Revista de Medicina Desportiva (English) July 2018 - Page 26

Dr . José Pedro Marques . Sports Medicine . Coimbra
Sport during the growth phase – potential risks
Two topics were discussed : the relationship between sports practice and the development of the femoroacetabular impingement ( FAI ) CAM type and the measures that are under way to stop the scourge of the shoulder and elbow overuse pathology in the little league baseball . Over the last years several authors have investigated the relationship between sports practice and the development of FAI . This interest was triggered by the developing evidence that considers : FAI is a risk factor for the hip osteoarthritis ; the Increased prevalence of FAI In athletes ; a greater prevalence of hip osteoarthritis in athletes . In 2015 , a meta-analysis reviewed the prevalence of FAI among athletes , including basketball , football and icehockey players . The most relevant results were : the male athletes are 1.9 – 8 times more likely to develop a CAM-type deformity ; grouped prevalence ( by subject ) equal to 29 vs . 19 % ( controls ); alpha angle of 61 vs . 51 ( controls ). The evidence points to a relationship between the type , intensity and frequency of sports practice and the likelihood of developing a CAM deformity . Sports like football , hockey and basketball , which involve repetitive movements at the level of the hip , appear to be associated with a higher prevalence of CAM . Also , professional sportsmen seem to have a higher prevalence than amateurs . As regards the relationship between the development of the skeleton and hip deformities , it was concluded that these begin to develop from the 10-12 years of age and the hip deformity markers ( alpha angle ) tend to get worse with age . CAM deformity does not develop after physis closure . The pathophysiology of CAM has been the subject of biomechanical and mechanobiological studies . The current theory is that the mechanical loads generated at extreme amplitudes of hip cause local stress in physis
and surrounding areas . These loads create on the prone growing bone a mechanical stimulus for bone growth in unhabitual areas , and the bone maturation process deviates from the normal . The bigger this stimulus , the greater the bone affixing . A positive correlation between the alpha angle and the training intensity and the higher prevalence of CAM on professional athletes , that train more frequently and with more intensely , explains this theory . The challenge for the future is to understand what the risky mechanical loads are . The identification will give way to the implementation of preventive measures ( recommendations to decrease workout load while the skeleton is still immature ; compensatory exercises ) that allow the restoration of the balance between the mechanical stimulus and the bone growth , thereby preventing the development of the CAM type deformity .
The injury epidemiology on baseball points to a high number of overuse lesions in the shoulder and in the elbow on the young launchers . There is for some time a strong evidence that allows the establishment of a causal link between the number of launches per game , duration of the season , the type of the throwing and the incidence of these injuries . Several governing authorities have been issuing a set of recommendations aimed to protect the immature pitcher from a skeletal point of view . They include the limitation on the number of pitches per game , the maximum number of games / week , the recommended number of days of rest after the launch session , among others .
Dr . Alexandre Marques . Physical and Rehabilitation Medicine . Coimbra
The pre-participation medical exam . Specificities .
The pre-participation medical exam is an indispensable tool for assessing the aptitude or inadequacy of sports practitioners and it should not be seen as just a simple bureaucraticlegal requirement . According to the current Portuguese legislation , the form is provided by the Portuguese Institute of Sport under the Programme Simplex . By following the items on the form , there is lesser risk for errors and forgetfulness . Thus , the personal and family medical histories are relevant , and they can rise the suspicion of clinical issues that forbit sports practice . It is Important to inquire about non-traumatic sudden death in the family before the age of 30 . The sports habits help to know the kind of athlete , the sport level and the past injuries . A 20-year subject that has never practiced sports willing start sports activity is quite different from an individual under the same conditions , but 40 years old . This one deserves redoubled attention . Biometrics allows check the evolution of the weight , and it gives quick access to the body mass index . The ectoscopic exam gives a global idea of the athlete ’ s morphology and it can call the attention for a particular issue . The evaluation is done with the candidate standing and with as little clothing as possible , in order to have a good view looking from the front , the back and the side . The asymmetries of the limbs must be evaluated and in particular of the lower limbs the measurement of length from the anterior-superior iliac spine to the internal malleolus on the ankle can be done . Some dysmetria require correction . The evaluation of muscle masses must be done at rest and during contraction against resistance . The back must be observed , front the back and profile views , with attention to the leveling of the shoulders and iliac crests . The Adams test will help to decide for scoliosis . On the knees it is important to look for varus , valgus , flexum or recurvatum knees . Also , the shoulder girdle and the ankle joint deserve particular attention since they are very requested during sports m movements . With feet side by side , or on a slight external rotation , the Achilles tendon , usually vertical , is observed , and a possible calcaneal valgus , a flat or cavus foot is looked for . In case of doubt , a medical expertise should be asked . Some of these conditions can be corrected , can impair performance and can be a risk for other injuries .
24 july 2018 www . revdesportiva . pt
Dr. José Pedro Marques. Sports Medicine. Coimbra Sport during the growth phase – potential risks Two topics were discussed: the relationship between sports prac- tice and the development of the femoroacetabular impingement (FAI) CAM type and the measures that are under way to stop the scourge of the shoulder and elbow overuse pathol- ogy in the little league baseball. Over the last years several authors have investigated the relationship between sports practice and the development of FAI. This interest was triggered by the developing evidence that considers: FAI is a risk factor for the hip osteoarthritis; the Increased prevalence of FAI In athletes; a greater prevalence of hip osteoarthritis in athletes. In 2015, a meta-analysis reviewed the preva- lence of FAI among athletes, includ- ing basketball, football and ice- hockey players. The most relevant results were: the male athletes are 1.9 – 8 times more likely to develop a CAM-type deformity; grouped preva- lence (by subject) equal to 29 vs. 19% (controls); alpha angle of 61 vs. 51 (controls). The evidence points to a relationship between the type, inten- sity and frequency of sports practice and the likelihood of developing a CAM deformity. Sports like foot- ball, hockey and basketball, which involve repetitive movements at the level of the hip, appear to be asso- ciated with a higher prevalence of CAM. Also, professional sportsmen seem to have a higher prevalence than amateurs. As regards the rela- tionship between the development of the skeleton and hip deformities, it was concluded that these begin to develop from the 10-12 years of age and the hip deformity markers (alpha angle) tend to get worse with age. CAM deformity does not develop after physis closure. The pathophysi- ology of CAM has been the subject of biomechanical and mechano- biological studies. The current theory is that the mechanical loads generated at extreme amplitudes of hip cause local stress in physis 24 july 2018 www.revdesportiva.pt and surrounding areas. These loads create on the prone growing bone a mechanical stimulus for bone growth in unhabitual areas, and the bone maturation process deviates from the normal. The bigger this stimulus, the greater the bone affix- ing. A positive correlation between the alpha angle and the training intensity and the higher prevalence of CAM on professional athletes, that train more frequently and with more intensely, explains this theory. The challenge for the future is to understand what the risky mechani- cal loads are. The identification will give way to the implementation of preventive measures (recommenda- tions to decrease workout load while the skeleton is still immature; com- pensatory exercises) that allow the restoration of the balance between the mechanical stimulus and the bone growth, thereby preventing the development of the CAM type deformity. The injury epidemiology on baseball points to a high number of overuse lesions in the shoulder and in the elbow on the young launchers. There is for some time a strong evi- dence that allows the establishment of a causal link between the number of launches per game, duration of the season, the type of the throwing and the incidence of these injuries. Several governing authorities have been issuing a set of recommenda- tions aimed to protect the immature pitcher from a skeletal point of view. They include the limitation on the number of pitches per game, the maximum number of games/week, the recommended number of days of rest after the launch session, among others. Dr. Alexandre Marques. Physical and Rehabilitation Medicine. Coimbra The pre-participation medical exam. Specificities. The pre-participation medical exam is an indispensable tool for assessing the aptitude or inadequacy of sports practitioners and it should not be seen as just a simple bureaucratic- legal requirement. According to the current Portuguese legislation, the form is provided by the Portuguese Institute of Sport under the Pro- gramme Simplex. By following the items on the form, there is lesser risk for errors and forgetfulness. Thus, the personal and fam [HYYKB[\ܚY\\H[][ [^B[\HH\X[ۈو[X[\Y\]ܘ]ܝXXK]\[\ܝ[[]Z\HX]ۋ]][X]XY[X][H[Z[HYܙHHYHو BܝX][ۛH[و]]KHܝ][[B\[\Y\ˈH ^YX\XX]\]\XXYܝ[[œ\ܝX]]H\]Z]HY\[H[[]YX[[\H[YBۙ][ۜ] YX\ \›ۙH\\\YXY][[ۋ[Y]X[XH]KB[ۈوHZY []]\]ZX˜X\HHX\[^ BXX^[H]\Hؘ[YXBوH]]x&\[ܜH[][[H][[ۈ܈H\XKB\\YKH][X][ۈ\ۙB]H[Y]H[[[]\]H[\XK[ܙ\]HHY]B[HH۝ HX[BYKH\[[Y]Y\وH[X›]\H][X]Y[[\X[\وH\[XHYX\\[Y[و[HH[\[܋\\\[܂[XX[HH[\[X[[B\ۈH[H[HۙKYB\Y]XH\]Z\HܜX[ۋB][X][ۈو]\HX\\]\HۙH]\[\[۝XB[ۈYZ[\\[KHX›]\H؜\Y ۝HX˜[ٚ[HY]]][[ۈH][[وH[\[[XXܙ\ˈHY[\\[[XYH܈[\ˈۈHۙY\š]\[\ܝ[܈\\[ B\^[H܈X\][HۙY\ˈ[H[\\H[H[B[\\H\X[\][[ۂ[H^H\H\H\]Y\Y\B[ܝH[ݙ[Y[ˈ]Y]YHHYK܈ۈHY^\[][ۋHX[\[ۋ\X[B\X[ \؜\Y [HKBH[[X[[\H]܈]\™\Y܋[\HوX BYYX[^\\H[H\Y YHو\Hۙ][ۜ[BܜXY [[\Z\\ܛX[B[[HH\܈\[\Y\