Training, Injury, and Lifestyle Characteristics of Recreational Triathletes.

ABSTRACT: Triathlon is a popular sport among recreational and competitive athletes. As triathletes compete in races ranging from 16 to 140.6 miles and train in three disciplines simultaneously, it is difficult to identify injury risk factors. The aim of this study was to evaluate characteristics of a group of recreational triathletes regarding their medical history, training regimen, and injuries. Thirty-four triathletes completed this survey. We found a wide range of body types, training habits, and lifestyle characteristics. As in previous studies, we found a high rate of injuries in our surveyed triathletes. Injury rates were higher in athletes who had completed a longer race and those who reported higher training times per week. Additionally, many individuals have medical problems, use a variety of supplements, and follow specific dietary restrictions, which need to be considered in addition to training when assessing injury risk and recovery from injury.

Changes in clinical measures and tissue adaptations in collegiate swimmers across a competitive season.

BACKGROUND: Competitive swimmers incur shoulder pain and injury. Physical characteristics such as shoulder range of motion (ROM) and endurance and tissue adaptations such as posterior capsule thickness (PCT) may be risk factors in addition to high training volume. HYPOTHESIS/PURPOSE: 1) To identify the most provocative special test and prevalence of positive special tests for shoulder impingement tests in a group of collegiate swimmers, (2) to assess shoulder pain and disability, internal rotation (IR) and external rotation, and horizontal adduction (HADD) ROM and posterior shoulder endurance longitudinally over a competitive collegiate season, and (3) determine if there is a relationship between swimming yardage, supraspinatus tendon organization, and PCT. METHODS: Thirty Division III swimmers were tested poolside at the beginning (T1), middle (T2), and end (T3) of their season. Dependent variables included pain and disability, shoulder ROM, Posterior Shoulder Endurance Test (PSET) value, and PCT. Analyses of variance with follow-up t tests compared measures over time, and Pearson correlation coefficients were performed. RESULTS: Despite increased swimming yardage, disability was reduced from T1 to T3 (P = .003). There was a reduction in bilateral IR and HADD ROM from T1 to T3. PSET values increased on the right from T1 to T3 (P = .014). There was a significant positive correlation between swimming yardage at T1 and T2 and PCT at T3 (P = .034, P = .028). CONCLUSION: A loss of shoulder IR and HADD was observed across the season concurrent with less swimming-related disability, which may indicate a favorable adaptation. Improved PSET scores over the season is consistent with prior research linking endurance and less pain and disability.

Severe Sea Lion Bites in Urban Cold-Water Swimmers.

BACKGROUND: A series of sea lion bites in open-water swimmers recently gained the attention of the national and international media. Pinniped (the clade including seals and sea lions) bites historically have been in people who hunt or handle marine mammals. As populations of humans and pinnipeds continue to grow, interactions with animals by those participating in recreational activities are likely to become more frequent. CASE REPORTS: In December of 2017 and January of 2018, four sea lion (Zalophus californianus) bites in humans occurred at a popular open-water recreational swimming area in San Francisco, California. Three swimmers required treatment at a local trauma center and two required surgery. Two of the wounds were potentially life threatening; one swimmer required a field tourniquet to stop bleeding from the antecubital fossa, and the bite in another narrowly missed the femoral artery. The purpose of this report is to offer an in-depth discussion of antimicrobial use and rabies postexposure prophylaxis in patients with severe pinniped bites. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Information from this report can be used in conjunction with input from local experts to develop a thoughtful therapeutic plan for patients with severe pinniped bites. Doxycycline is the first-line antibiotic therapy, but broader coverage may be needed for severe wounds with the potential for contamination. The likelihood of rabies is low, and rabies postexposure prophylaxis should be reserved for cases that involve unusually aggressive animal behavior or other factors suggestive of rabies.

Differential Diagnosis of Complicated Bone Stress Injury in a Female Collegiate Swimmer.

An 18-year-old woman presented to a direct-access military physical therapy clinic after a fall directly onto the knee, with subsequent medial knee pain. The history and examination of the patient led the physical therapist to order radiographs, which revealed a pre-existing metaphyseal fibrous defect. On the same day, an orthopaedic consultation recommended magnetic resonance imaging and computed tomography, which showed a progression from a benign cortical defect to disruption of the posterior femur and surrounding bone marrow edema consistent with bone stress injury. J Orthop Sports Phys Ther 2018;48(10):823. doi:10.2519/jospt.2018.7731.

A prospective injury surveillance study in canyoning.

INTRODUCTION: Little is known about injuries in canyoning. It was the purpose of this study to determine injury rates, patterns, causes and risk factors in canyoning; and to identify targets for future injury prevention strategies. METHODS: From May to October 2015, 109 participants from 17 different countries were prospectively followed via a monthly e-mail-based questionnaire. RESULTS: During 13,690 h of canyoning, 57 injury-events occurred. The overall injury-rate was 4.2 injuries/1000 h of canyoning. The hand (23%) and lower leg and foot (25%) were most frequently involved. Most of the injuries were mild (n = 27, 49%) and limited to the soft-tissue. There were seven severe injuries (12%) with two lateral malleolar fractures, both necessitating surgery. The majority of injuries were due to material failure (44%) and significantly more injury-events were reported when the tour included rappelling (p = 0.037). Canyoning guides suffered from significantly less injuries compared to beginners and advanced canyoneers (p < 0.001). CONCLUSIONS: The majority of canyoning injuries are mild. On the other side, roughly one-tenth suffered from severe injury. Canyoning guides are less prone to injury-events and beginners should consider performing tours with experienced guides. Notwithstanding, rappelling was the most common activity associated with an injury and the material used was deemed causative for an injury-event in almost half of all cases. Further improvement in canyoning equipment, frequent equipment service, and instructional courses to ensure adequate employment of equipment might minimize the risk of getting injured.

Autologous tenocyte implantation into shoulder tendon pathology in an elite swimmer.

INTRODUCTION: The use of novel bioengineer treatment techniques such as Autologous Tenocyte Implantation (ATI) have shown promising improvements in both pain ratings and functional outcomes in elbow, gluteal and shoulder tendon pathology. This case will review the injury timeline of ATI intervention in an elite male swimmer with subscapularis tendon pathology and investigate whether ATI has a concomitant healing effect associated with improved functional outcomes. METHODS: A palmaris longus tendon biopsy was performed and cells were expanded by in-vitro culture. Autologous tenocytes were injected into the subscapularis site identified. Three blinded radiologists reported on pre and post shoulder MRIs using the same 3T MRI protocol. A validated rating scale for severity of tendinopathy (0-3) and degree of tear (0-3) was used and hand-held Dynamometry (HHD) strength was recorded. RESULTS: Independent blinded radiology review demonstrated a significant reduction in tear size and improved tendon morphology. IR strength on HHD returned to baseline strength levels post ATI (231-253N) 6 weeks post intervention. The athlete returned to full training (volume and intensity) pain free and international level competition at 4 months post ATI. CONCLUSION: An athlete who had previously undergone unsuccessful conservative management demonstrated significant improvement in function and in tendon morphology post intervention.

Cryotherapy: biochemical alterations involved in reduction of damage induced by exhaustive exercise

When exercises are done in intense or exhaustive modes, several acute biochemical mechanisms are triggered. The use of cryotherapy as cold-water immersion is largely used to accelerate the process of muscular recovery based on its anti-inflammatory and analgesic properties. The present study aimed to study the biochemical effects of cold-water immersion treatment in mice submitted to exercise-induced exhaustion. Swiss albino mice were divided into 4 treatment groups: control, cold-water immersion (CWI), swimming exhaustive protocol (SEP), and SEP+CWI. Treatment groups were subdivided into times of analysis: 0, 1, 3, and 5 days. Exhaustion groups were submitted to one SEP session, and the CWI groups submitted to one immersion session (12 min at 12°C) every 24 h. Reactive species production, inflammatory, cell viability, and antioxidant status were assessed. The SEP+CWI group showed a decrease in inflammatory damage biomarkers, and reactive species production, and presented increased cell viability compared to the SEP group. Furthermore, CWI increased acetylcholinesterase activity in the first two sessions. The present study showed that CWI was an effective treatment after exercise-induced muscle damage. It enhanced anti-inflammatory response, decreased reactive species production, increased cell viability, and promoted redox balance, which could decrease the time for the recovery process.

Posterior Cruciate Ligament Injuries Associated With Military Survival Swim Training.

OBJECTIVES: Posterior cruciate ligament (PCL) injuries are relatively common injuries associated with athletic activities and high-energy trauma. Posterolateral corner (PLC) injuries frequently accompany injury to the PCL. Diagnosis can be challenging and requires a comprehensive history and physical examination. Patients frequently report vague, nonspecific symptoms and the mechanism of injury is often useful in localizing injured structures. Two of the more common mechanisms for PCL injury include a direct blow to the proximal anterior tibia with the knee flexed, as well as a significant knee hyperextension injury. With a PCL tear, patients rarely describe an audible "pop" that is commonly reported in ACL injuries. On physical exam, a frequent finding in PCL tears is a loss of 10 to 20° of knee flexion. Although the most common clinical tests for PCL tears include the posterior drawer test, the posterior sag sign, and the quadriceps active test, there is a lack of high-quality diagnostic accuracy studies. MATERIALS AND METHODS: Two cases of U.S. Military Academy Cadets who sustained PCL injuries while removing combat boots during military survival swim training are presented. The results of the clinical examination are accompanied by magnetic resonance imaging results and intraoperative arthroscopic images to highlight key findings. RESULTS: Both patients were evaluated and diagnosed with PCL injures within 10 days of their injuries. Each reported feeling/hearing a "pop," which is atypical in PCL tears. Both patients demonstrated a lack of active and passive knee flexion, which is a commonly reported impairment. One patient was managed nonsurgically with physical therapy and eventually returned to full duty without limitations 9 months after his injury. The other patient, who sustained a combined PCL-PLC injury, underwent a PCL reconstruction and PLC repair and reconstruction 8 weeks after his injury. He returned all training, with the exception of contact/collision sports, 9 months after surgery. Both patient's rehabilitation programs consisted of a progression of exercises to improve range of motion, muscle strength/endurance, motor control, and muscular power. CONCLUSION: Military and sports medicine professionals should be aware of the potential for PCL injury with this unusual, and previously unreported, mechanism of injury during survival swim training. Prompt diagnosis and appropriate treatment is essential to prevent long-term disability.

[Effects of Core Stability Training on Masters Swimmers]. / Auswirkungen eines Rumpfstabilisationstrainings bei Masters-Schwimmern.

Background Back pain is a frequent problem for swimmers, especially for Masters swimmers. The cause seems to be insufficient core stability. Objective The goal of this study is to investigate whether specific core musculature training has a positive influence on low back pain and swimmers' perceived performance. Method Two groups (Masters swimmers and a control group) performed a guided 8-week training program. Changes in the core musculature were documented via tests carried out before and after the training program. Additional information was collected during the tests and at a follow-up interview 6 months later. Results Although a significant improvement was seen in both groups, the overall improvement in the Masters group was greater. At the follow-up interview, 72.3 % of all participants reported less back pain and said that they also noticed other benefits in daily life and during swimming. Conclusion This study shows that an 8-week training program can lead to an obvious and long-lasting decrease in back pain in all tested groups, particularly in Masters swimmers.

[Ruptured vascular adrenal cyst after being hit by a wave]. / Rupturierte vaskuläre Nebennierenzyste durch Badeunfall.

Endothelial cysts of the adrenal gland are a rare entity of adolescents. We here present the case of a 19-year-old woman, who developed right abdominal pain after trauma. Magnetic resonance imaging showed a tumor in the right adrenal gland with suspicious signs for malignancy. Histopathological examination revealed the diagnosis of an endothelial (vascular) adrenal cyst. In most cases, cysts of the adrenal gland remain clinically inapparent. In cases of clinically manifest symptoms, surgical intervention represents the standard for therapy.

Hamstring Injury After Swimming in a Patient With Multiple Hereditary Osteochondromatosis.

Reported here is a 20-year-old male suffered a hamstring strain after a prolonged bout of swimming. After ultrasound imaging, the patient's injury was considered to be the result of nearby osteochondromas. Case reports have been previously published concerning anterior cruciate ligament injury, rotator cuff tears, subacromial impingement, or femoroacetabular impingement in multiple osteochondromatosis. However, to the best of our knowledge, this is the first reported case of a hamstring injury secondary to an osteochondroma.

Prevalence of 'surfer's ear' in Cornish surfers.

OBJECTIVES: To establish the prevalence of external auditory canal exostosis ('surfer's ear') in Cornish surfers and investigate the potential impact on healthcare. METHOD: A total of 105 surfers were interviewed and otologically assessed on popular Cornish beaches. The degree of exostosis was graded as mild, moderate or severe. RESULTS: The prevalence of external auditory canal exostosis was 63.81 per cent (33.33 per cent mild, 18.10 per cent moderate and 12.38 per cent severe). The degree of exostosis showed a significant correlation with absolute cold-water exposure time. However, there was individual variation in susceptibility to external auditory canal exostosis; 12 per cent of surfers with excessive cold-water exposure showed no exostosis. Regression analysis of surgical operations performed at the Royal Cornwall Hospital for exostosis over the last 13 years revealed an average increase of 1.23 operations per year, with an average of 13 cases per year over the last 9 years. CONCLUSION: Exostosis of the external auditory canal is common in Cornish surfers. There appears to be individual variation in terms of susceptibility to this condition. The possible reasons for this are discussed. The increase in the technically difficult surgical operations performed for exostosis is likely to have implications for health resources in the future.

High prevalence of overuse injury among iron-distance triathletes.

BACKGROUND: Triathlon is an increasingly popular sport at both the elite and the recreational level. However, there have been few high-quality studies of injuries and illnesses among triathletes. OBJECTIVE: To register overuse problems and acute injuries among iron-distance triathletes throughout a training season leading up to a major event. METHODS: A 26-week prospective cohort study was conducted including 174 participants of the 2011 Norseman Xtreme Triathlon. Data on overuse injuries located in the shoulder, lower back, thigh, knee and lower leg were collected every second week using the Oslo Sports Trauma Research Center Overuse Injury Questionnaire. Illnesses, acute injuries and overuse problems affecting other anatomical areas were also recorded using standard injury surveillance methods. RESULTS: The average prevalence of overuse problems was 56% (95% CI 51 to 61) (490 cases). The average prevalence of substantial overuse problems was 20% (95% CI 18 to 21) (165 cases). The most prevalent sites of overuse problems were the knee (25%), lower leg (23%) and lower back (23%). The acute injury incidence was 0.97 injuries per 1000 h of training (36 cases) and 1.02 injuries per 1000 h of competition (5 cases). A majority of moderate and severe acute injuries were located at the knee, shoulder/clavicle and sternum/ribs. The predominant types of acute injuries were contusions, fractures and sprains. The incidence of illness was 5.3/1000 athlete-days (156 cases). CONCLUSIONS: Overuse problems constitute the majority of injury cases among iron-distance triathletes, and are far more common than acute injuries and illnesses. The most prevalent sites of injury in the present study were the knee, lower leg, lower back and shoulder. Future injury prevention studies in iron-distance triathletes should focus on these areas.

Natação e aspectos morfológicos do músculo esquelético em processo de reparo após criolesão / Swimming and morphology of skeletal muscle repair process after cryoinjury

O objetivo do estudo foi investigar a influência da natação sobre as alterações morfológicas do músculo esquelético em processo de reparo após criolesão. Foram usados 45 ratos divididos em cinco grupos: controle (n=5); sham (n=5), adaptação (n=5), criolesionados e tratados com natação sacrificados após 7, 14 e 21 dias (n=15); criolesionados e sem tratamento aquático sacrificados após 7, 14 e 21 dias (n=15). As sessões de natação foram realizadas 6 vezes por semana com 90 min de duração cada. Ao término do protocolo os animais foram sacrificados e a análise morfológica da área da lesão foi realizada. A análise morfológica semiquantitativa demonstrou que os músculos do grupo controle apresentaram aspecto histológico normal. O grupo sham apresentou edema, mionecrose e infiltrado inflamatório em grau 1. Nos grupos 7, 14 e 21 dias, não existiram diferenças estatisticamente significativas nas 4 etapas de remodelamento tecidual avaliadas (infiltrado inflamatório, edema, necrose e fibras musculares imaturas) entre os grupos lesionados quando comparados aos grupos com lesão e tratamento aquático. Em conclusão, foi possível verificar que a natação não causou alterações morfológicas durante o reparo do músculo esquelético após criolesão.

The aim of study was investigate the influence of swimming on the morphological changes in skeletal muscle repair process following cryoinjury. There were used 45 rats divided into 5 groups: control (n=5), sham (n=5), adaptation (n=5), cryolesioned treated with swimming and sacrificed after 7, 14 and 21 days (n=15), untreated and cryolesioned sacrificed after 7, 14, and 21 days (n=15). Animals swan for 90 min/ each session and 6 times a week. At the end of the protocol, the animals were sacrificed and morphological analysis of the lesion area was performed. The semi-quantitative morphological analysis showed that the muscles in the control group exhibited normal histological aspects while the sham group exhibited edema, myonecrosis and inflammatory infiltrate grade 1. In groups 7, 14, and 21 days, the results indicated that there were no statistically significant differences in four stages of tissue remodeling evaluated (inflammatory infiltration, edema, necrosis, and immature muscle fibers) between the injured groups compared to groups with lesion and treated with swimming. In conclusion, it was verified that swimming did not alter morphological aspects of skeletal muscle during the repair process following cryoinjury.

Treinamento em natação com baixa intensidade não protege músculo esquelético contra lesões induzidas por exercício exaustivo em ratos / Low-intensity swimming training does not protect the skeletal muscle

Enquanto o exercício aeróbico regular promove adaptações benéficas ao músculo esquelético, o exercício físico exaustivo induz lesões musculares. O objetivo deste estudo foi verificar se um programa de natação com baixa intensidade é capaz de proteger músculos esqueléticos contra lesões induzidas por exercício exaustivo. Ratos Wistar (peso: 376,50 ± 4,36g; idade: 90 dias) foram divididos aleatoriamente em quatro grupos: controle sedentário (CS); sedentário submetido a teste de exaustão (SE); treinado em natação (TN); treinado em natação submetido a teste de exaustão (TNE). Animais dos grupos TN e TNE foram submetidos a um programa de natação sem sobrecarga por 90 minutos/dia, cinco dias/semana, durante 17 semanas. Após este período, os grupos SE e TNE foram submetidos a um teste de exaustão em natação. Após eutanásia, fragmentos dos músculos sóleo e reto femoral foram coletados e submetidos à análise histológica e de proteínas de choque térmico (HSP70). Os resultados mostraram que o tempo até a exaustão foi maior no grupo TNE que no SE (125,0 ± 6,0 vs. 90,0 ± 8,5min, respectivamente, P < 0,05). Os níveis de lactato sanguíneo durante o teste e exaustão foram menores no grupo TNE que no SE (5,31 ± 0,22 vs. 8,76 ± 0,59mmol/L, respectivamente, P < 0,05). A frequência de fibras lesadas nos músculos foi maior nos grupos SE (sóleo: 34,86 ± 0,04; reto femoral: 37,57 ± 0,07) e TNE (sóleo: 41,57 ± 0,08; reto femoral: 39,57 ± 0,05), comparada aos grupos CS (sóleo: 13,88 ± 0,81; reto femoral: 16,75 ± 0,79) e TN (sóleo: 24,14 ± 0,06; reto femoral: 24,0 ± 0,05), respectivamente (P < 0,05). Não houve diferença significativa nos níveis de HSP70 dos músculos analisados entre os quatro grupos. Concluimos que apesar do treinamento em natação melhorar o desempenho dos animais no teste de exaustão, não promoveu proteção aos seus músculos esqueléticos contra as lesões induzidas pelo exercício exaustivo.

While regular aerobic exercise promotes beneficial adaptations to the skeletal muscle, acute exhaustive exercise causes structural damage to the skeletal muscle cells. The aim of this study was to verify whether a low-intensity swimming program protects the skeletal muscles against damage induced by exhaustive exercise. Male Wistar rats (weight: 376.50 4.36g; age: 90 days) were randomly divided into four groups: sedentary control (SC, N=8); sedentary submitted to exhaustive test (SE, N=7); swimming trained (TN, N=7); swimming trained submitted to exhaustive test (TNE, N=7). Animals of TN and TNE groups were submitted to a swimming regimen without overload for 90 min/day, 5 days/wk, during 17 weeks. Forty-eight hours after the last training session, animals from SE and TNE groups were submitted to an exhaustive exercise protocol. At sacrifice, fragments of soleus and rectus femoris muscles were collected and submitted to histological analysis and heat shock protein (HSP70) expression measurement. The results showed that the time until exhaustion was greater in the STE than in SE group (125.0 6.00 vs. 90.0 8.48 min, respectively, P<0.05). The levels of blood lactate during exhaustive exercise were lower in animals from TNE than SE (5.31 ± 0.22 vs. 876 ± 0.59 mmol/L, respectively, P<0.05)The frequency of damaged fibers in the muscles was greater in SE (soleus: 34.86±0.04; rectus femoris: 37.57 ± 0.07) and STE (soleus: 41.57±0.08; rectus femoris: 39.57 ± 0.05), compared to groups SC (soleus: 13.88±0.81; rectus femoris: 16.75 ± 0.79) and ST (soleus: 24.14±0.06; rectus femoris: 24.0 ± 0.05), respectively (P<0.05). There was no significant difference at the HSP70 levels of the analyzed muscles among the four groups (P>0.05). In conclusion, although a low-intensity swimming training increased the animals' performance in the exhaustive exercise test, it did not protect their skeletal muscles against damage induced by exhaustive exercise.

Congenital spine deformities: a new screening indication for blunt cerebrovascular injuries after cervical trauma?

Blunt cerebrovascular injuries (BCVI) carry significant morbidity if not diagnosed and treated early. A high index of clinical suspicion is needed to recognize the injury patterns associated with this condition and to order the requisite imaging studies needed to diagnose it accurately. We report of BCVI associated with a congenital cervical spine malformation after blunt trauma. We recommend inclusion of cervical spine malformations to the current Eastern Association for the Surgery of Trauma screening criteria for BCVI and explain our rationale for the same.

The practical management of swimmer's painful shoulder: etiology, diagnosis, and treatment.

Shoulder pain is the most common musculoskeletal complaint in competitive swimmers. Problems with the shoulders of swimmers resemble that of the disabled thrower's shoulder, but the clinical findings and associated dysfunctions are not quite the same. Therefore, swimmers with shoulder pain should be evaluated and treated as a separate clinical entity, aimed toward underlying pathology and dysfunction. Balanced strength training of the rotator cuff, improvement of core stability, and correction of scapular dysfunction is central in treatment and prevention. Technical and training mistakes are still a major cause of shoulder pain, and intervention studies that focus on this are desirable. Imaging modalities rarely help clarify the diagnosis, their main role being exclusion of other pathology. If nonoperative treatment fails, an arthroscopy with debridement, repair, or reduction of capsular hyperlaxity is indicated. The return rate and performance after surgery is low, except in cases where minor glenohumeral instability is predominant. Overall, the evidence for clinical presentation and management of swimmer's shoulder pain is sparse. Preliminary results of an intervention study show that scapular dyskinesis can be prevented in some swimmers. This may lead to a reduction of swimmer's shoulder problems in the future.