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Our MAG and WAG teams have now had their first National Squad training camps for the year at the AIS. They had a chance to use the new recovery centre and utilize the physiology department for testing. The WAG girls used the running ‘beep test’ for the first time to test cardiovascular endurance. This has been shown to be a valid predictor of VO2 max and they are planning to re-test in March and July.
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KNEE JOINT ARTICULAR CARTILAGE LESIONS |
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Of interest to the gymnastics community is the October 2006 publication of Journal of Orthopaedic and Sports Physical Therapy which is a special issue dedicated to articular cartilage and meniscal lesions. Wilk and co-workers discussed ‘Rehabilitation of Articular lesions in the Athlete’s Knee’ and note that an articular cartilage lesion includes any injury to the cartilage that causes softening, fissuring and fibrillation. Bone bruises and other abnormal findings on MRI are included as these suggest alteration of the healthy joint state. All should be treated as risk factors for future degeneration and OA changes.
This group of physical therapists, surgeons and sports trainers recommend a minimum of 2 weeks partial weight-bearing on crutches for any bone bruising. They propose that when the lesion is on the weight bearing aspect of the knee or patellofemoral joint then limiting load during early rehabilitation may reverse potential for future articular cartilage loss.
In this paper, the authors highlight a growing concern for evidence showing NSAIDs have a negative effect on cartilage metabolism (by reducing glycosaminoglycan synthesis). This is important to note in the gymnastics community where use of anti-inflammatories is extremely common and often self-prescribed.
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VITAMIN D AND ELITE GYMNASTICS |
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‘Sun’ thing to think about - Vitamin D and Elite Gymnasts - Katherine Cook, Sports Dietitian
As a dietitian looking after elite gymnasts I place a great significance on ensuring each athlete consumes a nutrient rich diet including a regular intake of calcium rich foods. My interest in calcium has, however, developed an increased curiosity regarding another important nutrient, Vitamin D, which has a direct relationship to the use of calcium in the body.
Calcium’s primary role in the body is to provide an integral part of bone structure. In order for calcium to perform this role it requires our body to have an adequate amount of active vitamin D, as both calcium and vitamin D work synergistically. Vitamin D exists in our body in an inactive form, however is different to most nutrients, as it requires direct UV sunlight exposure to change vitamin D to its active form that can be used by the body. This means individuals require some amount of unscreened, unprotected UV sun exposure, quite contrary to the current sun safe messages provided to the Australian population.
Exposing the skin to UV radiation from the sun produces about 90% of active vitamin D that is bioavailable in the body. Although some foods contain vitamin D, adequate vitamin D levels cannot be achieved through diet alone.
Current recommendations suggest we need approximately 2 -15 minutes of sun exposure during October to March and between 3 - 44 minutes of sun exposure during April to September. The time of UV sun exposure required within these ranges is dependant of on your location within Australia and the time of day.
Insufficient levels of vitamin D will hinder calcium’s role in the body and has been shown to contribute to the development of osteoporosis. Recent research demonstrates a significant number of Australians have at least marginal vitamin D deficiency, with particular reference to young women. Two studies have indicated 43% of young women have a marginal vitamin D deficiency compared to the 23% in the general population. Other Australian groups identified as being more susceptible to vitamin D deficiency include dark skin pigmentation, housebound or bedridden elderly people and those who cover their skin for cultural or religious reasons.
Considering this information in light of our elite gymnasts, I wonder if our athletes are at a greater risk of inadequate vitamin D exposure. Between long training hours, school commitments and heavily promoted health messages encouraging Australians to reduce sun exposure, is this limiting the sun exposure of elite gymnasts and is this placing this group at risk of developing a vitamin D deficiency? If so, is such a deficiency contributing to problems with bone health and development? This is ‘sun’ thing I think we should think about more.
Many thanks to Katherine Cook for her contribution this month.
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WRIST INJURY IN GYMNASTICS |
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DiFiori, Caine and Malina (May 2006, American Journal of Sports Medicine) published a review of wrist pain, distal radial physeal injury and ulnar variance in the young gymnast. They note rates of loading up to 16 times body weight through the wrist with approximately 45% of gymnasts experiencing wrist pain of at least 6 months duration. They note the most common causes of pain to be distal radial physeal stress reaction, scaphoid impaction syndrome and dorsal impingment with other more rare causes including scaphoid stress reaction and avascular necrosis of the capitate.
More specifically, Snider et al (Journal of Canadian Chiropractors, August 2006) suggest that partial or full scapholunate interosseous ligament tears are a common precursor to these bony symptoms. They reported on 3 case studies of elite male gymnasts with chronic wrist pain and a variety of changes seen on MRI, bone scans and xrays (including triquetrum bone fragment, OA sccapholunate joint, chondromalacia of scaphoid, lunate and distal radius and lunate bone bruise.) All had MR arthrography which demonstrated SLL tearing. Pain was often ulnar sided and always dorsal and related to weight-bearing in extension. All proceeded to arthroscopy at which point the SLL was debrided. Following arthroscopy and rehabilitation all returned to full training with wrist support to limit excessive extension range.
This research into wrist pain in gymnasts highlights the challenges of differentially diagnosing chronic dorsal wrist pain clinically and conservatively. Perhaps we should all consider the use of extension-limiting wrist guards at the first sign of dorsal wrist pain and unload athletes early to avoid chronic stress onto these structures.
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FEEDBACK |
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If you have something to comment on, please contact us for our next edition of GA e-news.
Keren Faulkner For GA SSSMC
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