Effect of hyperbaric oxygen on oxygen uptake and measurements in the blood and tissues in a normobaric environment.

OBJECTIVE: To examine venous partial pressure of oxygen (PvO(2)), transcutaneous oxygen tension (tcPO(2)), and VO(2)MAX in a normobaric environment after a single hyperbaric oxygen (HBO(2)) treatment. METHODS: This was a prospective study of conditions after the intervention compared with baseline. The participants were 10 moderately trained (VO(2)MAX = 57.6 ml/kg/min) men. Two HBO(2) treatments consisting of breathing 95% oxygen at 2.5 atmospheres absolute (ATA) for 90 minutes were administered on non-consecutive days. Baseline testing included measures of VO(2)MAX, tcPO(2), and anthropometry. At 6.0 (1.0) minutes after the first HBO(2) treatment, a VO(2)MAX test was performed. After the second HBO(2) treatment, leg and chest tcPO(2) and PvO(2) were monitored for 60 minutes. RESULTS: VO(2)MAX, running time, and peak blood lactate were not altered after the HBO(2) treatment. Leg tcPO(2) was lower (p = 0.003) and chest tcPO(2) was unchanged after the HBO(2) treatment compared with baseline values. PvO(2) was significantly (p<0.001) lower in the first three minutes after treatment than subsequent values, but no other differences were found. CONCLUSIONS: A single HBO(2) treatment at 2.5 ATA for 90 minutes does not raise PvO(2), tcPO(2), or VO(2)MAX in a normobaric, normoxic environment.

Concussions among university football and soccer players: a pilot study.

OBJECTIVE: A pilot study to examine the incidence and characteristics of concussions for one season of university football and soccer. DESIGN: Retrospective survey. PARTICIPANTS: 60 football and 70 soccer players reporting to 1998 fall training camp. Of these, 44 football and 52 soccer players returned a completed questionnaire. MAIN OUTCOME MEASURES: Based on self-reported symptoms, calculations were made to determine the number of concussions experienced during the previous season, the duration of symptoms, the time for return to play and any associated risk factors for concussions. RESULTS: Of all the athletes who returned completed questionnaires, 34.1% of the football players and 46.2% of the soccer players had experienced symptoms of a concussion during the previous season. Only 16.7% of the concussed football players and 29.2% of the concussed soccer players realized they had suffered a concussion. All of the concussed football players and 75.0% of the concussed soccer players experienced more than one concussion during the season. The symptoms from the concussion lasted for at least 1 day in 28.6% of the football players and 18.1% of the soccer players. Variables that increased the odds of suffering a concussion during the previous season for football and soccer players included a past history of a recognized concussion. CONCLUSION: More university soccer players than football players may be experiencing sport related concussions. Variables that seem to increase the odds of suffering a concussion during the previous season for football and soccer players include a history of a recognized concussion. Despite being relatively common, many players may not recognize the symptoms of a concussion.

Operative management of "hockey groin syndrome": 12 years of experience in National Hockey League players.

BACKGROUND: At the elite level of hockey, groin injuries can threaten a player's career. The aim of this review is to describe the clinical presentation and evaluate our operative approach to "hockey groin syndrome" in National Hockey League (NHL) players. METHODS: Between November 1989 and June 2000, 22 NHL players with debilitating groin pain underwent operative exploration. A repair, including ablation of the ilioinguinal nerve and reinforcement of the external oblique aponeurosis with a Goretex (W.L. Gore & Associates, Inc, Flagstaff, Ariz) mesh, was performed. Medical records were reviewed, and the players or their trainers were contacted by telephone after a mean follow-up period of 31.2 months to assess function, symptoms, and overall satisfaction. RESULTS: All patients had tearing of the external oblique aponeurosis, with branches of the ilioinguinal nerve emerging from the torn areas. At follow-up, 18 players (82%) had no pain, whereas 4 (18%) reported mild, intermittent pain. All 22 patients returned to playing hockey, with 19 (85%) able to continue their careers in the NHL. CONCLUSIONS: The "hockey groin syndrome," marked by tearing of the external oblique aponeurosis and entrapment of the ilioinguinal nerve, is a cause of groin pain in professional hockey players. Ilioinguinal nerve ablation and reinforcement of the external oblique aponeurosis successfully treats this incapacitating entity.

Recommendations for grading of concussion in athletes.

Mild sports-related concussions, in which there is no loss of consciousness, account for >75% of all sports-related brain injury. Universal agreement on concussion definition and severity grading does not exist. Grading systems represent expertise of clinicians and researchers yet scientific evidence is lacking. Most used loss of consciousness and post-traumatic amnesia as markers for grading concussion. Although in severe head injury these parameters may have been proven important for prognosis, no study has done the same for sport-related concussion. Post-concussion symptoms are often the main features to help in the diagnosis of concussion in sport. Neuropsychological testing is meant to help physicians and health professionals to have objective indices of some of the neurocognitive symptoms. It is the challenge of physicians, therapists and coaches involved in the care of athletes to know the symptoms of concussion, recognise them when they occur and apply basic neuropsychological testing to help detect this injury. It is, therefore, recommended to be familiar with one grading system and use it consistently, even though it may not be scientifically validated. Then good clinical judgement and the ability to recognise post-concussion signs and symptoms will assure that an athlete never returns to play while symptomatic.

Concussions during the 1997 Canadian Football League season.

OBJECTIVE: To examine the incidence and characteristics of concussions for one season in the Canadian Football League (CFL). DESIGN: Retrospective survey. PARTICIPANTS: 289 players reporting to CFL training camp. Of these, 154 players had played in the CFL during the 1997 season. MAIN OUTCOME MEASURES: Based on self-reported symptoms, calculations were made to determine the number of concussions experienced during the previous season, the duration of symptoms, the time for return to play after concussion, and any associated risk factors for concussions. RESULTS: Of all the athletes who played during the 1997 season, 44.8% experienced symptoms of a concussion. Only 18.8% of these concussed players recognized they had suffered a concussion. 69.6% of all concussed players experienced more than one episode. Symptoms lasted at least 1 day in 25.8% of cases. The odds of experiencing a concussion increased 13% with each game played. A past history of a loss of consciousness while playing football and a recognized concussion while playing football were both associated with increased odds of experiencing a concussion during the 1997 season. CONCLUSION: Many players experienced a concussion during the 1997 CFL season, but the majority of these players may not have recognized that fact. Players need to be better informed about the symptoms and effects of concussions.

A complete approach to groin pain.

Focused history questions and physical exam maneuvers are especially important with groin pain because symptoms can arise from any of numerous causes, sports related or not. Questions for the patient should attempt to rule out systemic symptoms and clarify the pain pattern. Some of the most possible causes of groin pain include stress fracture of the femoral neck or pubic ramus, Legg-Calvé-Perthes disease, slipped capital femoral epiphysis, acetabular labral tears, iliopectineal bursitis, avulsion fracture, osteitis pubis, strain of the thigh muscles or rectus abdominis, inguinal hernia, ilioinguinal neuralgia, and the 'sports hernia.' Depending on the diagnosis, conservative treatment is often effective.

Effects of hyperbaric oxygen on aerobic performance in a normobaric environment.

The purpose was to examine the acute effects of a hyperbaric oxygen (HBO2) treatment on a) recovery following prolonged exercise and b) aerobic performance in a trained population. Subjects were six male and six female, trained runners with mean Vo2max values of 64.6 +/- 5.6 and 51.9 +/- 6.6 ml x kg(-1) x min(-1), respectively. Subjects performed four exercise-HBO2 conditions in random order: a) control, b) exercise-no HBO2, c) no exercise-HBO2; and d) exercise-HBO2. Exercise was a 90-min run at 75-80% of Vo2max x HBO2 treatments consisted of breathing 95% O2 at 2.5 atm abs for 90 min. At the end of each condition, aerobic performance was assessed with a VO2max test and by the oxygen cost of running on a treadmill at three submaximal velocities. Recovery was not enhanced following a single HBO2 treatment at 2.5 atm abs for 90 min, nor did it alter submaximal or maximal running performance.

Exercise-induced asthma.

Exercise-induced asthma (EIA) is a common condition that can impede physical activity, particularly for children, adolescents, and young adults. A detailed patient history can help the physician identify subtle EIA clues such as fatigue or poorer performance than training would predict. A careful physical exam can help rule out conditions that mimic EIA such as respiratory infections or cardiac conditions. Pulmonary function testing is often useful for assessing severity and establishing a baseline for assessing treatment efficacy. Treatment options include nonpharmacologic measures that address the exercise environment and warm-up routines. Several medication options and combinations can help patients avoid symptoms and participate fully in fitness and sports activities.

A randomized controlled trial of the effect of naproxen on delayed onset muscle soreness and muscle strength.

OBJECTIVE: To determine the effect of naproxen in attenuating the symptoms (muscle soreness level) and signs (plasma creatine kinase [CK] activity and muscular strength decrement) of delayed onset muscle soreness (DOMS) induced by repeated bouts of eccentric exercise. DESIGN: The design was a randomized, double-blind, placebo-controlled, crossover trial with two testing phases of 8 days' duration that were separated by a "washout" period of 7 days. SETTING: University-based sports science center. PARTICIPANTS: Twenty healthy male volunteers who responded to a notice in the university's athletic complex. INTERVENTIONS: Eccentric single-leg exercises were performed on days 1, 3, and 4 to induce DOMS in the quadriceps muscles. Naproxen or placebo tablets (500 mg) were taken orally twice per day beginning on day 2 and continuing until the end of the testing phase. MAIN OUTCOME MEASURES: Perception of muscle soreness and knee extensor torque were evaluated daily throughout each phase. Plasma CK levels were evaluated on days 1, 3, 6, and 8 of each phase. RESULTS: After the eccentric exercise, plasma CK levels were similarly elevated in both naproxen and placebo conditions (F=1.42; p=0.25). After DOMS developed, naproxen reduced the perception of soreness on day 3, when muscle soreness was highest (F=2.20; p=0.04). After treatments with naproxen, peak quadriceps torque during leg extension at 60 degrees/s was higher than that after treatment with the placebo (F=4.77; p=0.04). There were no significant differences between the naproxen and placebo conditions for leg extension at 180 degrees/s (F= 1.66; p=0.21) and 300 degrees/s (F=0.71; p=0.41). CONCLUSION: The data indicate that therapeutic doses of naproxen do not prevent CK release into the plasma but decrease the perception of muscle soreness and positively influence quadriceps peak torque.

Lower abdominal pain syndrome in national hockey league players: a report of 11 cases.

PURPOSE: Groin injuries are a major diagnostic and therapeutic challenge in sports medicine. The aim of this review is to describe the clinical and surgical findings associated with an atypical lower abdominal pain syndrome occurring in elite ice hockey players. CASE SUMMARIES: Eleven professional ice hockey players from various National Hockey League teams were referred to the Montreal General Hospital between 1989 and 1996, suffering from atypical refractory pain and paraesthesia in the lower abdomen. Despite the use of conventional investigative procedures such as physical examination, ultrasound, bone scan, computed tomography scan, and magnetic resonance imaging scan, preoperative findings were consistently negative. Operative findings revealed varying degrees of tearing of the external oblique aponeurosis and external oblique muscle associated with ilioinguinal nerve entrapment. Repair of the external oblique tear, ablation of the ilioinguinal nerve, followed by a 12-week planned course of physiotherapy allowed all to return to professional ice hockey careers. DISCUSSION: While soft tissue injuries are the most common cause of groin pain in the athlete, tears of the external oblique aponeurosis and superficial inguinal ring have rarely been cited as a consistent cause of lower abdominal pain in athletes. Inguinal nerve entrapment is also rare in patients without a history of previous lower abdominal surgery. RELEVANCE: These 11 cases emphasize the importance of including another diagnostic possibility in the differential diagnosis of chronic overuse injuries of the lower abdomen.