Overtraining syndrome in the athlete: current clinical practice.

Competitive athletes are pushed routinely to the limits of their physical abilities. When tempered with periods of rest and recovery, a highly demanding training schedule can have tremendous benefits. However when an athlete is pushed too far, overtraining syndrome (OTS) can develop and result in career-ending damage. Overreaching and overtraining are part of the same spectrum that can lead to OTS. The pressure to perform placed on elite athletes is a real danger. Athletes and coaches understand the importance of rest days, but the insidious onset of OTS slowly saps the efficacy of recovery times so the athlete is no longer able to reach previously attainable goals. Identifying markers that correlate with overreaching and overtraining can arrest progression of a potentially negative cycle. We will examine the current literature and discuss possible screening tests and red flags that will assist in preventing OTS from occurring.

Metabolic testing in the office.

The three most commonly used metabolic tests are the Resting Metabolic Rate, Anaerobic Threshold Testing, and V.O2max. For several decades, these metabolic tests have been confined to the setting of university-based physiology laboratories and cardiopulmonary environments, i.e., metabolic carts in the intensive care units. The information gathered is used as a research and clinical tool in evaluating metabolic activity in a variety of physiological states from a body at rest, to exercise (aerobic and anaerobic), in certain medical states like illness, fed/starvation, and medicinal or supplementation affective states. Over the last decade, as technology has improved, so have the metabolic testing carts. They have become widely available for mainstream use by a variety of health care professionals. The purpose of this article is to review these three tests and how they may be useful in a medical practice.

Intrarater and interrater reliability of a manual technique to assess anterior humeral head translation of the glenohumeral joint.

The purpose of this study was to determine the intrarater and interrater reliability of a manual anterior humeral head translation test. Fifteen subjects were positioned lying in a supine position with their identity shielded from examiners. A standard manual anterior humeral head translation test was performed and repeated with the glenohumeral joint in 90 degrees of elevation in the scapular plane, with use of the grading method proposed by Altchek and Dines in 1993. Reliability was assessed with the coefficient of agreement and kappa statistic. Intrarater reliability was 81.4% comparing grade I and II translation. This decreased to 54% when examiners distinguished between grades I, I+, II, and II+. Interrater reliability for the same comparisons was 70.4%, decreasing to 37.3%. On the basis of these data, the technique of manually assessing anterior humeral head translation studied has poor overall interrater reliability and only fair intrarater reliability. The test-retest accuracy of humeral head translation is enhanced when examiners only determine the relationship of the humeral head relative to the glenoid rim.

Osteoarthritis of the glenohumeral joint: nonsurgical treatment options.

Glenohumeral osteoarthritis is a relatively uncommon type of osteoarthritis characterized by loss of anterior or forward flexion. Assessing range of motion, impingement, and strength, combined with radiologic imaging, can help determine the extent of damage. Published studies focus primarily on surgical treatment, but commonly used nonsurgical approaches include anti-inflammatory medications, oral and injectable viscosupplementation, and physical therapy. These conservative measures can be very effective for active patients and also appeal to their physicians who consider shoulder surgery as a last resort.