Posterior deltoid shoulder tightness and greater contralateral lower limb muscle strength are associated with swimmers' shoulder pain.

OBJECTIVES: To identify factors associated with shoulder pain in swimmers based on elastic muscle modulus, joint range of motion, and isometric muscle strength. DESIGN: Cohort study. METHODS: Forty-eight competitive swimmers without shoulder pain (age: 18-28 years; men: 29) were followed-up for 6 months. Baseline measurements of the elastic modulus of the pectoralis minor, supraspinatus, infraspinatus, posterior deltoid, and pectoralis minor muscles were obtained using shear wave elastography. Range of motion and isometric strength were measured using a goniometer and a hand-held dynamometer, respectively. A questionnaire was administered weekly for 6 months to determine shoulder pain occurrence. Each item was compared between shoulders with and without pain at baseline. For participants with shoulder pain exceeding 2 weeks, shear wave elastography and range of motion at baseline (pre pain) and during follow-up (post pain) were compared. RESULTS: Of 46 swimmers followed-up for 6 months, 20 reported shoulder pain. 14 swimmers with pain were evaluated twice. Participants with shoulder pain during follow-up had significantly higher posterior deltoid and pectoralis minor stiffness at baseline and high lower extremity isometric muscle strength contralateral to the shoulder with pain compared to those without pain (p < 0.05). Swimmers with pain exceeding 2 weeks exhibited no differences in ultrasound shear wave elastography and range of motion at baseline and after pain onset. CONCLUSIONS: Posterior deltoid and pectoralis minor muscle stiffness, and high isometric lower extremity strength contralateral to the shoulder with pain may be associated with shoulder pain development, thereby indicating the importance of maintaining posterior deltoid and pectoralis minor muscle flexibility during conditioning.

A challenging case of lumbar vertebral burst fracture with alcohol withdrawal delirium: A case report.

BACKGROUND: Delirium tremens is a symptom of alcohol withdrawal syndrome that occurs 48 to 96 hours after the last drink in 5% of withdrawing patients. METHODS: This report describes the clinical progression of a case of lumbar vertebral burst fracture with alcohol withdrawal delirium that was difficult to manage. RESULTS: A 47-year-old man was rushed to our hospital complaining of lumbar back pain and numbness in both lower extremities resulting from a 6-m fall during civil engineering work. Computed tomography (CT) revealed a L1 burst fracture with a highly protruding bone fragment in the spinal canal. Magnetic resonance imaging disclosed significant compression of the conus and intramedullary signal changes. We immediately performed posterior spinal fusion and vertebroplasty using instrumentation. On the 4th postoperative day, he became severely agitated, as diagnosed as having delirium tremens related to alcohol withdrawal syndrome, and soon began appropriate medication with diazepam. Although his symptoms persisted until 6 days postoperatively, follow-up CT detected no evidence of screw loosening or breakage. CONCLUSION: We encountered a patient with severe delirium tremens developing several days after thoraco-lumbar fusion surgery. Prompt internal fixation successfully treated the spinal injury and prevented neurological damage. It may also be necessary to consider treatment strategies for patients with a background of heavy alcohol consumption in consideration of delirium tremens and other symptoms of alcohol withdrawal.

Acute cerebral microbleeds at the edge of lacunar strokes: cause or result.

We investigated the pathogenic relationship between cerebral microbleeds and lacunar strokes. Two cases of lacunar strokes in the region of the basal ganglia, a 72-year-old man and a 67-year-old man, were studied; both cases showed cerebral microbleeds in the stroke areas. The cerebral microbleeds were surrounded by oedema, and the oedema faded out over time, suggesting the cerebral microbleeds had developed acutely. The cerebral microbleeds were located at the ventrolateral edge of the lacunar infarctions, and the locations appeared to be at or near the sites of occlusion of the lenticulostriatal branches. Although a cerebral microbleed and a lacunar infarction may be two unrelated events on juxtapositioned vessels, or a cerebral microbleed may be haemorrhagic conversion of an infarction, a cerebral microbleed could cause an occlusion of the arterial branch, leading to lacunar infarction of its supplying territories.

Physique, range of motion, and gross muscle strength in hemiplegic para swimmers: a cross-sectional case series.

[Purpose] The physical functions related to swimming should be evaluated to enhance competitive performance and prevent sports injuries. This study aimed to determine the physique, range of motion, and gross muscle strength of the limbs among hemiplegic para swimmers. [Participants and Methods] Three male para swimmers with hemiplegia and five male para swimmers with impaired vision were included in the study. The limb circumference, range of motion, quadriceps flexibility, and gross muscle strength were evaluated. The hemiplegic swimmers and swimmers with impaired vision were compared using an unpaired t-test. [Results] The maximum values of the upper and forearm circumferences; the range of motion for shoulder flexion, external rotation, ankle dorsiflexion on the paretic side; and the single-leg sit-to-stand test of the dominant limb were significantly lower in hemiplegic swimmers than in swimmers with impaired vision. [Conclusion] Hemiplegic swimmers had decreased upper limb circumferences on the paretic limb; the range of motion for shoulder flexion, external rotation, and ankle dorsiflexion on the paretic limb; and muscle strength on the dominant lower limb.

Injuries and physical characteristics affecting swimmer participation in the Olympics: A prospective survey.

OBJECTIVE: To identify injuries and physical characteristics affecting swimmers' performance. DESIGN: Prospective study. SETTING: Laboratory-based. PARTICIPANTS: Sixty-four Rio Olympic candidates (36 men, 28 women), who were high level swimmers ranked among the top 32 in the 2014 World Ranking in swimming. The participants were categorized into the Olympian group (n = 25), swimmers who were consecutively selected for the Olympic team, and the non-Olympian group (n = 39), swimmers who were not. MAIN OUTCOME MEASURES: Four months prior to the Olympic qualification in 2016, an orthopedist and two physical therapists evaluated injuries and 11 physical characteristics of the swimmers. The prevalence of total overuse injuries, shoulder and low back injury, and physical characteristics were compared between the two groups. RESULTS: The female swimmers in the non-Olympian group had a 53.3% prevalence of total overuse injuries, which was significantly higher than that of those in the Olympian group with 15.4% (p = 0.037). The prevalence of total over use injuries in male swimmers in both the Olympian and non-Olympian groups was 41.7%. Female Olympian group showed that the shoulder external rotation range of motion was significantly less than that of non-Olympian group (97.8 ± 5.7 and 103.6 ± 7.3, p = 0.046). CONCLUSIONS: In female swimmers, total overuse injuries four months before an important competition influence their performance at the event.

Association of eHealth Literacy With Lifestyle Behaviors in University Students: Questionnaire-Based Cross-Sectional Study.

BACKGROUND: Maintenance of good health and a healthy lifestyle have significant impacts on the lives of university students. However, university students are prone to engage in risky health behaviors, resulting in impaired health status. Electronic health (eHealth) literacy is an important factor in maintaining a healthy lifestyle. However, no studies have assessed the eHealth literacy levels and the associated lifestyle behaviors among university students in Japan. OBJECTIVE: The purposes of this study were to clarify the eHealth literacy level, the participant characteristics associated with eHealth literacy, and the association of eHealth literacy with lifestyle behaviors of students in a Japanese university. METHODS: A questionnaire-based cross-sectional study of 3183 students at a national university in Japan was conducted. eHealth literacy was quantified using the Japanese version of the eHealth Literacy Scale (eHEALS). The association between participant characteristics (gender, school year, department of study, and living status) and eHEALS score was assessed using t tests. Additionally, the associations of eHealth literacy with lifestyle behaviors (exercise, smoking, alcohol consumption, etc.) were evaluated using logistic regression analyses. RESULTS: The mean eHEALS score was 23.6/40 points. The mean eHEALS score for students in medical departments was 27.0/40 points, which was 2.9 points higher than that of nonmedical students (P<.001). Similarly, the graduate school participants had higher scores than the undergraduate students. The proportion of participants who exercised regularly was higher in the high eHEALS score group than in the low score group, with an adjusted odds ratio of 1.39 (P<.001). CONCLUSIONS: The eHealth literacy level of university students in Japan was comparable to that of the general Japanese population. Graduate students, as well as those in medical departments, had higher eHealth literacy. Furthermore, students with higher eHealth literacy had better exercise routines.

Injury trend analysis in the Japan national swim team from 2002 to 2016: effect of the lumbar injury prevention project.

OBJECTIVES: This study aimed to clarify the trends of injury occurrence in the Japan national swim team for 15 years and to evaluate the effectiveness of the lumbar injury prevention project. It also aimed to verify the incidence of swimming-related injuries among swimmers by sex, age and swimming style. METHODS: The target group comprised 488 swimmers who participated in the Olympics, Asian Games and Universiade from 2002 to 2016; we compiled data for the total number of injuries in each body part. The lumbar injury prevention project started in 2008 and included two components (deep trunk muscle exercises and evaluation of lumbar disc degeneration using MRI). We analysed the prevalence of lumbar injury before (2002-2008) and after (2009-2016) implementation of the lumbar injury prevention project by χ2 test. We compared age, sex and swim strokes between the injured and non-injured groups by χ2 test and unpaired t-test. RESULTS: The most common injury site was the lower back, followed by the shoulder and knee. The lumbar injury prevalence was significantly lower after implementation of the prevention project (23.5% vs 14.8%; p<0.05). Shoulder injuries were common in backstroke swimmers. The injury rate was significantly higher in female than in male swimmers. The injured group was significantly older than the non-injured group. CONCLUSIONS: Lumbar injury prevention intervention might be effective to prevent lower back injury in swimmers. Injury risk factors included female and old age; younger female athletes should prevent the development of injuries as they mature.

IMMEDIATE EFFECTS OF DEEP TRUNK MUSCLE TRAINING ON SWIMMING START PERFORMANCE.

BACKGROUND: In recent years, deep trunk muscle training has been adopted in various sports, including swimming. This is performed both in everyday training and as part of the warm-up routine before competitive races. It is suggested that trunk stabilization exercises are effective in preventing injury, and aid in improving performance. However, conclusive evidence of the same is yet to be obtained. The time of start phase of swimming is a factor that can significantly influence competition performance in a swimming race. HYPOTHESIS/PURPOSE: If trunk stabilization exercises can provide instantaneous trunk stability, it is expected that they will lead to performance improvements in the start phase of swimming. The purpose of this study was to investigate the immediate effect of trunk stabilization exercises on the start phase in swimming. STUDY DESIGN: Intervention study. METHODS: Nine elite male swimmers (mean age 20.2 ± 1.0 years; height 174.4 ± 3.5 cm; weight 68.9 ± 4.1 kg) performed the swimming start movement. The measurement variables studied included flying distance, and the time and velocity of subjects at hands' entry and on reaching five meters. Measurements were taken in trials immediately before and after the trunk stabilization exercises. A comparison between pre- and post-exercise measurements was assessed. RESULTS: The time to reach five meters (T5m) decreased significantly after trunk stabilization exercises, by 0.019 s (p = 0.02). Velocity at entry (Ventry) did not demonstrate significant change, while velocity at five meters (V5m) increased significantly after the exercises (p = 0.023). In addition, the speed reduction rate calculated from Ventry and V5m significantly decreased by 5.17% after the intervention (p = 0.036). CONCLUSION: Trunk stabilization exercises may help reduce the time from start to five meters in the start phase in swimming. The results support the hypothesis that these exercises may improve swimming performance. LEVELS OF EVIDENCE: Level 3b.

Active recovery effects on local oxygenation level during intensive cycling bouts.

We hypothesised that the oxygen supply to the fatigued muscles is improved after the recovery with exercise caused by aerobic metabolism in the slow twitch fibres during the recovery period. Ten males performed a 30 s maximum cycling (1st Exercise), followed by a 20 min rest interval (Interval Rest) in which participants were either sitting (No Exercise) or low intensive cycling (Active). Then they again underwent a 30 s bout of maximum cycling (2nd Exercise). The total work of the 2nd Exercise was higher in Active compared to No Exercise (297 ± 14 vs 276 ± 23 J · kg(-1), P < 0.01). After Interval Rest, the muscle oxygenation level (P < 0.05) and blood lactate concentration (P < 0.05) were lower in Active compared to No Exercise. In Active, the total work was higher in the 2nd Exercise than the 1st Exercise (297 ± 14 vs 277 ± 23 J · kg(-1), P < 0.01), and muscle oxygenation levels during the 2nd Exercise were also higher at 10 (P < 0.05) and 15 (P < 0.01) s after the beginning of the exercise. It was suggested that active recovery exercise would manage to increase the muscle oxygenation level, and improve the performance during the 2nd Exercise accompanied with blood lactate control.

Active recovery effects by previously inactive muscles on 40-s exhaustive cycling.

The effects of active recovery using previously active and inactive muscle groups on power output and respiratory responses were examined. Ten male volunteers underwent two exhaustive 40-s bouts of leg cycling (1st Ex and 2nd Ex), separated by a 20-min recovery period. The recovery conditions were leg (Leg-Active) or arm (Arm-Active) cranking at 50% ventilatory threshold (VT), or sedentary control (Passive). The total output work (Total work) during the 2nd Ex in the Leg-Active condition was significantly higher than that in the Passive [299 vs. 282 J x kg body mass(-1) (J x BM(-1))]. The values of Total work, peak VO2 and peak heart rate during the 2nd Ex were significantly higher than those during the 1st Ex in both Leg- and Arm-Active. Total CO2 excess after the 1st Ex was significantly higher than that after the 2nd Ex (67.6 vs. 26.0 ml x BM(-1)) in Passive. After the 2nd Ex, the Total CO2 excess in the Leg-Active (51.5 ml x BM(-1)) was significantly higher than that in both the Passive (26.0) and Arm-Active (36.5), with Arm-Active being significantly higher than Passive. The recovery exercise using previously inactive muscles improved respiratory compensation ability related to performance enhancement.