Sports injury

الثلاثاء، 12 أبريل 2011

Delayed Onset Muscle Soreness (DOMS)

Delayed Onset Muscle Soreness (DOMS)

What are DOMS?
DOMS or delayed onset muscle soreness is a particular type of muscle soreness that sets in hours after exercise. The exercise is usually very hard or far more than the athlete would normally be accustomed to. In particular eccentric muscular contractions (where the muscle lengthens as it contracts) such as in hopping, bounding and other plyometric exercise, running downhill, squatting and the lowering phase when lifting weights, can cause DOMS.

DOMS usually occurs 12-48 hours post-exercise. Muscle aching and tightness are the most common symptoms, often resulting in a decreased range of motion. Any discomfort should start to ease within 3 days post-exercise and return to normal within a week. If your symptoms persist, it is definitely worth visiting your Doctor or a sports injury specialist to get it checked.

What causes DOMS / delayed onset muscle soreness?
DOMS is thought to be caused by microscopic muscle tears which occur when we exercise harder than usual. This is a normal process which is required for growth in muscle size and strength. However, if training is progressed too quickly excessive tearing can occur, which results in DOMS.
Also if you start a sport or exercise which your body is not accustomed to, DOMS can occur for the first few sessions. This is one of the reasons why training should start very lightly and progress gradually.

Treating DOMS
Time - allow the muscles to heal without over stressing them again - wait at least a week and until all symptoms have cleared before performing the same exercise again.
Massage may help reduce the effects.
Very light, preferably non weight bearing aerobic exercise and stretching may also be beneficial to improve the blood flow, warm the muscles and improve range of motion.
Hydrotherapy and spa baths my help reduce the effects of DOMS.
Alternating hot and cold baths - although there is no scientific proof that this is effective it is often used by professional athletes who believe it to be beneficial.
Preventing DOMS
The best way of treating DOMS, is by preventing it!
Always perform a warm-up prior to any high intensity exercise.
Always cool-down and stretch following exercise.
When starting a new activity, do little and often to allow your muscles to become accustomed to these new strains.
Whether you are a regular exerciser or a beginner, build-up gradually and allow your body time to recover in between sessions.
As a general rule, do not increase training intensity and duration by more than 10% per week!

Epilepsy

Epilepsy

Epilepsy is a neurological condition which affects the brain. Its most dominant and well known feature is the seizure (convulsions, or fit).

Epilepsy is relatively common, affecting approximately 2% of the population, with more than 75% of individuals being diagnosed in childhood or adolescence. Whilst between 10 and 30% of people may suffer a seizure at some point in their life, this does not result in a diagnosis of epilepsy. Diagnosis relies on the occurrence of two or more seizures, as well as the results of an Electro-Encephalogram (EEG). An MRI scan may also be used to provide images of the brain and blood tests taken to rule out other medical conditions.

What Causes Epilepsy?
Seizures occur due to an abnormal electrical discharge within the brain. Whilst this is clear, often the cause of an individuals epilepsy, is not known. In some cases it may be due to genetic or anatomical abnormalities, or even following surgery, a stroke or a head injury.

What Happens during a Seizure?
Most epileptic seizures are known as Tonic-Clonic seizures. These involve a period of muscle stiffness (tonic phase), followed by muscle twitching and involuntary movements (clonic phase). The individual may or may not loose consciousness during the seizure. Most seizures last no more than 30 seconds.

Afterwards, it is common for the individual to be confused, dreary and to have a headache.

What should I do if I see someone having a Seizure?
Observing a seizure can be unnerving, or even frightening, especially for children. But it is important to remember that seizures are rarely life-threatening and that the individual does not feel pain or even really remember it.

The most important things to do if you observe a seizure are to protect the individual from injury and to observe the patient so that you are able to give a good description of what happened if required by the patients Doctor.

During a seizure, involuntary muscular contractions and twitching/shaking are common. In some cases this can be quite extreme. It is important that the individual is protected from injuring themselves during the seizure. This can be done by placing something soft such as a pillow or blanket under the head and moving/padding any hard objects in the immediate vicinity.

Once the seizure has ended, the patient will start to breathe normally again and consciousness will slowly return, although they may feel very sleepy.

It is not usually necessary to call an ambulance, especially if seizures are frequent. Diagnosed epileptics usually carry an identity card or wear an i.d. bracelet. An ambulance may be required if:

It is their first seizure.
The seizure continues for 5 minutes or more.
They are injured during the seizure.
A second seizure occurs without them gaining consciousness inbetween.

How is Epilepsy Treated?
Epilepsy treatment usually involves a combination of medication and lifestyle adaptations.

Certain factors are known to increase the likelihood of seizures in epileptics, although what affects one person may not affect another. Common triggers include:

Alcohol
Drugs
Sleep deprivation
Stress
Illness
Skipping meals
Hormones (especially in women)
Flashing lights
Anti-Epileptic Drugs (AED's) are used in the majority of cases of epilepsy. AED's aim to prevent seizures by reducing the excitability of the brain. AED's are generally very effective with around 50% of epileptics on AED's being free of seizures. Around 30% may suffer occasional seizures. There are several different types of AED and if one does not control an individuals seizures, another one may.

Side-effects of AED's may include tiredness, lack of concentration and reduced co-ordination.

Epilepsy and Exercise
In general, exercise is recommended for those with epilepsy as in the majority of cases regular exercise helps to control seizures. Occasionally exercise may lead to an increase in seizures and so this should be monitored and each case treated accordingly.

There are some considerations when exercising with epilepsy, especially when seizures are frequent. Sports where any impairment in split-second neuromuscular timing could be dangerous (such as rock climbing, motor racing or sky diving) should not be undertaken. Other sports which could present a dangerous situation, were a seizure to occur, should be considered on an individual basis.

Fibromyalgia

Fibromyalgia

What is fibromyalgia?
Fibromyalgia is a widespread muscular pain and fatigue condition. Pain and tenderness is felt throughout the body, not just in one specific muscle or area. The word fibromyalgia means pain in the fibrous tissues in the body. The pain originates from the muscles, tendons and ligaments which are the connective tissues in the body. Fibromyalgia is often associated with chonic fatigue, decreased pain threshold and stress. It is much more common in women than it is in men affecting women 9 times more than men. It usually develops between the ages of 30 and 60 years old.

Symptoms of fibromyalgia
Widespread pain and tenderness throughout the body.
Fatigue
Poor sleep patterns.
Muscles may feel soft and doughy rather than tense and tight.
Myofacial trigger points are usually found in the muscles.
Patients complain they ache all over or feel they have pulled muscles or overworked them.
Poor muscle endurance.
Irritable bowel syndrome
Dysmenorrhea (cramps or painful menstruation)
Chronic headaches.
Causes of fibromyalgia
Although the exact cause of fibromyalgia is not known it is thought the following may be factors:

Infection (viral or bacterial)
Car accident or trauma
Rheumatoid arthritis
Lupus (an autoimmune disease - like a self-allergy where the body attacks its own cells and tissues) or hypothyroidism.
Changes in weather (or air pressure), cold or draughty environments, hormonal fluctuations (premenstrual and menopausal states), stress, depression, anxiety and over-exertion can make symptoms worse.

Treatment of fibromyalgia
Drugs that improve the patients ability to sleep may be prescribed although sleeping pills themselves are often avoided as long term dependance can occur. Medicines that boost the body's level of serotonin and noradrenalin can help sleep, pain and immune system function are commonly prescribed.
Acupuncture, acupressure, nutrition, relaxation techniques, osteopathic manipulation, chiropractic care, therapeutic massage and hydrotherapy are also common treatments for fibromyalgia.
Exercise programmes can also be effective forms of treatment.
Cognitive therapy or psychotherapy is also a treatment option.

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Depression

Depression

Depression is an illness which results in feelings of extreme sadness that interfere with your daily life. Often the terms clinical depression and depressive illness are also used to describe depression.

Depression is a common condition with up to 15% of the population suffering from a bout of depression at some point in their lives. This figure is however just an estimate as many people do not seek help for depression. Women are twice as likely to suffer with depression as men, although men are less likely to visit their doctor about feelings of depression.

Once you have suffered with depression once, you are more likely to have further episodes in the future. Also if depression runs in your family, you are more at risk of becoming depressed yourself.

Symptoms of Depression
There are many varying signs of depression, which can be psychological, physical or social and interfere with your daily life to some extent.

Psychological symptoms

Low self-esteem
Continued feelings of sadness
Irritability
Feelings of hopelessness
Teariness
Indecisiveness
Feelings of guilt
Lack of motivation
Anxiety
Loss of sex drive
Suicidal thoughts.
Physical symptoms

Lack of energy
Unexplained aches and pains
Disturbed sleep patterns
Changes to the menstrual cycle (in women)
Slow speech and movement
Changes in appetite (usually lowers)
Sudden weight loss (or occasionally gain).
Constipation.
Social symptoms

Difficulties in home and family life
Poor performance at work
Avoidance of social activities
Reduced interest in usual hobbies/pastimes.
Causes of Depression
Depression can occur for many reasons. Most commonly it occurs as a reaction to a life event, such as a death, divorce, illness, redundancy or money issues. Depression can also be linked to hormone levels and so is common in women during pregnancy, miscarriage, childbirth and the menopause.

As already mentioned, depression can be hereditary. Studies have shown that a certain type of gene can be passed from parent to child which affects the levels of the chemical serotonin in the brain. This is a mood altering chemical which is thought to be lower in concentration in those who are more at risk of suffering depression.

Other risk factors include the excessive use of alcohol or recreational drugs, as well as the continued use of certain prescribed medications.

Diagnosis and Treatment
Diagnosis

There are no specific tests which can be carried out to diagnose depression and so this is done via a thorough consultation where the Doctor conducts a detailed interview regarding the patients symptoms, emotions and life patterns or changes. The Doctor may also take blood or urine samples for testing, to rule out any conditions which can cause similar symptoms, such as an under active thyroid.

Treatment

Treatment of depression usually combines both medication, therapy and self-help although will vary depending on the severity of the condition and the length of time it has been a problem.

Mild or short-lived cases may not initially be prescribed antidepressant medication. Instead the patient my be monitored over a few weeks and may also be recommended to try:

Self-help books
Talking to someone, whether it be a friend, family member of professional counsellor.
Exercise - this has been shown to improve spirits in many cases.
In more severe cases then antidepressant medications are usually prescribed, again in combination with counselling or cognitive behavioral therapy.

Medications for Depression

There are several forms of antidepressants which are available and what works well for one person may not for another. They may also result in mild to moderate side-effects.

Antidepressants take 2 to 4 weeks from when they are first taken to start having an effect. Initially you should be seen every one to two weeks by either your Doctor or a nurse to make sure that everything is ok with the medication. They can then administer any changes in medication or dose.

If working, then the medication should be taken continually whilst symptoms persist and then for up to 6 months after all symptoms have gone. In persistent cases of depression, the patient may be kept on the treatment indefinitely.

The most commonly prescribed form of antidepressants are SSRI's (selective serotonin reuptake inhibitor). These are used initially in most cases of moderate to severe depression. They work by increasing the level of serotonin and other neurotransmitters in the brain. Side effects can include headaches, sleep disturbances, nausea and anxiety, although these usually improve in time.

Diabetes

Diabetes

Diabetes (also called diabetes mellitus) is a relatively common condition which affects the levels of sugar within the blood. Up to 2.6 million people in the UK have diabetes, with half a million estimated to be unaware of their condition.

Insulin is a hormone which is released by the pancreas and acts to regulate blood sugar levels by helping it move into the body's cells, where it is used to produce energy. If insulin is not doing this job, then the glucose stays in the blood.

Two types of Diabetes:
Type 1:
This form of diabetes occurs before the age of 40 and most commonly in children. It occurs because the insulin producing cells have been destroyed and so the body cannot produce insulin to control blood sugar levels. This form of diabetes is controlled using injections of insulin (or sometimes with a pump), controlling the diet and regular exercise. It is often also known as insulin dependent diabetes. Approximately 15% of people with diabetes in the UK, have type 1 diabetes.

Type 2:
Type 2 diabetes occurs usually past the age of 40, when the amount of insulin produced decreases, or doesn't work effectively. It is sometimes known as non-insulin dependent diabetes, or adult-onset diabetes. Unfortunately, the prevalence of type 2 diabetes in younger people is increasing, due to a rise in people who are overweight. Type 2 diabetes is often controlled with a healthy diet and exercise, although in more severe cases, medication may be required. Approximately 85% of people with diabetes in the UK, have type 2 diabetes.

Symptoms of undiagnosed diabetes
Here is a list of symptoms which may indicate a case of diabetes:

Extreme thirst
Increased desire to pass urine
Unexplained weight loss
Extreme tiredness
Burred vision
Slow healing
Repeated cases of thrush
Complications of Diabetes
Short-term
Hypoglycaemia
A 'hypo' occurs when the blood sugar levels drop too low. This may occur if too much insulin is injected, meals or snacks are missed, alcohol is consumed without food, or following exercise. When at risk of a hypo, the sufferer will usually experience some warning signs which should prompt them to correct the problem. These include shaking, tingling lips, pounding heart, dizziness, confusion, going pale and sweating. When a hypo occurs, the individual should consume a fast acting high-carbohydrate drink or sugar tablets, followed as soon as possible by a long-acting carb snack such as a cereal bar, piece of fruit or a sandwich. If left untreated, the individual would eventually loose consciousness.

Ketoacidosis
If insulin levels are too low, insulin is not moved into the body's cells to make energy. To make up for this, the body starts using fat as an energy source, which produces an acidic by product known as ketones. These Ketones are extremely harmful and so the body attempts to excrete them in the urine. When ketones are present and blood glucose levels are rising (due to low insulin levels), the person becomes more and more thirsty as the body attempts to flush out the ketones. If not removed, ketoacidosis develops - which means increased acidity of the blood due to the presence of ketones. Nausea and vomiting usually then occur which only increase dehydration and so worsen the problem. Other symptoms include blurry sight and deep and rapid breathing.

A combination of the ketoacidosis and high blood glucose levels can lead to the individual falling into a coma, which could be fatal. If ketoacidosis is suspected, call a doctor immediately.

Long term

Cardiovascular disease
Retinopathy
Kidney disease
Mastopathy - hard lumps in the breasts
Skin and nerve conditions
Carpal tunnel syndrome
Frozen shoulder
Dupuytren's contracture
Tenosynovitis

Diabetes and exercise
People with diabetes are encouraged to exercise regularly to help control blood sugar levels and improve insulin sensitivity, as well as to maintain a healthy weight and reduce the risk of cardiovascular conditions. Muscles which are working hard require more energy and so more glucose is drawn from the blood, helping to maintain a more constant level.

Some safety considerations must be made before someone with diabetes exercises:

Enough carbohydrate has been taken prior to exercise, to provide the muscles with the required energy and prevent a 'hypo'.
Excess insulin has not been administered, as this reduces blood glucose levels, as does exercise. This could lead to ketoacidosis.
Always carry a fast acting source of carbohydrate such as glucose tablets or a sugary drink.
Drink plenty of fluid throughout.
Diabetics should not exercise if:

Blood sugar levels are above 300 mg/dl
If you are ill or recovering from illness

Delayed Onset Muscle Soreness (DOMS)

Chronic Fatigue

Chronic Fatigue

A certain degree of fatigue is normal in an athlete training hard for their sport or event. However, excessive and persistent fatigue and feelings of legarthy with a reduced sporting performance, often indicate a more serious problem.

There are many possible causes of chronic fatigue and in order to narrow down the possibilities the coach or sports medicine practitioner must ask the right questions:

Is there a constant feeling of fatigue, or does this occur before or after training/competition, at a particular venue (may suggest an allergy) or in warm weather (possible dehydration)
Does the patient fall asleep during the day?
How long has this tiredness been present? (try to establish if it first occurred after a competition, trip abroad or illness etc)
Are there any associated symptoms? (sore throat or a cold may indicate upper respiratory tract infection)
Are there any respiratory symptoms (such as a post-exercise cough or chest tightness) which may indicate exercise induced asthma or lower respiratory tract infection?

Causes of fatigue
As already mentioned there are endless causes of persistent fatigue. Some of the most common are listed here:

Overtraining syndrome
Viral illness
Inadequate diet low in carbohydrate or protein intake
Depletion of iron stores (Anaemia)
Chronic fatigue syndrome
Other conditions to look out for:

Dehydration
Exercise-induced asthma
Allergies
Jet lag
Psychological stress
Medication
Hypothyroidism
Diabetes
Pregnancy
Eating disorders
Infections
Neuromuscular disorders
If the answer to the problem is not immediately apparent, as it is not with so many of these cases, investigations should be undertaken to get to the bottom of the problem

Medical examination
In case the current fatigue problem is due to an undiagnosed medical condition, a thorough medical examination should be performed. This should include a complete medical history and subjective assessment of the current condition (including gastrointestinal, neuromuscular and menstrual (in females) symptoms).

An examination should include resting heart rate and blood pressure as standard, along with any other examinations the clinician feels may be beneficial.

Further investigations and tests may be necessary and can include:

Urine tests (to test glucose and protein levels)
Blood tests (haemoglobin, white cell count, urea, electrolytes, Vitamin B12, thyroid function)
Chest x-rays/Electrocardiogram (ECG)
Lung spirometry
Training diary
Keeping a diary of the training performed each day, along with the symptoms and feelings of fatigue can be a key diagnostic aid. This can help to see if the athlete gets enough rest and if there has been a recent change in training methods, intensity or volume. The amount of sleep and rest should be recorded each day, as should social events and other commitments.

Nutrition diary
A nutrition diary should also be recorded daily and should include everything consumed, including supplements, drinks and alcohol. This can help determine if the athlete eats enough in general, consumes adequate volumes of carbohydrate and protein to support their training or has any allergies or intolerance's.

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