Eating disorder risks and awareness among female elite cyclists: an anonymous survey.

BACKGROUND: Eating disorders (EDs) are an increasingly recognized concern in professional sports. Previous studies suggests that both female gender and endurance sports put athletes at risk. Female elite cyclists are hence of specific interest. The present study aimed at evaluating the distribution of the individual risk of ED in this group. Further the association between individual risk and both the awareness for the topic ED and the deviation from "normal" weight was depicted. METHODS: Female cyclists registered with the Union Cycliste Internationale were contacted via email or facebook and asked to complete a survey comprising age, weight, the Eating-Attitude-Test (EAT-26), and questions regarding ED awareness. The observed distribution of the EAT-26 score was compared to results from previous studies in normal subjects and athletes. The distribution of the ED awareness was described and ED awareness was correlated with the EAT-26 score. Both the deviation from ideal weight and the body mass index (BMI) were correlated with the EAT-26 score. RESULTS: Of the 409 registered athletes 386 could be contacted, 122 completed the questionnaire. Age ranged from 20-44yrs, BMI from 17.0 to 24.6 kg/m2. In the EAT-26, 39 cyclists (32.0%) scored above 20 points indicating a potential benefit from clinical evaluation, 34 cyclists (27.9%) scored 10-19 points suggesting disordered eating. Sixteen athletes (13.2%) had been treated for an ED. About 70% of athletes had been pressured to lose weight. The mean EAT-26 score was above the average observed in normal female populations. It was also above the average observed in many female athlete populations, but lower than in other leanness focussed sports. More than 80%of athletes perceived elite cyclists at risk for developing ED. Increased ED awareness and deviation from the ideal weight were associated with higher EAT-26 scores, but not the body mass index. CONCLUSION: Female cyclists are at risk of developing ED and they are aware of this risk. To improve their health and well-being, increased efforts to support elite cyclists and their teams in preventive activities and early detection are crucial.

Effects and mechanisms of strength training in children.

It has been demonstrated that strength training can be organized in children in a safe and effective way. However, there is limited data regarding its impact on muscle hypertrophy. This study investigated the effects of a high-intensity strength training (HIS) on knee extensor/flexor strength, countermovement (CMJ) jumping height, postural control, soft lean mass and muscle cross-sectional area (CSA) of the dominant leg in prepubertal children. Thirty-two children participated in this study and were assigned to an intervention (INT; N=17) or a control class ( N=15). The INT participated in 10 weeks of weight-machine based HIS integrated in physical education. Pre/post tests included the measurements of peak torque of the knee extensors/flexors at 60 and 180°/s, CMJ jumping height, postural sway, soft lean mass of the leg by bioelectrical impedance analysis, and CSA (m. quadriceps) by magnetic resonance imaging. HIS resulted in significant increases in knee extensor/flexor peak torque (60°/s and 180°/s). HIS did not produce significant changes in CMJ jumping height, postural sway, soft lean mass, and CSA. Although HIS was effective at increasing peak torque of the knee extensors/flexors in children, it was unable to affect muscle size. It appears that neural factors rather than muscle hypertrophy account for the observed strength gains in children.

[Weber fibular ligament-plasty with plantar tendon with Segesser modification]. / Fibuläre Bandplastik mit Plantarissehne nach Weber modifiziert nach Segesser.

UNLABELLED: Ankle joint injuries are one of the most frequently diagnosed sports injuries. In our clinic we observed between 1981-92 18% ankle joint injuries in 11.350 patients. The acute injury was generally handled conservatively by functional treatment with a special shoe; only comminute injuries like fractures, luxations or tendon injuries would lead to the decision to perform surgery. The ratio of acutely performed surgery compared to late surgery was decreasing: 1981 1:3, compared to 1992 1:50. Reconstructive surgery of the lateral ligament complex is indicated under the following conditions: patient suffering from recurrent trauma and feeling of instability and/ or in case of comminuted overuse injuries caused by instability like the entrapment of the tibial nerve in the tarsal tunnel, achilodynia caused by instability of the rearfoot or luxation of the peroneal tendons. Reconstruction of the lateral ligaments of the ankle should be done anatomically, operations with effect of tenodesis should be avoided. TECHNIQUE: We modified the technique of Weber to reconstruct the lateral ligaments. An autograft (plantaris tendon) is used for this procedure. The plantaris tendon is removed through a medial sided minimal incision on the injured leg with a special stripper. Through the lateral incision on the lateral malleolus drill wholes are made at the anatomical ligament insertions of the calcaneus, talus and fibula. The graft is passed through the drill wholes this way the Lcf and Ltfa are anatomically reconstructed. The tendon sheat of the peroneal tendons will be closed if needed with residual plantaris tendon. The postoperative treatment is the same as conservative treatment with full-weight-bearing in a special shoe three days after surgery with 30 degrees (10-0-20) range of motion. ROM will be increased to 50 degrees after three weeks. For the first three weeks the leg will be positioned in a 90 degrees splint over night. Two series of patients altogether 584 patients in the time from 1981-1991 were operated. The difference of the two groups lied in the technique of surgery (in group 2 the calcaneofibular ligament was reconstructed as well as the peroneal tendon sheat) as well as the postoperative treatment was altered (group one removable cast for the first three weeks versus functional treatment after surgery in group 2 as described in the postop treatment). RESULTS: 443 (76%) out of 584 operated patients were followed at least one year after OP. Working ability: 19% (group 1)/25% (group 2) of the patients after two weeks, 31/42% after 2-4 weeks and 79/88% after 4-6 weeks. Full sports activity to previous sport 8/17% after 4-6 weeks, 26/38% after 6-8 weeks, 65/70% after 8-12 weeks. The group 2 achieved full sports activity and working ability on average two weeks before the patients of group one. Personal evaluation: 88/90% felt their ankle joint to be more stable postoperatively, 10/9% as stable as before and 2/1% described it as less stable. Clinical evaluation: The modified Benedetto score showed in 76/81% very good results, in 9/7% good and 13/8% bad results. In conclusion the described reconstruction of the fibular ligaments without damaging the active stabilizing muscles is a valid technique. The reconstruction of the calcaneofibular ligament improved the long term results of surgery. The functional postoperative rehabilitation (special shoe and night brace) does shorten the time for the patients working ability as well as the return to full sports activity. The long term results on the other hand appeared to be similar for both groups. The advantage of our technique using the plantaris tendon as a graft. The use of autograft material having the same tensile strength as the original ligaments anatomically reconstructed. Surgery with tenodesis effects should be abandoned. The good results occurring while performing late surgery leave the chance for primary conservative treatment of lateral ligament injuries.

[Lesions of the growth plate caused by sports stress]. / Störungen der Wachstumsfugen durch sportliche Uberbelastung.

Besides the positive physiological, psychological and social aspects, sports activities in adolescents bear the risk of injuries and overuse of the locomotor system. Previous examinations have shown that increased stress to the growth plates by sports activities, in relation to the intensity of strain during growth spurts, can influence normal growth. In female gymnasts, hormonal changes can decrease the growth speed and long-term growth. On the other hand, during more intensive phases of growth the column cartilage of the growth plate is the weakest part of the locomotor system because of the influence of somatotropin and low levels of testosterone. This can cause subchondral stress fractures in the growing cartilage that later on, if missed or not sufficiently treated, can cause osteochondrosis dissecans. The apophysis of tendons of big muscle groups can show loosening of the apophysis caused by increased muscle strength and acute or chronic microtrauma. Male adolescents show an incidence of lesions in the relation of 9:1 to female adolescents. The therapy for apophyseal lesions is generally nonoperative. Due to the persistent growth possibility, pseudotumors can occur, which can cause problems in differential diagnosis among skeletal tumors. Too high pressure, pushing and tearing forces can influence growth. Later examinations of previous high-level sportsmen and patients with coxarthrosis with and without a sports history show that blockage of the rotation of the foot during growth, for example caused by soccer shoes, can cause high pushing forces on the femoral epiphysis, which can lead to epiphyseolysis cap. fem. lenta and thereby to pre-arthritic deformities. This is overcorrection of the "physiological" epiphyseolysis, described by Morscher. Knowledge of the reduced strength of the growth plate indicates better adaptation of training and supervision of the adolescent high-level sportsman. A regular check-up of the growing athlete and a reduction in sports intensity during the growth spurts, prohibition of negative training parts and sometimes even prohibition of sports at all, if there is a lesion of the growth plate or hormonal disorders, are sometimes necessary to minimize late defects. In addition to this, a reduction of strain in some sports and, for example, prohibition of rotation-blocking soccer shoes in the adolescent soccer player is necessary.

[The Achilles tendon in sports]. / Die Achillessehne im Sport.

Achillodynia is a generic term for various types of ailments in the region of the Achilles tendon. For adequate therapy a specific diagnosis is absolutely necessary. Besides an accurate anamnesis and the right choice of terrain and shoes, as well as a clinical examination where one has to specifically keep an eye on muscular imbalance between the gastrocnemius and the soleus muscle and disorders of the ligamentous control of the calcaneus caused by fibular ligament instabilities, a procedure such as radiology, ultrasound, and MR imaging is inevitable. From the differential diagnosis point of view a distinction between peritendinitis, mechanically triggered bursitis (calcaneal and subachilles), bony alterations of the calcaneus (calcaneus spur, Haglund exostosis persistent nucleus of the apophysis, fatigue fracture, etc) and a partial or total rupture (a one-time occurrence or multiple occurrences) has to be made. Occasionally, entrapment of the ramus calcaneus of the sural nerve causes calcaneal pain. If clinically not confirmed, lumbar pain ought to be taken into consideration (discopathy, Bechterew disease, etc). Metabolic disorders (especially uric acid) and underlying rheumatic diseases must be excluded. The therapy of achillodynia includes local and peroral antiphlogistic medication as a concomitant measure. More important is the causal influence of etiological factors, i.e., the correction of muscular imbalance, ensuring control of the calcaneus through bandages and adjustment of sport shoes, changes in training buildup and exercise intensity, just to mention a few. If necessary, surgically splitting the peritendineum, sanitation of a partial rupture, bursectomy and removal of mechanically obstructive exostosis must be done.