Living, training and playing in the heat: challenges to the football player and strategies for coping with environmental extremes.

Dehydration and hyperthermia both, if sufficiently severe, will impair exercise performance. Dehydration can also impair performance of tasks requiring cognition and skill. Body temperature may exceed 40 °C in competitive games played in hot weather, but limited data are available. Football played in the heat, therefore, poses a challenge, and effects on some aspects of performance become apparent as environmental temperature increases above about 12-15 °C. Prior acclimatization will reduce the impact of high environmental temperatures but provides limited protection when humidity is also high. Ingestion of fluids is effective in limiting the detrimental effects on performance: drinks with added carbohydrate and electrolytes are generally more effective than plain water and drinks may be more effective if taken cold than if taken at ambient temperature. Pre-exercise lowering of body temperature may aid some aspects of performance, but the efficacy has not been demonstrated in football.

Hydration and sweating responses to hot-weather football competition.

During a football match played in warm (34.3 ± 0.6 °C), humid (64 ± 2% rh) conditions, 22 male players had their pre-match hydration status, body mass change, sweat loss and drinking behavior assessed. Pre-match urine specific gravity (1.012 ± 0.006) suggested that all but three players commenced the match euhydrated. Players lost 3.1 ± 0.6 L of sweat and 45 ± 9 mmol of sodium during the 90-min match and replaced 55 ± 19% of their sweat losses and hence by the end of the game were 2.2 ± 0.9% lighter. The water volume consumed during the game was highly variable (1653 ± 487 mL; 741-2387 mL) but there was a stronger relationship between the estimated pre-game hydration status and water volume consumed, than between sweat rate and water volume consumed. In a second match, with the same players 2 weeks later in 34.4 ± 0.6 °C, 65 ± 3% rh, 11 players had a sports drink available to them before and during the match in addition to water. Total drink volume consumed during the match was the same, but approximately half the volume was consumed as sports drink. The results indicate that substantial sweat water and electrolyte losses can occur during match play in hot conditions and a substantial water and sodium deficit can occur in many players even when water or sports drink is freely available.

The effects of exercise, heat, cooling and rehydration strategies on cognitive function in football players.

We investigated the cognitive effects of exercising in the heat on the field players of two football teams in a series of three matches. Different rehydration and cooling strategies were used for one of the teams during the last two games. Cognitive functions were measured before, during and immediately after each football match, as well as core temperature, body mass, plasma osmolality and glucose levels, allowing an estimate of their differential impacts on cognition. The pattern of results suggests that mild-moderate dehydration during exercise in the heat (up to 2.5%) has no clear effect on cognitive function. Instead, plasma glucose and core temperature changes appear to be the main determinants: higher glucose was related to faster and less accurate performance, whereas core temperature rises had the opposite effect. The 50% correlation between plasma glucose and core temperatures observed during exercise in the heat may help to stabilize cognitive performance via their opposing effects. The glucose-like effects of sports drinks appear to be mediated by increased plasma glucose levels, because drinks effects became non-significant when plasma glucose levels were added to the models. The cooling intervention had only a beneficial effect on complex visuo-motor speed.

Effect of hot environmental conditions on physical activity patterns and temperature response of football players.

Heat stress may contribute to decreased match performance when football is played in extreme heat. This study evaluated activity patterns and thermal responses of players during soccer matches played in different environmental conditions. Non-acclimatized soccer players (n=11, 20±2 years) played two matches in conditions of moderate heat (MH) and high heat (HH) index. Core temperature (T(c) ) and physical performance were measured using a telemetric sensor and a global positioning system, respectively. The average ambient temperature and relative humidity were MH 34±1 °C and 38±2%; HH 36±0 °C and 61±1%. Peak T(c) in the MH match was 39.1±0.4 °C and in the HH match it was 39.6±0.3 °C. The total distance covered in the first and second halves was 4386±367 and 4227±292 m for the MH match and 4301±487 and 3761±358 m for the HH match. Players covered more distance (P<0.001) in the first half of the HH match than in the second half. In football matches played at high environmental temperature and humidity, the physical performance of the players may decrease due to high thermal stress.

Tendon lengthening repair and early mobilization in treatment of neglected bilateral simultaneous traumatic rupture of the quadriceps tendon.

Bilateral simultaneous traumatic rupture of the quadriceps tendon is a rare injury that is most frequently seen in elderly patients with predisposing diseases such as gout, hyperparathyroidism and diabetes. Delay in diagnosis is not uncommon. One of the main problems in treatment is loss of motion, especially flexion, after surgical repair. We report a case that was diagnosed 5 months after the trauma and was treated by Scuderi's tendon lengthening technique. Range-of-motion exercises were started early without using the generally recommended 4-6 weeks of immobilization in plaster cylinder or knee brace. Five years of follow-up showed full range of motion in both knees with sound tendons. Stable fixation makes starting early motion and accelerated rehabilitation feasible and thus the most common complication, loss of motion, is prevented.

Arthroscopic fixation of intercondylar eminence fractures using a 4-portal technique.

PURPOSE: We report an easy-to-use 4-portal technique for arthroscopic treatment of intercondylar eminence fractures and compare results of 2 groups of cases, adolescents and adults, and 2 types of internal fixation, sutures and screws. TYPE OF STUDY: Surgical technique and retrospective study. METHODS: The study was carried on 2 groups of patients, adolescents and adults, with intercondylar eminence fractures who were treated arthroscopically. For internal fixation, sutures were used in 8 adolescents and screws were used in 13 adults. In the technique we describe, anteromedial superior and inferior, and anterolateral superior and inferior portals were used. RESULTS: The average follow-up period for the adolescents was 27.3 months (range, 11 to 57 months), and for the adults was 19.6 months (range, 7 to 71 months). We did not encounter any cases of nonunion. There were only 3 complications, 1 of arthrofibrosis resulting from a delay of rehabilitation due to a vascular compromise and 2 cases of tenderness over the screw that responded well to its removal. Union occurred earlier in adolescents, but rehabilitation was easier in adults. CONCLUSIONS: Beside satisfactory results obtained by arthroscopic treatment of intercondylar eminence fractures, arthroscopy also provides the possibility to determine and treat associated pathologies. With the experience we gained, the procedure with the 4-portal technique in treating these fractures became much easier as a routine approach.

Arthroscopic resection of bucket-handle tears with the help of a suture punch: a simple technique to shorten operating time.

We describe a surgical technique that has been used successfully for excising bucket-handle tears. The technique is routinely used in our department and has been found to shorten operating time. A suture punch is used to pass the suture through the bucket-handle tear. Manually maneuvering the free suture ends, it is always possible to cut the posterior or anterior attachment of the tear under direct visualization without the need for an additional portal and without the risk of losing the excised fragment in the joint. In our experience, the technique is simple, inexpensive, and reliable, but more importantly, it has shortened operating time significantly.

Comparison of intraarticular bupivacaine with the addition of morphine or fentanyl for analgesia after arthroscopic surgery.

A randomized study on 30 patients undergoing knee arthroscopy was performed. Group I (n = 15) received 50 mg of 0.25% bupivacaine and 1 mg of morphine, and group II (n = 15) received 50 mg of 0.25% bupivacaine and 100 micrograms of fentanyl. The visual analogue scale was recorded at intervals of 1, 2, 3, 4, 6, 12, 24, and 48 hours after the operation. Supplementary analgesia requirements were also recorded. In group I, pain scores were lower than group II (P < .05) during the 1st, 2nd, 3rd, 12th, 24th, and 48th hours. The duration of analgesia on group I was significantly longer than group II. The combination of intraarticular morphine and bupivacaine has a longer analgesic duration and effect than a combination of fentanyl and bupivacaine.

Comparison of prilocaine and bupivacaine for post-arthroscopy analgesia: a placebo-controlled double-blind trial.

Arthroscopic surgery requires early postoperative analgesia for early discharge and early rehabilitation of patients. To accomplish the effectiveness of intraarticular application of local anesthetics, a placebo-controlled double-blind trial was performed. Results were evaluated using the visual analog scale on a blind basis. The mean pain scores were generally lower in the bupivacaine group than in the control or prilocaine group. There were no statistically significant differences between the oral intake of analgesics and the level of analgesia obtained in all three groups. We consider the local application of analgesics to be ineffective for post-arthroscopy analgesia.

The relationship between the treatment of congenital dislocation of the hip and avascular necrosis.

The most important complication following the treatment of congenital dislocation of the hip is avascular necrosis. The potential sequelae that may arise after the onset of avascular necrosis are worse than if the hip remained dislocated. We evaluated 38 hips in which avascular necrosis developed after reduction. The average patient age at the time of reduction was 4.3 years, with a follow up of 6 to 15 years. Twelve hips had closed reduction and 26 had open reduction. Following reduction, 8 hips had Type I, 6 had Type II, 9 had Type III, and 15 had Type IV avascular necrosis. In this article, we evaluate our cases and review current literature on the subject. Close follow up and timely interventions can reduce potential sequelae to a minimum.

Pott's disease and extrapleural anterior decompression. Results of 108 consecutive cases.

Between 1973 and 1988, 108 patients with a preoperative diagnosis of spinal tuberculosis were treated by anterior extirpation and interbody fusion at Ankara University Medical Faculty, Orthopedic Surgery and Traumatology Department. In 96 cases the operations were performed intrapleurally, as Hogston described. For 12 patients who had spinal involvement at lower thoracic and upper lumbar segments an extrapleural and extraperitoneal approach was used. The extrapleural approach is strongly recommended for patients who have compromised pulmonary reserve. When this approach is used adequate exposure can be obtained and postoperative rehabilitation of patients is facilitated. Advantages and disadvantages of the extrapleural approach and the results obtained from 108 patients are presented.