Revista de Medicina Desportiva (English) July 2018 - Page 28

The remainder of the examination is also very important , and it cannot be forgotten the ophthalmic and otolaryngologist evaluation , where any abnormal situation can often be corrected if detected early . The teeth should be systematic observed to look for any untreated tooth decays . These infectious foci perpetuate bacteremia that is clinical inapparent and it becomes a risk for repeated musculotendinous injuries . The genitourinary-urinary evaluation Includes the registration and the particular assessment female athlete , the existing of qualitative changes in the composition of urine and still the search of varicocele and of hernias , which , although they don ’ t contraindicate , they may be a problem on some sports modalities . On the cardiac and circulatory examination is important : bilateral palpation the radial and femoral pulses ( very important for the diagnosis of aorta coarctation ); the cardiac auscultation should complement by the palpation and the site of the heart maximum impact on the thorax ( with particular attention to the existence of murmurs ); the pulmonary auscultation should contemplate the forced expiration , a simple procedure that may reveal a bronchospasm , that cannot be find on another way ; measure of the heart rate and of blood pressure with braces validated for children and for obese people . The use of other diagnostic exams has been discussed by other specialists , but the EKG must always be carried out .
Dr . António Araújo . Physical and Rehabilitation Medicine . Coimbra
Fatigue fractures-particularities of the child and adolescent
Stress fractures are overuse injuries of the bone that result from a dynamic process over the time with increased repeated loads applied on the musculoskeletal system and with inappropriate recovery time between sessions . This pathology affects any age being more common on the athletes and military . The process of bone remodeling is dynamic over time and after the application of excessive load on the bone microfractures occur , starting the process of bone remineralization . When there is not enough time for bone recovery , a stress reaction with imbalance between remodeling and bone resorption is generated resulting in fractures in stress points . In childhood , 15 to 30 % of fractures affect the growth epiphyses , particularly in long bones such as radio , tibia and fingers . Improper treatment of these fractures can cause permanent deformities . Excessive and repeated loads on the growth epiphyses promote the disruption of endochondral ossification with enlargement of the involved physis . The high-risk stress fractures correspond to fractures located in the femoral neck , tibial diaphysis , patella bone , talus , navicular and 5 th metatarsal bone and they are fractures of more difficult bone consolidation , so the early identification is fundamental to the success of the treatment . The most prevalent associated extrinsic factors are inadequate nutrition , training methodology errors , intensity changes and training regimen and alteration of the training surface . The presentation of this clinical entity may be acute with pain located at the end or after exercise , subacute with pain that occurs earlier during exercise and lasts longer after its termination or chronic with persistent pain throughout training or walking . The diagnosis requires a high index of suspicion and can be confirmed by imaging exams , emphasizing the MRI as the most sensitive examination and with the ability to identify the first bone changes , namely the bone marrow edema and the periosteum reaction . The prevention of these lesions should include an individualized training regimen for the athlete , with appropriate loads and intensity , use of sports equipment and training surface appropriate to the activity to be performed , healthy diet with foods rich in calcium and vitamin D and the knowledge of the most susceptible anatomical sites of fatigue fracture taking into account the sport envolved with the application of appropriate injury prevention programs .
Dra . Adriana de Sousa Lages . Endocrinologist . Coimbra
Relative Energy Deficiency in Sports ( RED-S )
The “ Triad of the female athlete “ was conceptually defined , in 1997 by American College of Sports Medicine ( ACSM ), as frequent syndrome occuring among female athletes , which combines the presence of eating disorders , amenorrhea and osteoporosis . In 2007 , the ACSM redefined this concept in order to include three interrelated components : energy availability ( EA ), menstrual function and bone health . The concept of EA is introduced , and it is the energy available for bodily physiological functions , after subtraction from the energy spent during physical training , from the energy obtained through food intake . It is desired that there is a balance between the ingestion and the energy spent . The low EA represents the cornerstone of the metabolic consequences associated with the “ female athlete ’ s triad ”. Particularly in sports where the athlete belongs to a particular category of weight or in which body composition is an important condition of the performance athletic , energy availability It is often conditioned . In 2014 , the International Olympic Committee defined the concept of Relative Energy Deficiency In Sports ( RED-S ) emphasizing the inclusion of all athletes ( not only female ) and referring the problem as a multi-organ syndrome that affects , for example , the metabolic rate , the gonadal and immunological functions , the protein synthesis and the athlete ’ s bone and cardiovascular health . Additionally , the RED-S reduces the performance athletic : less resistance , increased risk of injury , worse performance capacity , concentration and cognition , deficit coordination , mood disturbance and decreased athlete ’ s muscular strength . Therefore , emphasizing the identification of the athlete at risk of RED-S , the multidisciplinary monitoring , including the endocrinologist , is essential in order to optimize the performance , reduce the risk of injury and boost sports capabilities .
26 july 2018 www . revdesportiva . pt
The remainder of the examination is also very important, and it cannot be forgotten the ophthalmic and otolaryngologist evaluation, where any abnormal situation can often be corrected if detected early. The teeth should be systematic observed to look for any untreated tooth decays. These infectious foci per- petuate bacteremia that is clinical inapparent and it becomes a risk for repeated musculotendinous injuries. The genitourinary-urinary evalua- tion Includes the registration and the particular assessment female athlete, the existing of qualitative changes in the composition of urine and still the search of varicocele and of hernias, which, although they don’t contraindicate, they may be a problem on some sports modali- ties. On the cardiac and circulatory examination is important: bilateral palpation the radial and femo- ral pulses (very important for the diagnosis of aorta coarctation); the cardiac auscultation should comple- ment by the palpation and the site of the heart maximum impact on the thorax (with particular atten- tion to the existence of murmurs); the pulmonary auscultation should contemplate the forced expiration, a simple procedure that may reveal a bronchospasm, that cannot be find on another way; measure of the heart rate and of blood pressure with braces validated for children and for obese people. The use of other diagnostic exams has been discussed by other specialists, but the EKG must always be carried out. Dr. António Araújo. Physical and Rehabilitation Medicine. Coimbra Fatigue fractures-particularities of the child and adolescent Stress fractures are overuse inju- ries of the bone that result from a dynamic process over the time with increased repeated loads applied on the musculoskeletal system and with inappropriate recovery time between sessions. This pathology affects any age being more com- mon on the athletes and military. The process of bone remodeling is 26 july 2018 www.revdesportiva.pt dynamic over time and after the application of excessive load on the bone microfractures occur, starting the process of bone remineraliza- tion. When there is not enough time for bone recovery, a stress reaction with imbalance between remod- eling and bone resorption is gener- ated resulting in fractures in stress points. In childhood, 15 to 30% of fractures affect the growth epiphy- ses, particularly in long bones such as radio, tibia and fingers. Improper treatment of these fractures can cause permanent deformities. Excessive and repeated loads on the growth epiphyses promote the disruption of endochondral ossi- fication with enlargement of the involved physis. The high-risk stress fractures correspond to fractures located in the femoral neck, tibial diaphysis, patella bone, talus, navicular and 5 th metatarsal bone and they are fractures of more dif- ficult bone consolidation, so the early identification is fundamental to the success of the treatment. The most prevalent associated extrinsic factors are inadequate nutrition, training methodology errors, inten- sity changes and training regimen and alteration of the training sur- face. The presentation of this clinical entity may be acute with pain located at the end or after exercise, subacute with pain that occurs ear- lier during exercise and lasts longer after its termination or chronic with persistent pain throughout training or walking. The diagnosis requires a high index of suspicion and can be confirmed by imaging exams, emphasizing the MRI as the most sensitive examination and with the ability to identify the first bone changes, namely the bone marrow edema and the periosteum reac- tion. The prevention of these lesions should include an individualized training regimen for the athlete, with appropriate loads and inten- sity, use of sports equipment and training surface appropriate to the activity to be performed, healthy diet with foods rich in calcium and vitamin D and the knowledge of the most ͍ѥѽ)ͥѕ́ѥՔɅɔхѼ)չЁѡЁٽٕݥѠѡ)ѥɽɥє)ɕٕѥɽɅ̸)ɄɥM̈́)1̸ɥи) Ʉ)Iѥٔɝ䁥)M̀IL)QqQɥѡѡєq݅)Յ䁑܁)ɥ Ḿ5( M4́ɕՕЁ幑ɽȴ)ѡѕ̰ݡ)́ѡɕ͕ѥ)ͽɑ̰ɡѕ)ɽ̸ͥ%ܰѡ M4ɕ)ѡ́ЁɑȁѼՑѡɕ)ѕɕѕ聕ɝ)م䀡Յչѥ)ѠQЁ)́ɽՍЁ́ѡɝ)مȁͥ)չѥ̰ѕȁՉɅѥɽ)ѡɝЁɥͥ)Ʌɽѡɝ䁽х)ѡɽ՝х%Ё́ͥɕѡ)ѡɔ́ݕѡ̴)ѥѡɝиQ)ɕɕ͕́ѡɹѽѡ)х͕Օ́ͽѕ)ݥѠѡqѡїéɥtAȴ)ѥձɱ䁥́ݡɔѡѡє)́Ѽѥձȁѕ䁽)ݕЁȁݡ䁍ͥѥ)́хЁѥѡȴ)ɵѡѥɝ䁅م)%Ё́ѕѥ%аѡ)%ѕɹѥ= ѕ)ѡЁIѥٔɝ)%M̀ILͥ)ѡͥѡѕ̀)䁙ɕɥѡɽ)́ձѤɝ幑ɽѡ)̰ȁᅵѡх)Ʌєѡչ)չѥ̰ѡɽѕѡͥ́)ѡѡїéɑم͍Դ)ȁѠѥ䰁ѡIL)ɕՍ́ѡəɵѡѥ)́ɕͥхɕ͕ɥͬ)䰁ݽ͔əɵ)Ʌѥѥ)Ёɑѥɉ)ɕ͕ѡїé͍ձ)ɕѠQɕɔͥ饹ѡ)ѥѥѡѡєЁɥͬ)ILѡձѥ͍䁵)ѽɥՑѡɥ)а͕́ѥɑȁѼѥ)ѡəɵɕՍѡɥͬ)䁅Ё́ѥ̸