Nontraumatic Acute Hyperextension Myelopathy Associated With Weightlifting.

ABSTRACT: We describe the clinical course of a 56-yr-old woman without a significant medical history presenting with nontraumatic paraplegia found to have an infarction of the conus medullaris after intensive lumbar hyperextension exercises. This condition, known as surfer's myelopathy, has been described in multiple case reports that attributed a similar mechanism and presentation. We present a case of surfer's myelopathy associated with weightlifting, which has not been previously reported. We conclude that this diagnosis should be considered in patients who present after spine hyperextension activity with nontraumatic paraplegia. Furthermore, we support the nomenclature change to "acute hyperextension myelopathy," better reflecting the underlying pathophysiology.

Pectoralis Major Injuries: Presentation, Diagnosis, and Management.

¼: In the past 20 years, there has been a substantial increase in the prevalence of pectoralis major injuries, largely related to the rising popularity of weight-lifting and participation in contact sports. ¼: Treatment options are influenced by the severity of the injury, patient age, and the amount and type of physical activity. ¼: Although there is no consensus as to which treatment method is most effective, previous studies have demonstrated increased satisfaction among patients who undergo operative treatment. ¼: The average length of time from surgery to return to activity ranges from 6 to 24 months.

Incidência e localizações das lesões atribuídas à participação no treinamento funcional de alta intensidade / Incidencia y localización de lesiones atribuídas a la práctica de entrenamiento funcional de alta intensidad / Incidence and locations of injuries attributed to participation in high-intensity functional training

OBJETIVO: Verificar a incidência e as localizações das lesões atribuídas à participação no treinamento funcional de alta intensidade. MÉTODO: 189 sujeitos de ambos os sexos inseridos em dois centros de treinamento participaram deste estudo retrospectivo. Como instrumento de coleta de dados foi utilizado um questionário contendo perguntas subjetivas e de múltipla escolha. A proposta do questionário foi examinar a localização, o número de lesões e os possíveis fatores de risco para lesão em praticantes/atletas de treinamento funcional de alta intensidade. RESULTADOS: Foi identificada uma incidência de 6.1 lesões por 1000 horas de treinamento. Os segmentos corporais com maior frequência de lesão foram o ombro (35.4%), lombar (20.3%), joelho (12.7%) e punho (8.9%). Além disso, as principais causas de lesões identificadas em nosso estudo foram técnicas de execução incorreta (34.2%), esforço repetitivo (29.1%) e elevadas cargas (17.7%). CONCLUSÃO: Estes resultados fornecem dados relevantes para a compreensão da etiologia das lesões em praticantes de treinamento funcional de alta intensidade. Desta forma, é possível que profissionais envolvidos em treinamento funcional de alta intensidade monitorem as respostas do treinamento e atuem na prevenção de lesões durante o programa de condicionamento

OBJETIVO: Verificar la incidencia y localización de las lesiones atribuidas a la participación en entrenamiento funcional de alta intensidad. MÉTODOS: 189 sujetos de ambos sexos pertenecientes a dos centros de entrenamiento participaron en este estudio retrospectivo. Como instrumento de recolección de datos se utilizó un cuestionario que contenía preguntas subjetivas y de múltiple elección. El objetivo del cuestionario fue examinar la localización, gravedad, número de lesiones y los posibles factores de riesgo de lesión en practicantes/atletas de entrenamiento funcional de alta intensidad. RESULTADOS: Se identificó una incidencia de 6.1 lesiones por 1000 horas de entrenamiento. Los segmentos corporales con mayor frecuencia de lesión fueron el hombro (35.4%), región lumbar (20.3%), rodilla (12.7%) y muñeca (8.9%). Además, las principales causas de lesión identificadas en nuestro estudio fueron la técnica de ejecución incorrecta (34.2%), el esfuerzo repetitivo (29.1%) y lãs elevadas cargas (17.7%). CONCLUSIÓN: Estos resultados proporcionan datos relevantes para la comprensión de la etiología de las lesiones en los practicantes de entrenamiento funcional de alta intensidad. De esta forma, es posible que profesionales involucrados en entrenamiento funcional de alta intensidad monitoreen las respuestas al entrenamiento y actúen en la prevención de lesiones durante el programa de acondicionamiento

OBJECTIVE: To verify the incidence and locations of injuries attributed to participation in high-intensity functional training. METHODS: 189 subjects of both sexes enrolled in two training centers participated in this retrospective study. As a data collect instrument, a questionnaire containing subjective and multiple choices questions was used. The purpose of the questionnaire was to examine the location, severity, number of injuries and possible risk factors for injury to high-intensity functional training practitioners/athletes. RESULTS: An incidence of 6.1 injuries per 1000 hours of training was identified. The body segments with the highest frequency of injury were shoulder (35.4%), lumbar (20.3%), knee (12.7%) and wrist (8.9%). In addition, the main causes of injury identified in our study were incorrect execution techniques (34.2%), repetitive effort (29.1%) and high loads (17.7%). CONCLUSION: These results provide relevant data for the understanding of the etiology of the injury in high-intensity functional training practitioners/athletes. Thereby, it is possible for professionals involved in high-intensity functional training to monitor training responses and to act on injury prevention during the conditioning program

Ruptura del ligamento de Cooper: a propósito de un caso / Cooper ligament tear: a case - report / Rotura do ligamento de Cooper: a propósito de um caso

Presentamos el caso de una paciente mujer de 34 años de edad que presentó ruptura de ligamento de Cooper de la mama izquierda a raíz de movimiento brusco de torsión de tronco. Dicha patología es poco frecuente y es importante considerarla en los posibles diagnósticos diferenciales de una lesión pectoral. En la literatura no se encuentran casos reportados, pero debido al aumento de la participación de la mujer en el deporte consideramos importante tenerlo presente en pacientes que presenten dolor súbito de la pared costal anterior

We report a 34 years-old woman who presented a Cooper's ligament tear after sudden chest torsion. This condition is extremely rare (to our knowledge, this is the first report published in the literature) but its inclusion in the differential diagnosis of traumatic chest conditions must be considered, especially since the woman is increasing the participation in sport in the last decade

Apresentamos o caso de uma paciente mulher de 34 anos de idade que apresentou uma rotura do ligamento de Cooper da mama esquerda devido a um movimento brusco de torção do tronco. Esta patología é pouco frequente e é importante considerá-la nos possiveis diagnósticos diferenciais de uma lesão peitoral. Na literatura no se encontram casos reportados mas devido ao aumento da participação da mulher no desporto consideramos importante tê-lo presente em pacientes que apresentem uma dor súbita da parede costal anterior

Acute Paraspinal Compartment Syndrome After Deadlifting: A Case Report.

CASE: A 27-year-old African man was admitted with acute right-sided loin pain that had started 4 hours after deadlifting. Renal colic was suspected, but clinical and radiological examination revealed no pathology of the urinary system. Further investigation revealed rhabdomyolysis. The back pain worsened with flexion, and both loins were hard on palpation 24 hours later. High intracompartmental pressures confirmed acute paraspinal compartment syndrome. CONCLUSIONS: We performed fasciotomy of the back muscles 28 hours after the onset of pain. Eighteen months after surgery, the patient no longer performed deadlifts but returned to pain-free exercise.

Comparison of Post-Exercise Hypotension Responses in Paralympic Powerlifting Athletes after Completing Two Bench Press Training Intensities.

Background and objective: Post-exercise hypotension, the reduction of blood pressure after a bout of exercise, is of great clinical relevance. Resistance exercise training is considered an important contribution to exercise training programs for hypertensive individuals and athletes. In this context, post-exercise hypotension could be clinically relevant because it would maintain blood pressure of hypertensive individuals transiently at lower levels during day-time intervals, when blood pressure is typically at its highest levels. The aim of this study was to compare the post-exercise cardiovascular effects on Paralympic powerlifting athletes of two typical high-intensity resistance-training sessions, using either five sets of five bench press repetitions at 90% 1 repetition maximum (1RM) or five sets of three bench press repetitions at 95% 1RM. Materials and Methods: Ten national-level Paralympic weightlifting athletes (age: 26.1 ± 6.9 years; body mass: 76.8 ± 17.4 kg) completed the two resistance-training sessions, one week apart, in a random order. Results: Compared with baseline values, a reduction of 5-9% in systolic blood pressure was observed after 90% and 95% of 1RM at 20-50 min post-exercise. Furthermore, myocardial oxygen volume and double product were only significantly increased immediately after and 5 min post-exercise, while the heart rate was significantly elevated after the resistance training but decreased to baseline level by 50 min after training for both training conditions. Conclusions: A hypotensive response can be expected in elite Paralympic powerlifting athletes after typical high-intensity type resistance-training sessions.

Part II: Comparison of Crossfit-Related Injury Presenting to Sports Medicine Clinic by Sex and Age.

OBJECTIVE: To examine CrossFit-related injuries based on sex and age. DESIGN: Retrospective case series. SETTING: A tertiary-level pediatric sports medicine clinic. PARTICIPANTS: CrossFit athletes. MAIN OUTCOME MEASURES: CrossFit-related injuries by sex (males vs females) and age groups (≤19 years vs >19 years) using a χ analysis with P = 0.05, odds ratio (OR), and 95% confidence interval (95% CI). RESULTS: Among injured CrossFit athletes, female athletes sustained lower extremity injuries more frequently than male athletes (P = 0.011; OR, 2.65; 95% CI, 1.25-5.65). In observed CrossFit injuries, shoulder injuries were more frequently observed in male athletes compared with female athletes (P = 0.049; OR, 2.79; 95% CI, 0.98-7.95). Additionally, a greater proportion of CrossFit athletes aged 19 years and younger suffered trunk/spine injuries than those older than 19 years (P = 0.027; OR, 2.61; 95% CI, 1.10-6.21) in injured CrossFit athletes. CONCLUSIONS: The current results indicated sex- and age-specific susceptibility to CrossFit-related injuries based on body parts and diagnoses. The presented information may be useful to develop a safer exercise program, especially for pediatric and adolescent CrossFit participants.

Weightlifting Shoulder Injuries Presenting to U.S. Emergency Departments: 2000-2030.

Weightlifting is associated with a significant risk of shoulder injury. We used the National Electronic Injury Surveillance System (NEISS) database to identify patients presenting to U.S. emergency departments between 2000 and 2017 with weightlifting-associated shoulder injuries to determine how the health burden and demographic characteristics of these patients have changed over time. Our analyses demonstrated a significant increase in the national estimate of weightlifting-associated shoulder injuries between 2000 (N=8.073; C.I. 6.309-9.836) and 2017 (N=14.612; C.I. 12.293-16.930) (p<0.001), with linear regression (R2=0.87, P<0.001) projecting 22.691 national cases by 2030. Patients were most often males (83.3%; C.I. 81.5-85.2%) between 20-29 years of age (30.5%; C.I. 28.2%-32.8%) sustaining a sprain, strain, or muscle tear (65.1%; C.I. 60.4-69.8%). Additionally, the average age of injury (34.33 years; C.I. 33.43-35.23 years) in the 2012-2017 period was significantly higher than in prior periods (p<0.001). We postulated these findings may reflect older individuals more frequently participating in resistance training than in the past, and considered that contemporary fitness trends such as CrossFit might have higher injury rates. We believe increased awareness of this burden, coupled with focus on injury prevention strategies, could yield substantial national health and cost savings.

Brachialis Muscle Tendon Rupture of the Distal Ulnar Attachment in a Competitive Weight Lifter.

Isolated tears of the brachialis muscle are rare and often take on the clinical appearance of other pathology, such as a distal biceps brachii tendon tear or an intramuscular tumor, thus making diagnosis especially difficult. The authors describe the case of a 31-year-old competitive male weight lifter who was found to have a full-thickness tear of the brachialis tendon at its distal ulnar attachment after performing a 40.8-kg biceps curl. The authors describe the differential diagnosis, radiographic findings, and methods used that led to the diagnosis and also provide a comprehensive review of the literature on brachialis muscle injuries. The patient decided to proceed with conservative management consisting of a period of rest and physical therapy. At 10 months after the injury, the patient went back to weightlifting and biceps curls. He had progressed to full strength and had returned to all weightlifting activities at final follow-up. Isolated full-thickness brachialis muscle ruptures can be treated successfully with conservative management, including rest and physical therapy. [Orthopedics. 2019; 42(3):e339-e342.].

Severe Hypoglycemia Due to Cryptic Insulin Use in a Bodybuilder.

BACKGROUND: Bodybuilding is a demanding sport, which requires high-volume, high-resistance weight training and augmented nutritional intake, toward an increase of overall body muscle mass accompanied by an overall decrease of body fat percentage and mass. Among bodybuilders, the use of various legal and illegal supplements is common. These supplements may be naturally occurring or man-made. CASE REPORT: We discuss the case of a 30-year-old male bodybuilder presenting with coma due to severe hypoglycemia from unknown cause, necessitating iterative glucose infusions, which was subsequently found to be related to cryptic insulin injections. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: In strength athletes, especially amateurs, the recourse to performance-enhancement drugs (e.g., insulin) is frequent. Beyond the specificity of care required for surreptitious insulin intoxication, emergency physicians should be alert to the possibility that exogenous insulin has been injected for use as an ergogenic aid by bodybuilders and others seeking to increase their body muscle mass when they encounter a patient with a decreased level of consciousness and treatment-refractory hypoglycemia. Moreover, in case of suspicion of such intoxication, the use of other illegal supplements should be screened, due to potentially associated risks of complication.

Median Arcuate Ligament Syndrome Related to Bodybuilding.

BACKGROUND: Median arcuate ligament syndrome (MALS), also known as celiac artery compression syndrome, is characterized by postprandial abdominal pain and weight loss thought to be secondary to compression of the celiac artery ganglia by the median arcuate ligament (MAL). METHODS: A young female powerlifter presented with a 3-month history of postprandial epigastric pain and involuntary weight loss following the start of a vigorous weightlifting program. The diagnosis of MALS was established after excluding other possibilities and by detailed evaluation including magnetic resonance imaging and celiac plexus block. She was treated by laparoscopic MAL release. RESULTS: The patient experienced immediate and complete cessation of her pain. She has continued to be asymptomatic at 6 months after surgery. CONCLUSIONS: Heavy weightlifting may potentially lead to MALS. The laparoscopic approach to MAL release can be utilized to treat this condition with favorable results.

Rotura simultanea bilateral de tendon cuadricipital asociada a anabolizantes esteroideos / Bilateral simultaneous rupture of quadriceps tendon associated to anabolic steroids administration

La rotura bilateral y simultánea del tendón cuadricipital es una lesión rara con pocos reportes en la literatura, que suele ocurrir en mayores de 50 años con enfermedades sistémicas crónicas subyacentes. Presentamos el caso de un paciente masculino sano de 32 años con rotura bilateral de tendón cuadricipital durante la práctica de musculación asociada a la administración de anabolizantes esteroideos y el tratamiento realizado

Bilateral and simultaneous rupture of the quadriceps tendon is a rare injury with a few reports in record that usually occurs in people older than 50 years with underlying chronic systemic diseases. We present the case of a healthy 32-year-old male patient with bilateral quadriceps tendon rupture during weight training practice associated to anabolic steroids administration and the treatment provided

Epidemiology and Trends of Weightlifting-Related Sprains and Strains that Presented to Emergency Departments in the United States.

Despite potential health benefits of weightlifting and physical activity, individuals can suffer from a number of musculoskeletal injuries. This study aimed to: (i) compare incidence and annual trends of different weightlifting injury types presenting to emergency departments in the United States and (ii) identify frequency and annual trends of weightlifting-related sprains and strains to each body part. The National Electronic Injury Surveillance System was queried to identify all weightlifting-related injuries from 2010-2016. Incidence and annual trends of various types of weightlifting-related injuries were compared during the study period. Furthermore, frequency and annual trends of weightlifting-related sprains and strains to different body parts were assessed. The weighted estimated annual incidence of weightlifting-related injuries significantly increased from 86,910 in 2010 to 109,961 in 2016 (R2 = 3.382; p = 0.01). The most common weightlifting-related sprains and strains involved the lower trunk (29.4%), shoulder (22.6%), upper trunk (17.3%), neck (6.5%), upper arm (5.6%), wrist (4.8%), knee (3.4%), and elbow (2.6%). There was a significant increase in the frequency and trends of sprains and strains that involved the lower trunk (R2 = 0.631; p = 0.033). Weightlifting-related injuries have increased, of which sprains and strains were the most common. Additionally, the most commonly affected body part was the lower trunk. Further studies are needed to determine the etiologies of weightlifting-related lower trunk sprains/strains. This study may be beneficial to weightlifters, highlighting common injury types, thereby allowing them to take preventative measures.

Risk factors for acute injuries and overuse syndromes of the shoulder in amateur triathletes - A retrospective analysis.

OBJECTIVES: To investigate the prevalence of shoulder-related acute and overuse injuries in triathletes and examine the role of possible risk factors, in order to identify potential preventive measures. METHODS: We performed a retrospective epidemiologic study of 193 amateur triathletes between June and August 2013 and evaluated their competition and training habits, as well as the presence of acute and overuse injuries of the shoulder sustained during the past 12 months. Contingency tables were analyzed using Pearson's chi-squared test. Normally distributed data were compared with the independent samples t-test, while non-parametric analyses were performed with the Mann-Whitney U test. Binary logistic regression was used to identify important predictors of injuries. RESULTS: 12 participants (6%) sustained acute injuries and 36 athletes experienced an overuse injury. The acute injury rate amounted to 0.11 per 1000 hours of training and the overuse injury rate to 0.33 per 1000 hours of training. There was no association between athletes' age, height, weight, BMI, a history of shoulder complaints or triathlon experience in years and acute or overuse injuries. Male athletes had a trend for sustaining more acute injuries then female athletes (8% vs. 2%, p = 0.079). Athletes with acute injuries spent a significantly higher amount of time per week doing weight training (p = 0.007) and had a trend for a higher weekly duration of cycling training (p = 0.088). Athletes with overuse injuries participated in a significantly higher number of races compared to athletes without overuse injuries (p = 0.005). The regular use of paddles was associated with a significantly higher rate of overuse injuries (24% vs. 10%, p = 0.014). CONCLUSION: The regular use of paddles during swimming training appears to be a risk factor for the development of overuse injuries, while an increased duration of weight and cycling training seems to be associated with a higher rate of acute injuries.

Spontaneous hepatic rupture in a bodybuilder: a case report and review of the literature.

This article is the first description of a spontaneous hepatic rupture in a young bodybuilder with a history of clenbuterol and ephedrine alkaloid use. The patient presented with a sudden mid-epigastric pain and vomiting. Hemoglobin levels decreased a few hours later and a computed tomography scan was performed which revealed a rupture of the right liver capsule and hemoperitoneum. Two attempts at transarterial embolization did not control the bleeding and a right hemihepatectomy was performed. The pathological report identified a hepatic adenoma, a capsular tear and diffuse peliosis hepatis. The patient was discharged in a good condition after eleven days. Spontaneous hepatic ruptures are rare and life-threatening and are usually described in association with tumors, connective tissue diseases and gestosis. This article is a review of the available literature with regard to this condition, with a focus on its relation to peliosis hepatis and banned substance used by body image fanatics. The present case highlights the challenging diagnosis of this potentially fatal liver complication in a healthy appearing male, the risk associated with the online trade of performance enhancing drugs and its relation with peliosis hepatis.