The effect of different types of exercise on gastro-oesophageal reflux.

Sportsmen and women frequently experience abdominal and chest pain during exertion. The symptoms could be cardiac but may be caused by gastro-oesophageal reflux (GOR). The aim of our study was to investigate the effect of the two activities on GOR in 17 fit, healthy adults. GOR, assessed by intraoesophageal pH, was recorded on portable monitoring equipment before, during and after rowing and running. GOR was also measured after a light meal to simulate pre-training hydration. Three studies were performed: rowing, fasted running, and post-prandial running. GOR was infrequent before exercise, being seen in only 2 subjects. However, GOR was induced in 70% of rowers, 45% of fasted runners, and 90 % of fed runners during and immediately after exercise. The presence of food in the stomach greatly increased the amount of reflux during post-prandial running, (p < 0.006 against control) but reflux was also significantly higher in those who refluxed during fasted running (p < 0.03) and rowing (p < 0.08). There was no statistical difference in the amount of GOR between the two exercise periods. This study shows that both running and rowing induce significant amounts of GOR in a normally asymptomatic group of athletes. GOR should be considered in the investigation of exertional chest pain in patients attending a sports clinic.

Gastro-oesophageal reflux and exercise. Important pathology to consider in the athletic population.

Gastro-oesophageal reflux is commonly found in the general population, and has recently been demonstrated to occur more frequently during exercise than at rest. This fact is significant to the substantial number of athletes who complain of exertional upper gastrointestinal symptoms and exercise-induced chest pain. A diagnosis of exercise-induced gastro-oesophageal reflux can be confirmed by means of ambulatory pH monitoring. A positive diagnosis allows for appropriate management of the individual. This can involve simple measures, such as recommendations for changes in diet, timing of meals, and nature of exercise. However, pharmacological intervention may be required. A decrease in morbidity associated with cardiac origins of exercise-induced pain can also be expected with a more comprehensive understanding of this pathology.

The bipartite tarsal navicular bone: radiographic and computed tomography findings.

Two cases of bipartite tarsal navicular bone are presented. The radiographic and computed tomography (CT) findings of this anatomical variant are described. Correct recognition of this entity is important, both because it may be the cause of symptoms per se, and because it may be misdiagnosed as a fracture. When plain films are not diagnostic, CT scanning is helpful in distinguishing between a fracture and this variant.

Injury profile of amateur Australian rules footballers.

Australian Rules Football is played by numerous young Australians throughout winter each year. There have been a number of studies on professional and semi-professional footballers, establishing the nature and frequency of injuries within this football code. Medical cover of an amateur football club over the 1993 season allowed detailed recording of injuries over this period. The data collected revealed a markedly different injury profile to that seen previously. The injury rate in this study was 96 per 1000 player hours. The most common injury was concussion (15%), with hand fractures next most frequent (13.5%). The lower limb was the most common site of injury, with head and neck second and upper limb third. Injuries with an overuse component were seen less commonly in the amateur group while traumatic injuries were more frequent. The time allocated by amateur footballers to their sport is less than professional players, quite aside from the difference in skill level attained. Overuse injuries may be correspondingly much less frequent on a time basis alone. The increased incidence of traumatic injuries is postulated to be a manifestation of both less well developed skills and possibly less available and effective preventative measures such as ankle strapping and tape supplies. Considering the large number of young people playing amateur football and the significant time and cost of what are often relatively minor injuries, more work is required to establish what injuries are most common, and importantly, what measures can be taken to decrease their incidence.