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.

Creatine Supplementation Supports the Rehabilitation of Adolescent Fin Swimmers in Tendon Overuse Injury Cases.

Our purpose was to investigate the effect of creatine (Cr) supplementation on regeneration periods in tendon overuse injury rehabilitation of adolescent fin swimmers. The participants of this study were injured adolescent competitive fin swimmers (n = 18). The subjects were randomly assigned the creatine (CR) or placebo (PL) groups with a double-blind research design. The subjects were given Cr supplementation or received the placebo as part of the conservative treatment of the tendinopathy. We measured the segmental lean mass (SLM;kg), the ankle plantar flexion peak torque (PFT;N·m), the pain intensity (NRS;values), prior to immobilization, after immobilization (R2) and after the 2nd (R4) and 4th (R6) weeks of the rehabilitation period of the injured limb. The creatine kinase (CK; U/L) enzyme levels were measured before immobilization, and then every 24 hours for four days. There was a significant decrease in SLM (CR by 5.6% vs. PL by 8.9%; p < 0.03) after two weeks of immobilization in both groups (p < 0.001). After four weeks rehabilitation the SLM significantly increased in both groups (CR by 5.5% vs. PL by 3.8%; p < 0.01). The percent changes in PFT after supplementation in R4 (p < 0.001) and R6 (p < 0.03) were significantly different between groups. There was a significant percent increase measured in the CR group (R4 by 10.4%; p < 0.001; R6 by 16.8%; p < 0.001), whereas significant, but lower growth found in the PL group also took place (R4 by 7.1%; p < 0.001; R6 by 14.7%; p < 0.001) after four weeks of rehabilitation. Significantly faster decrease were found in NRS of CR versus PL group during treatment (p < 0.02). We detected significantly lower CK levels increase at the CR group compared to the PL group. The results of this study indicate that Cr supplementation combined with therapeutic strategy effectively supports the rehabilitation of tendon overuse injury of adolescent fin swimmers.

Comparison of swim recovery and muscle stimulation on lactate removal after sprint swimming.

Competitive swimming requires multiple bouts of high-intensity exercise, leading to elevated blood lactate. Active exercise recovery has been shown to lower lactate faster than passive resting recovery but may not always be practical. An alternative treatment, electrical muscle stimulation, may have benefits similar to active recovery in lowering blood lactate but to date is unstudied. Therefore, this study compared submaximal swimming and electrical muscle stimulation in reducing blood lactate after sprint swimming. Thirty competitive swimmers (19 men and 11 women) participated in the study. Each subject completed 3 testing sessions consisting of a warm-up swim, a 200-yard maximal frontcrawl sprint, and 1 of 3 20-minute recovery treatments administered in random order. The recovery treatments consisted of a passive resting recovery, a submaximal swimming recovery, or electrical muscle stimulation. Blood lactate was tested at baseline, after the 200-yard sprint, and after 10 and 20 minutes of recovery. A significant interaction (p < 0.05) between recovery treatment and recovery time was observed. Blood lactate levels for the swimming recovery were significantly lower at 10 minutes (3.50 +/- 1.57 mmol.L-1) and 20 minutes (1.60 +/- 0.57 mmol.L-1) of recovery than either of the other 2 treatments. Electrical muscle stimulation led to a lower mean blood lactate (3.12 +/- 1.41 mmol.L-1) after 20 minutes of recovery compared with passive rest (4.11 +/- 1.35 mmol.L-1). Submaximal swimming proved to be most effective at lowering blood lactate, but electrical muscle stimulation also reduced blood lactate 20 minutes postexercise significantly better than resting passive recovery. Electrical muscle stimulation shows promise as an alternate recovery treatment for the purpose of lowering blood lactate.

Irukandji syndrome case series from Australia's Tropical Northern Territory.

STUDY OBJECTIVE: We describe Irukandji syndrome (a painful hypercatecholaminergic condition caused by jellyfish envenoming) in Australia's Northern Territory. METHODS: We collected prospectively a standardized data set on patients presenting to health facilities in the Northern Territory. Additional cases were identified retrospectively. Data collected included demographic, geographic, seasonal, and environmental features, as well as sting details, clinical manifestations, investigations, management, and outcomes. RESULTS: From 1990 to 2007, Irukandji syndrome affected 87 people. Age ranged from 1 to 51 years (64% male victims; 41% children [63% indigenous]). Activities associated with stings included snorkeling or scuba diving (35%) and swimming (29%). Stings commonly occurred in water greater than 2 m deep (63%), with fine weather (73%) and still or light breeze (70%). Seasonal variation was bimodal; peaks in May and October corresponded to prevailing offshore winds in the Darwin and Gove areas, respectively. Pain was severe (65%), with rapid onset (<30 minutes in 79%). Sting lesions (visible in 63%) were mild, and nematocysts (detected in 7 cases) had variable morphology. Systemic features were common, including hypertension and ECG abnormalities. Severe complications included troponin-level increases (2 cases) and cardiomyopathy with ventricular tachycardia (1 case), but no fatalities. Management included vinegar as first aid (66%), parenteral opioids (70%) (range 2 to 82.5 mg morphine equivalents in adults), and magnesium sulfate (3 cases). Hospital admission (49%) and aeromedical retrieval (16%) were commonplace. CONCLUSION: Irukandji syndrome in the Northern Territory was clinically consistent with previous studies but had distinct seasonal, geographic, and environmental features. Indigenous children in remote coastal communities are at risk, and there is room for improvement in prevention and management.

Epilepsy-related injuries.

Only one prospective, controlled study has compared the risk of accidental injury in persons with epilepsy to controls without seizures. A mildly increased risk in the epilepsy group was found, predominantly due to injuries that result directly from a seizure. With regard to injury type, this study found significantly higher rates of only head and soft tissue injury; however, most injuries were minor. Several retrospective, population-based studies have suggested increased rates of more serious injury types. Submersion injury has a high mortality; the risk of submersion in children with epilepsy is 7.5-13.9 fold higher than in the general population. The risk of fracture is elevated approximately twofold, either resulting directly from seizure-induced injury or predisposed by drug-induced reduction in bone mineral density. Burns due to seizures account for between 1.6% and 3.7% of burn unit admissions. The risk of motor vehicle accidents in drivers with epilepsy also appears increased, albeit marginally. Several factors predispose to a higher risk of injury among those with epilepsy. Seizures resulting in falls increase the risk of concussion and other injuries. Higher seizure frequency, lack of a prolonged seizure-free interval, comorbid attention deficit disorder, or cognitive handicap may also increase the risk of injury. While some restrictions are necessary to protect the safety of the person with epilepsy, undue limitations may further limit achievement of independence. Given the high morbidity and mortality of submersion injury, those with active epilepsy should bathe or swim only with supervision; however, showering is a reasonable option. Appropriate vitamin D and calcium supplementation and periodic measurement of bone mineral density in those at risk for osteopenia are recommended.

Oral salt supplementation during ultradistance exercise.

OBJECTIVE: The objective of this study was to determine whether sodium supplementation 1) influences changes in body weight, serum sodium [Na], and plasma volume (PV), and 2) prevents hyponatremia in Ironman triathletes. SETTING: The study was carried out at the South African Ironman triathlon. PARTICIPANTS: Thirty-eight athletes competing in the triathlon were given salt tablets to ingest during the race. Data collected from these athletes [salt intake group (SI)] were compared with data from athletes not given salt [no salt group (NS)]. INTERVENTIONS: Salt tablets were given to the SI group to provide approximately 700 mg/h of sodium. MAIN OUTCOME MEASUREMENTS: Serum sodium, hemoglobin, and hematocrit were measured at race registration and after the race. Weights were measured before and after the race. Members of SI were retrospectively matched to subjects in NS for 1) weight change and 2) pre-race [Na]. RESULTS: The SI group developed a 3.3-kg weight loss (p < 0.0001) and significantly increased their [Na] (delta[Na] 1.52 mmol/L; p = 0.005). When matched for weight change during the race, SI increased their [Na] compared with NS (mean 1.52 versus 0.04 mmol/L), but this did not reach statistical significance (p = 0.08). When matched for pre-race [Na], SI had a significantly smaller percent body weight loss than NS (-4.3% versus -5.1%; p = 0.04). There was no significant difference in the increase of [Na] in both groups (1.57 versus 0.84 mmol/L). PV increased equally in both groups. None of the subjects finished the race with [Na] < 135 mmol/L. CONCLUSIONS: Sodium ingestion was associated with a decrease in the extent of weight loss during the race. There was no evidence that sodium ingestion significantly influenced changes in [Na] or PV more than fluid replacement alone in the Ironman triathletes in this study. Sodium supplementation was not necessary to prevent the development of hyponatremia in these athletes who lost weight, indicating that they had only partially replaced their fluid and other losses during the Ironman triathlon.

Box jellyfish (Carybdea alata) in Waikiki: their influx cycle plus the analgesic effect of hot and cold packs on their stings to swimmers at the beach: a randomized, placebo-controlled, clinical trial.

The study measured the analgesic effect of hot and cold packs on box jellyfish (Carybdea alata) stings to Waikiki swimmers at the beach. Analysis of data showed a minimal trend toward pain relief 10 minutes after the application of hot packs, particularly when the initial pain was mild to moderate. Cold packs showed no clinically significant relief of pain, compared to the control. Data tracking shows that most box jellyfish appear in Waikiki waters on the 9th or 10th day after the full moon.

Exploración clínica del hombro en el deporte / Physical examination of the shoulder in sport

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Aquatic sports massage therapy.

Athletic trainers are continually bombarded with requests to assist aquatic athletes with the management of musculoskeletal concerns involved with training and overtraining. The trainer has options for initial training management through the administration of massage, cryotherapy, thermotherapy, and injury-preventative strengthening exercises. This article describes and illustrates athletic training techniques such as massage, cryotherapy or cold applications, thermotherapy or heat applications, and proprioceptive neuromuscular facilitation or strengthening exercise.

Treating shoulder impingement using the supraspinatus synchronization exercise.

OBJECTIVE: More and more athletes are seeking care in the chiropractic office for athletic injuries. This article presents a case report of a young athletic patient suffering from bilateral shoulder pain-shoulder impingement and presents a review of the literature and a review of shoulder anatomy. This report introduces the supraspinatus synchronization exercise with discussion and illustrations. This patient was treated using the supraspinatus synchronization exercise. CLINICAL FEATURES: A 16-yr-old female was seen suffering from a 4-month history of shoulder pain. She was a competitive swimmer in high school athletics and the pain was made worse by swimming the backstroke. A clinical diagnosis of bilateral stage I impingement of the shoulder (Neer's classification) was made. INTERVENTION AND OUTCOME: The patient was given instructions on how to perform the supraspinatus synchronization exercise, conservative therapies including chiropractic manipulative therapy, ice, high-voltage electrical muscle stimulation and rehabilitation exercise band exercises were also used. The patient was treated for seven treatments over a 4-wk period with resolution of the condition. CONCLUSION: The shoulder is a very complex joint, and many authors discuss the necessity of smooth synchronous movement to keep it pain free without going into how one measures this synchronous movement. The case presented in this report responded quickly to conservative treatment using the supraspinatus synchronization exercise. A good well-designed clinical trial needs to be set up to check the efficacy of this exercise.

Overuse syndromes in baseball, tennis, gymnastics, and swimming.

The shoulder is the "center of action" for most sports including those discussed in this article. Overuse problems of the shoulder are the most common group of injuries affecting the athlete involved in baseball, tennis, swimming, and gymnastics. Most of the injuries can be directly related to the mechanics of throwing, swimming, or gymnastics. After diagnosis, treatment is directed at "selective rest" of the injured shoulder and modalities and medications intended to decrease the inflammatory response of the body to stress.