[Tendinitis in athletes: etiology, diagnosis and treatment]. / Tendinopathies du sportif: étiologie, diagnostic et traitement.

Tendinopathy is one of the most common diagnosis in sports. Knowledges about their etiology, the repair process to their diagnosis and their treatment have improved thanks to the development of imaging, especially ultra- sound. The disorder whose etiology could be mechanical or degenerative can cause long- term disability and sometimes the end of the sport carreer. The risk of reccurence is com- mon; this may lead to tendon rupture whose functional effects can be significative. The management should be early: it must respect the deadlines for tendon healing and pro- pose a gradual recovery efforts after elimina tion of the contributing factors involved.

[Patellofemoral pain syndrome: understand better in order to treat better]. / Mieux comprendre le syndrome douloureux fémoro-patellaire... pour mieux le traiter.

Patellofemoral pain syndrome (PFPS) is one of the most frequent cause of anterior knee pain in adolescents and adults. Due to its complex etiology, which is multifactorial and still poorly understood, its management is a major challenge for the practitioner. The diagnosis is made primarily on the history and clinical examination of the knee, but also of the entire lower limb, which may sometimes require the completion of imaging. The treatment is mostly conservative, focussing on rehabilitation with targeted and personalized therapy. Surgical treatment is reserved for cases with a causal structural lesion.

[Sports and athletes deserve doping hunting]. / Oui à la chasse au dopage pour la santé des athlètes et du sport!

This article reviews the evidence-based ergogenic potential adverse effects of the most common products in use by recreational and elite athletes today. This is an aggressively marketed and controversial area of sports medicine wordwide. It is therefore important for the scientific societies, clinicians, dieticians sports federations to be well versed in the more popular supplements and drugs in order to have an important role in information and prevention attitudes that can lead to health risks or addictions!

[Joint functional outcome score for the clinician]. / Scores de mesure fonctionnelle articulaire pour le praticien.

The sports clinician faces multiple treatment options when dealing with overload injuries, and it is important to evaluate their outcomes. Multiple scores exist, some clincian rated (CRO), others patient rated (PRO), the latter being currently favoured. This review presents some of these scores and we selected the ones we feel are the most appropriate for a sports clinician. We considered these common problems: tennis elbow, rotator cuff issues, groin pain, patellofemoral pain syndrome, achilles tendinopathy and ankle instability. In addition, an activity level score is useful to weigh the result in the context of return to performance. These scores help to create a common language between therapists and to evaluate treatments objectively.

Enhanced diastolic reflections on arterial pressure pulse during exercise recovery.

During recovery from a maximal or submaximal aerobic exercise, augmentation of central (aortic) systolic pressure by reflected pressure waves is blunted in healthy humans. However, the extent to which reflected pressure waves modify the central pulse in diastole in these conditions remains unknown. We evaluated systolic and diastolic central reflected waves in 11 endurance-trained athletes on recovery from a maximal running test on a treadmill (treadmill-max) and a 4000 m run in field conditions. On both occasions in each subject, the radial pulse was recorded with applanation tonometry in the resting preexercise state and then 5, 15, 25, 35, and 45 min after exercise termination. From the central waveform, as reconstructed by application of a generalized transfer function, we computed a systolic (AIx) and a diastolic index (AId) of pressure augmentation by reflections. At 5 min, both indices were below preexercise. At further time-points, AIx remained low, while AId progressively increased, to overshoot above preexercise at 45 min. The same behavior was observed with both exercise types. Beyond the first few minutes of recovery following either maximal or submaximal aerobic exercise, reflected waves selectively augment the central pressure pulse in diastole, at least in endurance-trained athletes.

[Lower intestinal distress during sports activities]. / Troubles gastro-intestinaux et activités sportives.

This article reviews the literature regarding gastrointestinal disturbances in particular in runners. The lower intestinal problems of motility and blood loss are discussed. These problems are directly related to running. These symptoms, especially diarrhea are common and can impact adversely both performance and the health of the athlete. Most cases are relatively benign. The sport medicine clinician should be familiar with the management of these problems in order to optimize the treatment and facilitate return to sport.

[The diabetic patient at altitude: pathophysiology and practical implications]. / Le diabétique en attitude: physiopathologie et conséquences pratiques.

The prevalence of diabetes is constantly growing and an ever increasing number of diabetics travel to moderate (1500-2000 m, 5000-6500 ft.) or high altitude (>2500 m, >8000 ft) for recreational purposes. Stays at moderate altitude are very well tolerated for a majority of diabetics, but can be limited by hypoxia or equipment failure due to freezing temperatures, or by the occurence of altitude-specific pathologies, as acute mountain sickness, which can mimick hypoglycemia in the diabetic. Beyond 2500 m, freezing, remoteness, hypoxia-induced anorexia, side effects of medications and the higher incidence of mountain sickness can make diabetes control difficult. A well informed and prepared diabetic patient, with sufficient and adequatly kept equipment, and a reasonably good fitness level, can enjoy and master mountaineering.

[Is stretching for sports performance still useful? A review of the literature]. / Les exercices d'étirement dans la pratique sportive ont-ils encore leur raison d'être? Une revue de la littérature.

Since 1980, according to several authors, it is accepted that increasing flexibility of a muscle-tendon unit allows a better performance and decreases sports injuries. Stretching is regularly included in warm-up and in cooling-down. However, there are contradictory findings in the literature. In contrast, since 1990, there's evidence suggesting that stretching not only does not prevent injuries, but can also decrease the level of performance. Some part of these contradictions can be explained by the various sports activities. Those requesting an increased flexibility, such as gymnastic, dancing or diving, necessitate pre-exercise stretching to optimize the level of performance. In contrary, for sports with slow stretch-shortening cycle such as jogging or cycling, there is no scientific data showing a positive effect of stretching.

Effect of a program of moderate physical activity on mental stress-induced increase in energy expenditure in obese women.

BACKGROUND: Energy restriction and physical activity are major components of weight reduction programs. Energy restriction is known to affect the sympathetic nervous system activity and to reduce several components of energy expenditure, including the stimulation of energy expenditure elicited by mental stress. The effect of physical activity on this parameter remains unknown. METHODS: This study was designed to assess the effect of physical training on the stimulation of energy expenditure during mental stress. Seven obese women (age 33 +/- 3 years, BMI 34.9 +/- 1.4 kg/m(2)) were studied before and after a 6 week program of aquagym (2 sessions of 50 min/week). Energy expenditure was measured by means of indirect calorimetry under hyperinsulinemic conditions before and during a 30 min mental stress. O(2) max was measured before and after physical training by means of the test of Balke. RESULTS: O(2) max was 23.4 ml/kg/min before physical training, and increased to 26.1 ml/kg/min at the completion of the training program (p<0.05). Body weight, resting energy expenditure and insulin-mediated glucose disposal [oxidative and non oxidative] were not modified after training. Mental stress increased energy expenditure by 12.3% before physical training (p<0.002 vs resting conditions) and by 12.6% after physical training (p<0.003 vs resting conditions, NS vs before physical training). CONCLUSION: Physical training per se does not alter the stimulation of energy expenditure induced by mental stress.

Oligo-amenorrheic long-distance runners may lose more bone in spine than in femur.

PURPOSE: Strenuous training can be associated with amenorrhea leading to amenorrhea-related accelerated bone loss. Insufficient calorie energy, calcium, and/or protein intakes can also be frequently encountered in women with intense training, possibly contributing to bone loss. Long-distance runners with or without regular menses (age range 19-37 yr) were prospectively studied. METHODS: Changes in areal bone mineral density (BMD) were measured at 1-yr interval. RESULTS: Among 10 eumenorrheic, 11 oligo-amenorrheic, and 9 oral contraceptive users, there was no difference in energy, calcium, or protein intakes. Baseline BMD values were significantly lower in the oligo-amenorrheic group than in the two others at the level of lumbar spine (anteroposterior view: 0.941+/-0.039 in oligo-amenorrheic vs 1.077+/-0.029 or 1.051 +/-0.017 g x cm(-2), P < 0.005, in the eumenorrheic and contraceptive user groups, respectively) but not in weight-bearing bone such as proximal and midshaft femur. Over a 1-yr interval, during which the three groups did not differ in terms of running distances and dietary intakes, oligo-amenorrheic women displayed a significant decrease in lumbar spine BMD in lateral view (-0.049+/-0.012 in oligo-amenorrheic vs -0.001+/-0.013 and 0.014+/-0.012 g x cm(-2), p < 0.005, in the eumenorrheic and contraceptive user groups, respectively). We did not detect any significant change in femoral neck, trochanter, or midshaft BMD. CONCLUSIONS: Oligo-amenorrhea in long-distance runners, with adequate dietary intakes, was associated with a decrease in BMD affecting more the lumbar spine than the proximal and midshaft femur during a 1-yr follow-up.

Physical activity and fat-free and fat mass by bioelectrical impedance in 3853 adults.

OBJECTIVE: To determine the effects of regular physical activity on body composition, as measured by bioelectrical impedance analysis (BIA), in a large Caucasian population of healthy subjects between 15 and 64 yr of age, and to observe the cross-sectional changes in body composition with increasing age. DESIGN: Cross-sectional comparison between sedentary and physically active adults (at least 3 h x wk(-1) at moderate or hard intensity level activity) during aging. SUBJECTS: A total of 3853 healthy adults (1036 sedentary and 1019 physically active men, and 1280 sedentary and 518 physically active women) between 15 and 64 yr of age. MEASUREMENTS: Height, weight, body mass index (BMI), and fat-free mass (FFM), fat mass, and % fat mass measured by 50-kHz BIA. RESULTS: Higher weight in older sedentary adults was due to a higher fat mass. In 55- to 64-yr-olds compared with 25- to 34-yr-olds, fat mass was 5.5 kg (P < 0.0001) higher in sedentary and 0.6 kg (P < 0.3) higher in physically active men, and 4.5 kg (P < 0.0001) and 2.0 kg (P < 0.04) higher in sedentary and physically active women, respectively. Physical activity was able to limit fat mass and weight gain in men over 25 yr of age and in women until 54 yr of age. Endurance type physical activity was not associated with increased FFM. For the same BMI, sedentary men and women have < 0.7 kg (P < 0.001) higher fat mass than physically active men and women. CONCLUSION: Therefore, the benefits of physical activity seem to include maintenance or prevention of an increase of BMI that in turn correlates with prevention of a fat mass increase for physically active subjects.

Body composition by x-ray absorptiometry and bioelectrical impedance in female runners.

Body composition interests athletes since athletic performance is influenced by and dependent on the proportion and total amount of fat-free mass (FFM) and fat mass. The use of bioelectrical impedance (BIA) has increased recently since portable instruments make the measurements easy to execute and relatively inexpensive. The purpose of this study was to test the degree of relationship between FFM and fat mass calculated in elite female runners with 12 different BIA formulas reported in the literature and measured by dual-energy x-ray absorptiometry (DXA). The present study shows that body composition by BIA is valid in female runners. Prediction equations used to calculate FFM and fat mass must be appropriate for this population subgroup and validated against other methods, such as DXA and hydrodensitometry. Those formulas that performed well in the controls gave poor results in the female runner and vice versa. The below average fat mass noted in female runners suggests that prediction equations for untrained women with average fat mass are inappropriate. The formula by RJL Systems-2 for women: FFM = 5.091 + 0.6483.height2/resistance + 0.1996.weight gave best predictions of FFM in female runners. Further research is necessary to validate BIA prediction formulas in other athletes.

A trial with diclofenac HEP plaster as topical treatment in minor sport injuries.

Diclofenac HEP plaster was tested in an open study in the treatment of different traumatic sport and overload injuries, to confirm the results of efficacy and tolerability already shown in other clinical studies. A total of 101 patients were assigned to treatment and were eligible for the evaluation of results at the end of a 14-day treatment period. The average score of spontaneous pain, assessed by means of a verbal scale and a visual analogical scale, showed a clear difference in pain rating between the beginning and end of treatment. In general 60% pain reduction was observed. The difference in analgesic activity was already apparent on the 7th day of treatment (-28%). The reduction of pain was confirmed by changes in another subjective sign related to the injury: provoked pain. This symptom decreased in a manner comparable to spontaneous pain: 61% pain reduction after 2 weeks of treatment. Global assessment of efficacy, performed by the investigator at the end of treatment, showed the clear therapeutic activity of local treatment with diclofenac HEP plaster. Satisfactory results were obtained and only 18% of the patients (most of them with chronic and persistent pain) experienced ineffective pain relief at the end of the 2-week treatment. The beneficial effects of diclofenac HEP plaster on pain are confirmed by the patients' assessment, since almost identical scores were obtained. It is striking that the overall tolerance of diclofenac HEP plaster, applied topically twice a day for 2 weeks, was "good" or "excellent" in the 101 patients treated. Any side effect was reported on the patient's card and all the patients completed the study.

Physiological response to whole-body vibration in athletes and sedentary subjects.

Whole-body vibration (WBV) is a new exercise method, with good acceptance among sedentary subjects. The metabolic response to WBV has not been well documented. Three groups of male subjects, inactive (SED), endurance (END) and strength trained (SPRINT) underwent a session of side-alternating WBV composed of three 3-min exercises (isometric half-squat, dynamic squat, dynamic squat with added load), and repeated at three frequencies (20, 26 and 32 Hz). VO(2), heart rate and Borg scale were monitored. Twenty-seven healthy young subjects (10 SED, 8 SPRINT and 9 END) were included. When expressed in % of their maximal value recorded in a treadmill test, both the peak oxygen consumption (VO(2)) and heart rate (HR) attained during WBV were greatest in the SED, compared to the other two groups (VO(2): 59.3 % in SED vs 50.8 % in SPRINT and 48.0 % in END, p<0.01; HR 82.7 % in SED vs 80.4 % in SPRINT and 72.4 % in END, p<0.05). In conclusions, the heart rate and metabolic response to WBV differs according to fitness level and type, exercise type and vibration frequency. In SED, WBV can elicit sufficient cardiovascular response to benefit overall fitness and thus be a potentially useful modality for the reduction of cardiovascular risk.

Effects of salbutamol on the contractile properties of human skeletal muscle before and after fatigue.

AIM: The study examined the effects of an oral acute administration of the ß2-agonist salbutamol (Sal) (6 mg) vs. placebo on muscle strength and fatigability in 12 non-asthmatic recreational male athletes in a randomized double-blind protocol. METHODS: Contractile properties of the right quadriceps muscle were measured during electrical stimulations, i.e. twitch, 1-s pulse trains at 20 (P(20) ) and 80 Hz (P(80) ) and during maximal voluntary isometric contraction (MVIC) before (PRE) and after (POST) a fatigue-producing protocol set by an electromyostimulation (30 contractions, frequency: 75 Hz, on-off ratio: 6.25-20s). In addition, the level of muscle voluntary activation was measured. RESULTS: In PRE and POST conditions, the peak torque (PT) of twitch, P(80) and MVIC were not modified by the treatment. The PT in POST P(20) was slightly, although not significantly, less affected by fatigue in Sal compared with placebo condition. Moreover, twitch half-relaxation time at PRE was smaller under Sal than under placebo (P < 0.05). No significant changes in the degree of voluntary activation were observed with Sal treatment in PRE or POST condition. CONCLUSION: Although these findings did not exclude completely an effect of Sal on peripheral factors of human skeletal muscle, oral acute administration of the ß2-agonist Sal seems to be without any relevant ergogenic effect on muscle contractility and fatigability in non-asthmatic recreational male athletes.