Association between hip joint impingement and lumbar disc disease in elite rowers.

OBJECTIVES: Lumbar disc disease is a known cause of back pain. Increasingly it is thought that cam morphology of the hip may have a causal role in development of lumbar disc disease. The aim of this study was to describe the morphology of the hip and investigate the association of cam morphology with lumbar disc disease observed on MRI in elite rowers. METHODS: Cross-sectional observational study of 20 elite rowers (12 male, 8 female, mean age 24.45, SD 2.1). Assessment included clinical examination, questionnaires, 3T MRI scans of the hips and lumbar spine. Alpha angle of the hips and Pfirrmann score of lumbar discs were measured. RESULTS: 85% of rowers had a cam morphology in at least one hip. Alpha angle was greatest at the 1 o'clock position ((bone 70.9 (SD 16.9), cartilage 71.4 (16.3)). 95% of the group were noted to have labral tears, but only 50% of the group had history of groin pain. 85% of rowers had at least one disc with a Pfirrmann score of 3 or more and 95% had a history of back pain. A positive correlation was observed between the alpha angle and radiological degenerative disc disease (correlation coefficient=3.13, p=0.012). A negative correlation was observed between hip joint internal rotation and radiological degenerative disc disease (correlation coefficient=-2.60, p=0.018). CONCLUSIONS: Rowers have a high prevalence of labral tears, cam morphology and lumbar disc disease. There is a possible association between cam morphology and radiological lumbar degenerative disc disease, however, further investigation is required.

Increased Oxidative Stress in Injured and Ill Elite International Olympic Rowers.

BACKGROUND: Identifying strategies that reduce the risk of illness and injury is an objective of sports science and medicine teams. No studies have examined the relationship between oxidative stress (OS) and illness or injury in international athletes undergoing periods of intensified training and competition. PURPOSE: The authors aimed to identify relationships between illness, injury, and OS. METHODS: A longitudinal, observational study of elite male rowers (n = 10) was conducted over 18 weeks, leading into World Championships. Following a recovery day and a 12-hour fast, hydroperoxides (free oxygen radicals test) and total antioxidant capacity (free oxygen radicals defense) were measured in venous blood, with the ratio calculated as the oxidative stress index (OSI). At all study time points, athletes were independently dichotomized as ill or not ill, injured or not injured. OS data were compared between groups using independent t tests. A Cox proportional hazard model was used to assess the association of OS with injury and illness while adjusting for age and body mass index. RESULTS: Free oxygen radicals defense was lower (P < .02) and OSI was higher (P < .001) with illness than without illness. Free oxygen radicals test and OSI were higher with injury than without injury (P < .001). A 0.5 mmol·L-1 increase in free oxygen radicals defense was associated with a 30.6% illness risk reduction (95% confidence interval, 7%-48%, P = .014), whereas 0.5 unit increase in OSI was related to a 11.3% increased illness risk (95% confidence interval, 1%-23%, P = .036). CONCLUSIONS: OS is increased in injured and ill athletes. Monitoring OS may be advantageous in assessing recovery from and in reducing injury and illness risk given the association.

Alterations in Redox Homeostasis During Recovery From Unexplained Underperformance Syndrome in an Elite International Rower.

PURPOSE: To examine a diagnosis of unexplained underperformance syndrome (UUPS, or overtraining syndrome) in an international rower describing a full recovery and return to elite competition the same year. METHODS: On diagnosis and 4 and 14 mo postdiagnosis, detailed assessments including physiological, nutritional, and biomarkers were made. RESULTS: Clinical examination and laboratory results for hematology, biochemistry, thyroid function, immunology, vitamins, and minerals were unremarkable and did not explain the presentation and diagnosis. Redox biomarkers including hydroperoxides, plasma antioxidant capacity, red blood cell glutathione, superoxide dismutase, coenzyme Q10, vitamin E (α- and γ-tocopherol), and carotenoids (lutein, α-carotene, ß-carotene) provided evidence of altered redox homeostasis. The recovery strategy began with 12 d of training abstinence and nutritional interventions, followed by 6 wk of modified training. At 4 mo postintervention, performance had recovered strongly, resulting in the athlete's becoming European champion that same year. Further improvements in physiological and performance indices were observed at 14 mo postintervention. Physiologically relevant increases in concentrations of carotenoids were achieved at each postintervention time point, exceeding the reported critical-difference values. CONCLUSIONS: Increasing athlete phytonutrient intake may enhance recovery and tolerance of training and environmental stressors, reducing the risk of unexplained UUPS. Alterations in redox homeostasis should be considered as part of the medical management in UUPS. This is the first reported case study of an elite athlete with alterations in redox homeostasis in conjunction with a diagnosis of UUPS.

Great Britain Rowing Team Guideline for diagnosis and management of rib stress injury: Part 1.

BACKGROUND: Rib stress injury (RSI) is the development of pain due to bone oedema caused by overload along the rib shaft and is commonly seen in rowers. Often clinicians who manage this injury are experienced with the condition at the elite level. There may, however, be a lack of confidence in diagnosing and managing this condition by clinicians who are not regularly exposed to this injury. As a result, an evidence-based guideline has been developed to aid diagnosis and management of RSI. METHODS: A detailed literature search was conducted reviewing the diagnosis and management of RSI. Detailed discussions were held by the Great Britain Rowing Medical Team to identify key issues in diagnosis and management of RSI. An up-to-date, evidence-based approach to managing RSI was created using both expert knowledge and current literature to formulate a functional guideline outlining best practice in management of RSI in rowers. RESULTS: A clinical guideline has been created incorporating 5 key areas: diagnosis, severity grading, investigation, management and associated risk factors for RSI. Important indicators for each key area are incorporated within the guideline using relevant literature where possible alongside expert opinion. The guideline has deliberately been kept concise and tailored for use in the clinical setting. CONCLUSIONS: A new clinical guideline for management of RSIs has been developed to facilitate clinicians in identifying RSI, aiding accurate diagnosis and providing effective management. This guideline is to be disseminated to clinicians, rowing coaches and clubs throughout the UK.

Olympic diabetes.

Winning an Olympic gold medal represents the pinnacle of achievement in any sporting event, to do so with diabetes is almost miraculous. This report outlines the history and management of Steven Redgrave's diabetes, and describes the physiology associated with the extremes of human endurance and the difficulties that this presents.