Exercise Physiology and Exercise Testing

1. Exercise Physiology and Exercise Testing REVIEW INCIDENCE OF INJURY AND DISEASE AMONG FORMERATHLETES STUDENT: TEACHER: Mladen Protić RNDr. Aleš Jakubec Ph.D

2. Introduction • It is well documented that cardiorespiratory exercise, as well as muscular strength and enduranceexercise, have a positive impact on a person’s health • However, there is a point of diminishing returns for these benefits, where overtraining and highintensityexercise may actually increase risk of traumatic injury, reduce health benefits, and impairimmunity due to the extreme stress put on the body • The purpose of this review was toexamine the incidence of injury in athletes in specific sports. • Acomprehensive review of literature led to 2 review articles and 68original research articles. • It examined impact of injuries on the following disease: Chronic diseases, osteoarthritis, hip injuries, knee injuries, upper-extremity injuries, ankle injuries, low-back spinal injuries, muscle and tendon injuries and fractures.

3. Chronic diseases • Chronic diseases such as heart disease, cancer, stroke, and diabetes are preventable through moderate physical activity, weight control and improved functioning of cardiovascular system. • Exercise at very high intensity increases the risk for musculoskeletal injuries and overtraining. • Prior research indicates endurance athletes seem to obtain more benefitsthan power athletes, but were also more likely to maintain activity. • Unless activity is maintained, priorparticipation in competitive athletics does not appear to be protective.

4. Chronic diseases

5. Osteoarthritis • Osteoarthritis is a disabling joint disorder characterized by pain, stiffness and degeneration of thejoints. • Osteoarthritis occurs prematurely in certain sports including: soccer, rugby, racket sports, track and field, long-distance running • Increased risk (prematurely) with joint injury and vigorous, high intensity training. • Power sports, repetitive and high impact sports (such as high-intensity long-distance running ) • Abnormal joint anatomy or alignment, previousjoint injury or surgery, joint instability, above-average body weight, disturbances of muscle innervationof a joint, or inadequate muscle strength seemed to increase risk of osteoarthritis. • Moderate, recreational activities does not increase the risk. • There is a little risk on a below elite level. • Activities well suited for patients with osteoarthritis: swimming, walking, stationary cycling and light weighttraining.

6. Hip injuries • Physical load from sport activities seems to be a risk factor for the development of severeosteoarthritis of the hip. • Women with high sports exposure and those with medium sports exposure had asignificantly higher risk of developing the disease • Former elite javelin throwers and high jumpers show degenerative changes. • There were nodifferences in passive hip rotation between former elite male long distance runners, soccer players,weight lifters, and shooters. • Hip rotation was lower in subjects with a high BMI than in those withlow BMI, suggesting obesity may be associated with hip disability. • Former elite male endurance athletes and track and field athletes had less hip disability, but more reported hip osteoarthritis.

7. Knee Injuries • Knee injury is the most common reason for permanent disability due to sports injury Osteoarthritis • Anterior cruciate ligament (ACL)/other knee injuries – linked to an increased risk • Team sport athletes, high BMI at the age of 20, kneeling or squatting work, soccer players, weight lifters – increased risk of developing premature knee osteoarthritis • Habitual physical activity was not associated with knee osteoarthritis in the recreational exerciser • Risk does not increase in below elite level or in recreational Jumper’s knee • 53% reported they had to quit their sport due to their pain (only 7% of controls) Replacement • Recreational exercises have a lower incidence of knee replacement than former athletes

8. Upper – extremity injuries • Although the number of lower-limb injuries is higher than upper-limb injuries in many sport, different upper extremity and shoulder injuries can also cause permanent disabilities. • Rotator cuff ruptures are common in throwers (baseball) and tennis players • Labrum tears in overhead throwing sports • Athletes who trained with throwing weights ofmore than 3 kg had a significantly higher risk of degenerative changes.

9. Ankle injuries • Long – term problem have been seen with ankle injuries such as ankle instability Osteoarthritis • Long – term and high intensity physical training is associated with premature development • Long-distance runners, especially the orienteers, showed significantly more radiological signs of degenerative ankle disease • Orienteers reportedsignificantly more functional instability of the ankle than track and field runners. • Elite volleyball- ruptures of the lateral ligaments, severe mechanical instability ,subchondral sclerosis, osteophytes can cause premature osteoarthritis

10. Low-back spinal injuries • Severe permanent disabilities due to spinal injuries are uncommon in sports • Competing insports may cause an increased number of anatomical changes in the spine, since it is exposedduring adolescence Osteophytes and radiological abnormalities • Abnormalities found in gymnastics, tennis, wrestling and soccer • Elite javelin throwers-radiological and clinicalsymptoms in the lumbar spine. • Shot putters, discusthrowers, and high jumpers- high prevalence ofosteophytes. Disc degeneration, convexing • Weight lifting- associated with degeneration throughout lumbar spine • Soccer- degeneration in the lower lumbar region • Convexing common in both

11. Muscle and tendon injuries Rupture or tear • Rupture or tear of pectoralis major and rectusfemoris lead to long-term, permanent problems. Achilles injuries • Most common injury to tendon in running sports. • Achilles overuse injury may cause future limitations. • Complete ruptures are found more often in athleteswho participate in sports involving explosiveacceleration or maximal effort.

12. Fractures Stress fractures • Female patients reported menstrual irregularities. • Runners with high weekly training mileage (117 kmaverage) were found to be at risk of recurrent stressfractures of the lower extremities. • Baseball pitchers with high loads may be susceptibleto repeat stress fractures. Low bone mass/osteoporosis risk • High training volumes at high intensities may have adetrimental effect on bone density (men or women). • Highest risk for amenorrheic athletes: bone losspresent regardless to it • Weight-bearing activity may not compensate forreduced estrogen levels. Malpositions/Immobility • Disability and joint degeneration. • Immobilization and disuse of injured extremity leadsto a rapid loss in local bone mass. • Fracture in lower extremity- more prominent loss ofbone than after an injury of upper extremity. • Substantial reductions in bone mass at adjacent sitesproximal and distal to fracture sites in extremities.

13. Conclusion • The majority of injuries in athletes appear to occur in the lower extremities (knee or ankle injuries) • Permanent disability resulted most often from knee injuries. • The risk of osteoarthritis after joint injury in athleticcompetition is high, according to each study analyzed. • Chronic diseaserisk is not decreased for athletes versus nonathletes, unless activity ismaintained throughout the lifespan. • This review may shed light into therisk carried in specific sports for injury. • It may serve as astarting place for future research into the risk of chronic disease inathletes with prior injuries. • Results confirm that moreresearch is needed in order to link injuries in early athletics with futurechronic disease risk.

14. Journal of Exercise Physiology Kelly Friery Department of Kynesiology/University of Louisiana at Monroe/Monroe,LA, USA Review Board: • Todd Astorino, Ph.D.Julien Baker, Ph.D.Tommy Boone, Ph.D.Lance Dalleck, Ph.D.Dan Drury, DPE.Hermann Engals, Ph.D.Eric Goulet, Ph.D.Robert Gotshall, Ph.D.Melissa Knight-Maloney,Ph.D.Len Kravitz, Ph.D.James Laskin, Ph.D.Derek Marks, Ph.D.Cristine Mermier, Ph.D.Daryl Parker, Ph.D.Robert Robergs, Ph.D.Brent Ruby, Ph.D.Jason Siegler, Ph.D.Greg Tardie, Ph.D.Chantal Vella, Ph.D.Lesley White, Ph.D.Ben Zhou, Ph.D.

15. Thank you for your attention