Asian Journal of Sports Medicine
Volume:6 Issue: 2, Jun 2015

Context: Low Back Pain (LBP) in athletes is common and has a broad spectrum of differential diagnoses that must be taken in to account when a clinician approaches the patient with LBP. The physicians should take into account spinal and extra spinal causes of low back pain in athletes.Evidence Acquistion: A literature review was performed for the years 1951 through 2013. Keywords used were Low Back Pain and Athletes. We searched MEDLINE, EMBASE, OVID, PUBMED, the Cochrane Library, ELSEVIER, and the references of reviewed articles, for English-language of Low Back Pain in Athletes. The two most common causes of LBP arising from spine in athletes are degenerative disc disease and spondylolysis with or without listhesis. Although most athletes, respond well to conservative treatment, surgical treatment is indicated when conservative treatment failes. The major concern in athletes with LBP is return to play and previous level of their activity after treatment. There is insufficient evidence regarding this issue in literature to define the optimal time of return to play following treatment

Context: There is an increasing interest to detect how exercise affects depression symptoms. Although recent findings confirm the positive effect of exercise on depression, there is no clear guideline regarding advice on exercise for patients with depression. The following review aims at presenting the contemporary literature regarding the nature of depression, exercise, the underlying mechanisms and the management of an exercise program in individuals with depression.Evidence Acquisition: We searched electronic databases including Cochrane Library, PubMed, ISI web of knowledge and PsychInfo (from January 2000 to October 2014). We reviewed the systematic reviews, meta-analyses, and large-scale randomized control trials on effects of exercise on depression. Recent evidence has emerged on characteristics of effective exercise programs and those patients with depression that will most benefit from the exercise programs. However due to the methodological weaknesses and inconsistencies of studies, conclusions must be made with caution. We have provided a number of recommendations for clinicians and researchers who plan to use exercise protocols in depression.

Some authors suggest that single joint (SJ) exercises promote greater muscle hypertrophy because they are easier to be learned and therefore have less reliance on neural factors. On the other hand, some authors recommend an emphasis on multi-joint (MJ) exercises for maximizing muscle strength, assuming that MJ exercises are more effective than SJ exercises because they enable a greater magnitude of weight to be lifted. The present study aimed to compare the effects of MJ vs. SJ exercises on muscle size and strength gains in untrained young men.Patients and Twenty-nine young men, without prior resistance training experience, were randomly divided into two groups. One group performed (n = 14) only MJ exercises involving the elbow flexors (lat. pull downs), while the other (n = 15) trained the elbow flexors muscles using only SJ exercises (biceps curls). Both groups trained twice a week for a period of ten weeks. The volunteers were evaluated for peak torque of elbow flexors (PT) in an isokinetic dynamometer and for muscle thickness (MT) by ultrasonography. There were significant increases in MT of 6.10% and 5.83% for MJ and SJ, respectively; and there were also significant increases in PT for MJ (10.40%) and SJ (11.87%). However, the results showed no difference between groups pre or post training for MT or PT. In conclusion, the results of the present study suggest that MJ and SJ exercises are equally effective for promoting increases in upper body muscle strength and size in untrained men. Therefore, the selection between SJ and MJ exercises should be based on individual and practical aspects, such as, equipment availability, movement specificity, individual preferences and time commitment.

Medial Tibial Stress Syndrome (MTSS) is common among military recruits and to our knowledge; the factors that might put the military recruits at higher risk of incidence of MTSS are not well known. This study was done to investigate the association between some anthropometric and anatomical factors and the prevalence of MTSS among military recruits.Patients and One hundred and eighty one randomly selected military recruits were included in this cross sectional study. Using history taking and physical examinations they were tested for MTSS. Accordingly the subjects were assigned to the case (those with MTSS) and control groups (normal healthy subjects). Using standard guidelines, the anthropometric and anatomical criteria of the subjects were measured. The correlation between the measurements and the prevalence of MTSS was tested using statistical analysis. Data of all the 181 subjects with the mean age of 30.7 ± 4.68 years were Included in the final analysis. The prevalence of MTSS was found to be 16.6% (30 people). Internal and external rotation range of motion, iliospinale height, the score of navicular drop test, and the trochanteric tibial lateral length were significantly different between healthy subjects and patients with MTSS (P < 0.05). The prevalence of MTSS was relatively lower in this study comparing to other studies on military personnel. It was not probably due to type of military shoes or exercise area surface (none of them were standardized); it could be due to low intensity trainings and the long intervals between training sessions.

Karate is a public sport that has athletes in various age ranges and abundant active sport clubs in Iran. The pattern of injury in this sport in Iranian athletes seems different from other countries. This study was performed with the purpose of considering the incidence and type of injury of karate athletes aged below 30 years from Tehran, Iran clubs. In a cross-sectional study, 10 karate clubs were selected in Tehran. Clubs were selected based on a cluster method from 5 different geographical regions of Tehran. All injuries were collected based on athletes’ or clubs’ weekly report with a designed questionnaire. The injuries were classified according to: low, medium and severe injury. Collected data was analyzed with SPSS software version 17. 620 athletes were studied totally and incidence rate of injury per athletes was 16.1% and 20.2 per 100 athletes. Ninety percent of injuries were during bout practice, 6% during fitness and 4% during kata. The rate of injury was more common in athletes with weight less than 70 kg and lower sport experience (P ≤ 0.05). The commonest locations for injury were head and neck followed by trunk, lower and upper limb, respectively. Just 2 cases needed surgical intervention and no one led to decreased level of consciousness. The most common type of injury was contusion, bruise and superficial scratch (64%). Severe injury was uncommon in this study and similar to other Iranian studies head and neck had the most injuries. Athletes with lower experience and lower weight were associated with higher injuries.

The best time of exercise along the day for weight management in overweight and obese patients is not determined. The time of exercise may influence its effect on appetite and food intake. The aim of this study was to compare the effects of two different times of exercise during the day on appetite, energy intake, and the rating of perceived exertion (RPE) on overweight women.Patients and Fifty overweight female subjects were recruited in this interventional study. Two sessions of exercise were performed in the morning and afternoon with the target heart rate corresponding to the ventilatory threshold (VT). The appetite was evaluated with visual analogue scale, the energy intake was measured with 24 hours food record and the RPE was determined by visual Borg scale; these variables were compared between the two sessions. The behavior of appetite in relation to hunger, satiety, fullness, prospective food consumption, tendency to salty, savoury, sweet and fatty foods, did not change significantly after both exercise sessions (P > 0.05). Except for the satiety, no significant difference was found among changes in the appetite scores between the two exercise sessions. The median change in the satiety score of the morning exercise was significantly higher than that of the afternoon exercise (5.5 (-8.5, 22.5) vs. -1 (-8, 4.5) respectively, P = 0.01). The median RPE value did not differ significantly between the morning and afternoon sessions (13 (12, 14) vs. 13 (12, 13) respectively, P = 0.46). There was no significant association between the time of exercise and the estimates of the carbohydrate (P = 0.41), fat (P = 0.23), protein (P = 0.13), and calorie intake (P = 0.18). One session of moderate intensity exercise disregarding the time of exercise did not affect appetite significantly. However, morning exercise may cause greater levels of satiety in comparison with afternoon exercise. Moderate intensity aerobic exercise did not alter the patterns of energy intake 24 hours following morning or afternoon exercise.

Nowadays, doping is an intricate dilemma. Football is the nationally popular sport in Iran. On the other hand, doping is a serious health hazard sport faces today. Studies dealing with athletes’ knowledge, attitudes and behavior concerning doping in football are scarce. Therefore, we aimed to investigate the knowledge and attitudes toward doping among the football coaches and players.Patients and In a cross sectional study, 375 participants (239 football players and 136 coaches) were studied. A specially made questionnaire was applied. In this study, football teams of different provinces of the country were selected by randomized clustered sampling and questionnaires were distributed among coaches and players. Knowledge of football coaches and players in three categories of doping definitions, recognition of prohibited drugs and side effects of anabolic steroids was poor or moderate in 45.3%, 88.5% and 96.5%, respectively. Football players and coaches have poor knowledge about doping in Iran. Moreover, they believe in some inappropriate myths without any scientific or rational basis.It seems necessary to design a comprehensive educational program for all of the athletes and coaches in Iran.

Carotid Intima Media Thickness (IMT) is currently used to assess the relationship between progression of coronary and systemic atherosclerosis. To date, however, the possible impact of regular physical activity (PA) on this parameter has not been well estimated. Our study aims to examine this aspect especially in the absence of cardiovascular (CV) risk factors. Patients and 100 master athletes (MA) and 51 sedentary controls (SC) were enrolled. They were evaluated by echo test with dedicated software (QIMT-Esaote) for IMT, and Bruce protocol and 2D echocardiography for cardiac hemodynamic parameters. All values were within normal range. Left IMT mean values were significantly higher than right IMT values in both MA and SC groups (MA: IMT left 635 ± 104 µ, IMT right 614 ± 104 µ and mean IMT 624 ± 91.9 µ; SC: IMT left 633 ± 78 µ, IMT right 622 ± 90 µ and mean IMT 627 ± 78.1 µ). A positive relationship was found in both groups between IMT mean values and age (P < 0.01) and between IMT mean values and peak systolic blood pressure (MA: 0.28 R, P < 0.01; SC: 0.32 R, P < 0.05). At rest, only in MA was a significant relationship evident, between mean arterial pressure value and IMT (P < 0.01). In the absence of CV risk factors, only age is associated with a slight increase of wall carotid thickening. The data are indicative of a physiological increase in IMT, as a consequence of increased peak effort systolic pressure after regular PA in athletes..

According to anecdotal findings, some wrestling coaches and wrestlers believe that cauliflower ear might lead to hearing loss. Our preliminary study showed that the prevalence of hearing loss reported by the wrestlers with cauliflower ear is significantly higher than this rate among wrestlers without cauliflower ear. To the best of our knowledge, no other study has confirmed this finding employing hearing tests. To evaluate and to compare the prevalence of hearing loss among wrestlers with and without cauliflower ears employing hearing tests.Patients and The subjects were randomly selected form 14 wrestling clubs in Tehran. Subjects were 201 wrestlers with cauliflower ears (100 wrestlers with one cauliflower ear and 101 wrestlers with two cauliflower ears) and 139 wrestlers without cauliflower ears. All the participants in this study were interviewed to collect information on demographic factors and medical history of risk factors and diseases related to hearing loss. The subjects in both groups underwent otoscopic and audiologic examinations. Audiometric examination results at the frequency range of 0.5 - 8 KHz showed that the prevalence of hearing loss among cauliflower ears was higher than this rate among non-cauliflower ears. Also, the percentage of positive history of ear infections among cauliflower ears (8.4%) was about two times more than this finding among non-cauliflower ears (4.9%). This difference tended to be significant (OR: 1.86, P = 0.06, 95% CI: 0.98 - 3.53). To the best of our knowledge, this is the first study showing that the prevalence of hearing loss among cauliflower ears is higher than this rate among non-cauliflower ears confirmed by audiological tests. This emphasizes that, more preventive measures such as mandatory ear gear for wrestlers are required.

The previous investigations in diurnal variation of endurance sports performance did not reach a consensus and have been limited. This study would be a valuable resource for endurance sports trainers and event managers to plan their training and competition in a specific time of day. The aim of this study is to find out the diurnal variation in cardiovascular endurance performance in the young athletes. Thirty five athlete students (15.17 ± 1.62 years) participated in this study. Maximal oxygen uptake (VO2max), post-exercise percentage of maximal heart rate (MHR% post-ex), post-exercise body temperature (BTemppost-ex), and post exercise blood lactic acid level (LApost-ex) were measured in this study. Three non-consecutive testings: A) Morning (09:00-10:00; AM), B) Noon (12:00-13:00; NN) and C) Afternoon (16:00-17:00; PM) were conducted. Participants were required to follow the meal plan and resting schedule for all testing days. VO2max was significantly higher at NN (F2. 68 = 3.29, P < 0.05, η2 = 0.088) in comparison with PM. The MHR%post-ex, BTemppost-ex, LApost-ex was not significantly different among three times of day. Diurnal effect on endurance performance was found and the highest exercise VO2max was identified at noon. Secondary school students or young athletes are recommended to have sports training related to VO2max at noon for the purpose of maximizing training effectiveness.

Muscle weakness and fatigue contribute to the reduction of daily activity in multiple sclerosis (MS) patients. Therapeutic strategies to promote improvements in muscle strength and endurance are limited in individuals with MS. Some evidence showed that exercise may improve and affect different aspects of the disease including quality of life, fatigue, motor and cognitive functions. To investigate the value of resistance training of moderate to high intensity on motor function, muscle strength, balance and perceived disability in male patients with multiple sclerosis compared to a control group. Patients and 20 male patients with MS (mean ± SD, age: 34.05 ± 7.8 y; Expanded Disability Status Scale (EDSS): 2.94 ± 1.5) were recruited and randomized either to the exercise (E) or control group (C). Group E participated in a three-time weekly individualized progressive resistance-training program (both upper and lower extremities) for eight weeks, while group C was advised not to change their physical activity habits. All initial measures (including EDSS, balance, muscle strength, and functional mobility) were re-evaluated at the end of the program. Two patients of group E left the program. The other eight subjects completed the program with no MS-related exacerbations/complications. There was a significant change in 2 of 3 aspects of ambulatory function [Three minutes step test (P = 0.001), Timed Up and Go test (P = 0.009)], muscle strength (P = 0.000), and EDSS (P = 0.014). Comparing the two groups, we did not observe any significant change in “Balance” (P = 0.407). The resistance training of moderate to high intensity was well-tolerated in MS patients and may be an effective intervention for improving muscle strength, functional ability and EDSS-based disease severity.

Exercise induced bronchospasm (EIB) commonly occurs during exercise. The comparative effects of different sports on airway responsiveness among prepubertal boys remain to be determined. To assess differences in post exercise spirometry between footballers, judokas and a control group in prepubertal boys.Patients and A total of ninety six prepubertal boys were studied. Bronchial hyper responsiveness (BHR) to exercise challenge test was defined by a diagnosis of baseline spirometry, followed by an incremental exercise test. To date, the best test to confirm EIB may simply be standard pulmonary function testing before and after high-intensity exercise. A 10% or greater post-challenge fall in forced expiratory volume in FEV1 is used as a diagnostic criterion. There was no significant difference in baseline spirometry between all groups (P > 0.05). The post exercise spirometry test revealed the presence of EIB in 16 of 32 (50%) footballers against 9 out of 32 (28.12%) in both judokas and control subjects at 5 min after the exercise. Also, there was a significantly higher decrease (P < 0.05) in mean FEV1 at 5 minuts in footballers (-9.60 ± 6.18) compared to judokas (-5.41 ± 5.85). The footballers have more BHR than judokas, especially at 5min after the exercise. This may be due to prolonged hyperventilation, atopy and increased exposure to inhaled allergens and pollutants during training and competition.

High-intensity of exercise or unaccustomed eccentric exercise can cause the phenomenon of Exercise-Induced Muscle Damage (EIMD) which usually results in cramps, muscle strain, impaired muscle function and delayed-onset muscle soreness. This study investigated the prophylactic effects of sauna towards the symptoms associated with muscle damage from eccentric exercises of wrist extensor muscle group.Patients and A total of twenty-eight subjects (mean age 20.9 years old, SD = 1.6) were randomly divided into the sauna group (n = 14) and the control group (n = 14). In the sauna group, subjects received sauna before eccentric exercise of the wrist extensor. The eccentric exercises were conducted on the non-dominant arm by using an isokinetic dynamometer. Pain Intensity (PI), Pressure Pain Threshold (PPT) and passive range of motion of wrist flexion (PF-ROM) and extension (PE-ROM) were measured as pain variables. Grip Strength (GS) and Wrist Extension Strength (WES) were measured as variables of wrist extensor muscle function. All the measurements were performed at baseline, immediately after and from 1st to 8th days after the exercise-induced muscle damage. The sauna group significantly demonstrated a lower deficit in ROM (passive flexion and passive extension), GS and WES following exercise than that of the control group (P < 0.05). Sauna application prior to the exercise-induced muscle damage demonstrated effectiveness in reduction of sensory impairment (PF-ROM and PE-ROM) and improvement of muscle functions (GS, and WES) in wrist extensor muscle group.

High intensity intermittent aerobic exercise is an elementary endurance training exercise to build soccer endurance. Many studies exist with professional soccer players. But limited research has been conducted with amateur soccer players. The aim of this study was to compare and assess the effects of the shuttle-run method and the Hoff-track method on the ability to recover in amateur soccer players within three weeks.Patients and Two amateur soccer teams were randomly assigned to shuttle-run group (n = 24; SRG) (SRG: shuttle-run group) or Hoff-track group (n = 18; HTG) (HTG: hoff-track group). They performed 2 times/week over three weeks their program. SRG performed a 20 m high speed shuttle-run until exhaustion and HTG covered at their highest speed level an obstacle track. Before and after training the yo-yo intermittent recovery test level 2 (YYIRTL2) was conducted. Significant differences were observed within (P < 0.05) and between the groups (P = 0.06; ES = 0.50) in distance covering during YYIRTL2. Both training methods seem to improve the ability to recover in amateur soccer players within a short time period during the competition season.

Arterial dissections are important causes of stroke in the young population. Dissection has been reported in association with some sports. It seems that this report is among the first ones of the cervical arterial dissection in a young swimmer. A 30-year-old male professional swimmer with no history of any major disease suddenly complained of severe ataxia, moderate headache, neck pain, unilateral left facial weakness, and feelings of tingling and paresthesia on the left side of his body and face a few minutes following head and body stretching exercises in land. There was no history of major head or neck trauma, manipulation, and practicing diving skills in the past. Acute infarction of the left cerebellum was diagnosed after performing brain computed tomography and magnetic resonance imaging (with contrast) studies. Cervical magnetic resonance angiography confirmed left vertebral artery dissection as the cause of infarction. Important differential diagnoses of cervicocephalic arterial dissection include other vascular or neurological causes of head and neck pain and/or local neurological syndromes and other causes of brain ischemia such as cardiac emboli, atherosclerosis, and vasculopathy of brain vessels. It is important that sports medicine practitioners pay attention to this less-diagnosed cause of stroke in young athletes.