the adult is characterized by substantial changes in physical size and maturity, and is controlled by the simultaneous influence of genetic components and the environment. Changes in the development of bones, muscles and adipose tissue are among the most important aspects of adolescent physical development. The aim of this research was to examine the correlation between bone mineral density (BMD) and neuromuscular performance in children at different stages of maturation. METHODS The study included 31 participants of both sexes (11.7±1.89 years). Body composition was assessed through bone densitometry using an energy duo X-ray source. The neuromuscular performance of the upper limbs was analyzed by the medicine ball hand grip and throwing tests. The lower limbs by the vertical counter-motion jump test, and skeletal maturation was analyzed by bone age. Maturation was used as an effect control between the association of BMD and neuromuscular performance. RESULTS The results demonstrated significant associations between the performance of upper (P<0.0001) and lower (P=0.01) limbs and BMD. On inter-group comparison for only the accelerated maturational stage, male participants had greater BMD than female participants (P=0.001; effect size 3.13). Regarding the maturational stages, male participants in the accelerated maturational stage demonstrated higher BMD than those in the normal and delayed maturational stages (P=0.04; effect size 3.10), whereas female participants did not demonstrate significant differences in BMD accumulation. CONCLUSIONS BMD has a strong correlation with the neuromuscular performance of upper and lower limbs of children of both sexes.
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Affiliation(s)
- Paulo F de Almeida-Neto
- Department of Physical Education, Federal University of Rio Grande do Norte (UFRN), Natal, Brazil -
| | - Ricardo F Arrais
- Department of Pediatrics, Federal University of Rio Grande do Norte (UFRN), Natal, Brazil
| | - Dihogo G de Matos
- Research Center in Sports Sciences, Health Sciences and Human Development (CIDESD), Trás os Montes and Alto Douro University, Vila Real, Portugal.,Group of Studies and Research of Performance, Sport, Health and Paralympic Sports (GEPEPS), Federal University of Sergipe (UFS), São Cristovão, Sergipe, Brazil
| | - Tatianny M Cesário
- Department of Physical Education, Federal University of Rio Grande do Norte (UFRN), Natal, Brazil
| | | | - Luíz F Silva
- Department of Physical Education, Federal University of Rio Grande do Norte (UFRN), Natal, Brazil
| | - Felipe J Aidar
- Group of Studies and Research of Performance, Sport, Health and Paralympic Sports (GEPEPS), Federal University of Sergipe (UFS), São Cristovão, Sergipe, Brazil.,Department of Physical Education, Federal University of Sergipe (UFS), São Cristovão, Sergipe, Brazil
| | - Eduardo E Santana
- Department of Physical Education, Federal University of Rio Grande do Norte (UFRN), Natal, Brazil
| | - Paulo M Silva Dantas
- Department of Physical Education, Federal University of Rio Grande do Norte (UFRN), Natal, Brazil
| | - Breno G Cabral
- Department of Physical Education, Federal University of Rio Grande do Norte (UFRN), Natal, Brazil
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Becerra Sandoval JC, Ventura Huamán L, De La Cruz-Vargas JA. [Factors associated with stress fracture: A case-control study in a Peruvian navy medical center]. Medwave 2020; 20:e7936. [PMID: 32885796 DOI: 10.5867/medwave.2020.05.7936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 06/06/2020] [Indexed: 11/27/2022] Open
Abstract
Introduction Stress fractures are injuries produced by the overuse of certain extremities, generating repetitive fatigue in the bone with insufficient rest periods and hormonal disorders, among others. High osteoclastic activity and lower activity of the osteoblasts at the cortical level occurs. Objective To determine the factors associated with a stress fracture in a single medical center of the Peruvian navy. Methods We conducted an observational, analytical case-control study. The dependent variable was stress fracture confirmed by magnetic resonance imaging of the patients; the independent variables were age, sex, calcemia, socioeconomic status, and time of daily physical activity. All data were extracted from the medical records. Crude and adjusted odds ratios were calculated with 95% confidence intervals. Results The sample was comprised of 238 patients (119 cases and 119 controls), of which 79.8% were male, and 20.2% were female; the average age was 20.25. In the bivariate analysis, stress fractures were associated with male sex (odds ratio 3.00; 95% confidence interval 1.51 to 5.95), hypocalcemia (2.83; 2.32 to 3.44), more than two hours of daily physical activity (24.7; 12.51 to 48.95) and socioeconomic level C (6.66; 2.82 to 15.74). Time dedicated to physical activity (adjusted odds ratio 44.46; 95% confidence interval 17.93 to 110.22) and socioeconomic level C (adjusted odds ratio 22.57; 95% confidence interval 7.03 to 72.74) were associated in the multivariate analysis. Conclusion We found that stress fractures were associated with physical activity time and a lower socioeconomic level. Further studies are needed to evaluate the relationship with other factors in the military population of Peru.
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Affiliation(s)
- John C Becerra Sandoval
- Centro Médico Naval Cirujano Mayor Santiago Távara, Lima, Perú. Adress: Mz. C Lt 5 Urb. 7 de Agosto 2do programa, Callao, Lima, Perú. . ORCID: 0000-0002-0743-5555
| | | | - Jhony A De La Cruz-Vargas
- Instituto de Investigación en Ciencias Biomédicas, Universidad Ricardo Palma, Lima, Perú. ORCID: 0000-0002-5592-0504
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Fields JB, Gallo S, Worswick JM, Busteed DR, Jones MT. 25-Hydroxyvitamin D, Vitamin D Binding Protein, Bioavailable 25-Hydroxyvitamin D, and Body Composition in a Diverse Sample of Women Collegiate Indoor Athletes. J Funct Morphol Kinesiol 2020; 5:E32. [PMID: 33467248 PMCID: PMC7739241 DOI: 10.3390/jfmk5020032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 05/04/2020] [Accepted: 05/06/2020] [Indexed: 12/24/2022] Open
Abstract
Women athletes are at higher risk for bone diseases; yet, information on vitamin D status ((25(OH)D), vitamin D binding protein (VDBP), and bioavailable 25(OH)D is limited. Collegiate athletes (n = 36) from volleyball (WVB), basketball (WBB), and track and field (WTF) were measured for (25(OH)D), VDBP, and bioavailable 25(OH)D; body composition and bone mineral density (BMD); and skin pigmentation. Participants self-reported daily vitamin D intake and sun exposure. One-way analysis of variance analyzed mean differences in measures across sports. Linear regression examined relationships between 25(OH)D; VDBP; bioavailable 25(OH)D; and whole body, hip, and spine BMD. Participants' (mean ± SD, 19.4 ± 1.4 years, 172.75 ± 8.21 cm, 70.9 ± 13.2 kg, and 22.9 ± 4.1% body fat) overall mean 25(OH)D was 70.5 ± 32.25 nmol/L, and 28% of participants were deemed inadequate and 61% below thresholds identified as sufficient for athletes. Although WBB athletes consumed higher (p = 0.007) dietary vitamin D (760.9 ± 484.2 IU/d) than WVB (342.6 ± 257.8) and WTF (402.3 ± 376.4) athletes did, there were no differences across sport in serum 25(OH)D. WVB and WTF had higher bioavailable 25(OH)D than WBB. No relationships existed between vitamin D status and body composition. Vitamin D inadequacy was identified among 1/3 of women indoor sport athletes. Consistent monitoring of vitamin D status and diet are recommended to sustain athlete health and sport performance.
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Affiliation(s)
- Jennifer B. Fields
- Frank Pettrone Center for Sports Performance, George Mason University, Fairfax, VA 22030, USA; (J.B.F.); (S.G.); (D.R.B.)
- School of Kinesiology, George Mason University, Manassas, VA 20110, USA;
| | - Sina Gallo
- Frank Pettrone Center for Sports Performance, George Mason University, Fairfax, VA 22030, USA; (J.B.F.); (S.G.); (D.R.B.)
- Nutrition and Food Studies, George Mason University, Fairfax, VA 22030, USA
| | - Jenna M. Worswick
- School of Kinesiology, George Mason University, Manassas, VA 20110, USA;
| | - Deanna R. Busteed
- Frank Pettrone Center for Sports Performance, George Mason University, Fairfax, VA 22030, USA; (J.B.F.); (S.G.); (D.R.B.)
| | - Margaret T. Jones
- Frank Pettrone Center for Sports Performance, George Mason University, Fairfax, VA 22030, USA; (J.B.F.); (S.G.); (D.R.B.)
- School of Kinesiology, George Mason University, Manassas, VA 20110, USA;
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Low Bone Mineral Density in Elite Female Athletes With a History of Secondary Amenorrhea in Their Teens. Clin J Sport Med 2020; 30:245-250. [PMID: 32341292 DOI: 10.1097/jsm.0000000000000571] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine whether secondary amenorrhea during teenage years influences bone mineral density (BMD) in female athletes in their 20s. DESIGN Original research. SETTING Japan Institute of Sports Sciences. PARTICIPANTS Two hundred ten elite female athletes older than 20 years were included in the study. MAIN OUTCOME MEASURES Information on the participants' past (ie, during their teenage years) and current menstrual cycle, training time, history of stress fractures, and blood tests for hormones received was obtained. Bone mineral density of the lumbar spine was evaluated by dual-energy x-ray absorptiometry; low BMD was defined as a Z-score ≤-1. We investigated the correlation factors for low BMD in athletes in their 20s by univariable and multivariable logistic regression analysis. RESULTS A total of 39 (18.6%) female athletes had low BMD. Secondary amenorrhea in their teens [odds ratio (OR), 7.11, 95% confidence interval (CI), 2.38-21.24; P < 0.001] and present body mass index (BMI) (OR, 0.56, 95% CI, 0.42-0.73; P < 0.001) were independent correlation factors for low BMD in the multivariable logistic regression analysis. The average Z-score for those with secondary amenorrhea in their teens and 20s, secondary amenorrhea in their 20s only, and regular menstruation was -1.56 ± 1.00, -0.45 ± 1.21, and 0.82 ± 1.11 g/cm, respectively. CONCLUSIONS Secondary amenorrhea for at least 1 year during teenage years in female athletes and BMI at present was strongly associated with low BMD in their 20s.
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