William W. Briner

Strategies for the prevention of volleyball related injuries

Although the overall injury rate in volleyball and beach volleyball is relatively low compared with other team sports, injuries do occur in a discipline specific pattern. Epidemiological research has revealed that volleyball athletes are, in general, at greatest risk of acute ankle injuries and overuse conditions of the knee and shoulder. This structured review discusses both the known and suspected risk factors and potential strategies for preventing the most common volleyball related injuries: ankle sprains, patellar tendinopathy, and shoulder overuse.

Common injuries in volleyball. Mechanisms of injury, prevention and rehabilitation.

SummaryVolleyball has become an extremely popular participation sport worldwide. Fortunately, the incidence of serious injury is relatively low. The sport-specific activity most commonly associated with injury is blocking. Ankle sprains are the most common acute injury. Recurrent sprains may be less likely to occur if an ankle orthosis is worn. Patellar tendinitis represents the most common overuse injury, although shoulder tendinitis secondary to the overhead activities of spiking and serving is also commonly seen. An unusual shoulder injury involving the distal branch of the suprascapular nerve which innervates the infraspinatus muscle has been increasingly described in volleyball players in recent years. Hand injuries, usually occurring while blocking, are the next most common group of injuries. Fortunately, severe knee ligament injuries are rare in volleyball. However, anterior crutiate ligament injury is more likely to occur in female players. Many of these injuries may be preventable with close attention to technique in sport-specific skills and some fairly simple preventive interventions.

Little league elbow

It is well known that the school-age athlete is susceptible to all forms of sports-related injuries, including acute, chronic, and recurrent types. Increasing concerns exist that chronic overuse orthopedic injuries are becoming more frequent occurrences in youth sports. Conditioning and training errors coupled with rapidly changing physical characteristics are some factors that contribute to rising injury rates. Year-round training in a single sport and longer competitive seasons are adding to the musculoskeletal stresses our adolescent athletes experience. Little League elbow is a valgus overload or overstress injury to the medial elbow. Classic Little League elbow refers specifically to an apophysitis of the medial epicondylar growth plate found in skeletally immature athletes. A general understanding of normal skeletal development, reasonable workload limits, and proper throwing biomechanics are essential for successful management of this injury. It is estimated that the incidence of baseball-related overuse injuries is 2–8%. Specifically, the annual incidence of the elbow pain in 9–12 year old range in baseball is 20–40%. Early recognition of this condition leads to better outcomes and should aid in the prevention of persistent functional disabilities in the athlete. There are many causes of elbow pain, but the purpose of this article is to focus on the diagnosis and treatment of medial elbow pain with an up-to-date discussion of proper management in the adolescent athlete.

Physical allergies and exercise: Clinical implications for those engaged in sports activities

There are several allergic responses that may occur in susceptible individuals as a result of exposure to physical stimuli. Most of these conditions are mediated by vasoactive substances and usually result in symptoms of urticaria and/or angioedema. There are 2 such conditions that may occur as a direct result from exercise. The first of these is cholinergic urticaria. Patients with cholinergic urticaria experience punctate (2 to 4mm) hives which occur reproducibly with exercise or with passive warming, such as might occur in a steam bath or hot pool. Life-threatening hypotension or angioedema usually do not occur with cholinergic urticaria. This condition usually responds well to oral hydroxyzine. Exercise-induced anaphylaxis (EIA) is a form of physical allergy that has been recognised with increasing frequency in recent years. This syndrome typically presents with generalised pruritus, a flushing sensation, a feeling of warmth and the development of conventional (10 to 15mm) urticaria in association with vigorous physical exertion only. Symptoms tend to occur variably with exposure to exercise and do not typically occur with passive warming. During symptomatic attacks, cutaneous mast cells degranulate and serum histamine levels increase. Treatment is problematic. Cessation of exercise with onset of symptoms and self-administration of epinephrine (adrenaline) are recommended. Other physical allergies that may affect exercising individuals include cold urticaria, localised heat urticaria, symptomatic der-matographism (dermographism), delayed pressure urticaria (angioedema), solar urticaria and aquagenic urticaria. Management of these conditions may include patient education, selective avoidance, antihistamines and, in some cases, induction of tolerance.SummaryThere are several allergic responses that may occur in susceptible individuals as a result of exposure to physical stimuli. Most of these conditions are mediated by vasoactive substances and usually result in symptoms of urticaria and/or angioedema. There are 2 such conditions that may occur as a direct result from exercise. The first of these is cholinergic urticaria. Patients with cholinergic urticaria experience punctate (2 to 4mm) hives which occur reproducibly with exercise or with passive warming, such as might occur in a steam bath or hot pool. Life-threatening hypotension or angioedema usually do not occur with cholinergic urticaria. This condition usually responds well to oral hydroxyzine. Exercise-induced anaphylaxis (EIA) is a form of physical allergy that has been recognised with increasing frequency in recent years. This syndrome typically presents with generalised pruritus, a flushing sensation, a feeling of warmth and the development of conventional (10 to 15mm) urticaria in association with vigorous physical exertion only. Symptoms tend to occur variably with exposure to exercise and do not typically occur with passive warming. During symptomatic attacks, cutaneous mast cells degranulate and serum histamine levels increase. Treatment is problematic. Cessation of exercise with onset of symptoms and self-administration of epinephrine (adrenaline) are recommended. Other physical allergies that may affect exercising individuals include cold urticaria, localised heat urticaria, symptomatic der-matographism (dermographism), delayed pressure urticaria (angioedema), solar urticaria and aquagenic urticaria. Management of these conditions may include patient education, selective avoidance, antihistamines and, in some cases, induction of tolerance.

Volleyball injuries :Managing acute and overuse disorders

Most volleyball injuries are related to blocking or spiking, both of which involve vertical jumps. The most common acute injuries include ankle and thumb sprains, and common overuse injuries include patellar and shoulder tendinitis, suprascapular neuropathy, and low-back injury. Symptoms will usually resolve with conservative treatment, which may include activity modification, such as reduced jump training or jumping on a sand surface, and technical instruction. Players who have significant symptoms from suprascapular neuropathy may require diagnostic electromyography and MRI before surgical decompression.

Palpitations in Athletes

In an athletic population, the incidence of palpitations varies from 0.3% to as high as 70%, depending on age and type of sport being studied. Palpitations, or an awareness of an increased or abnormal heart beat, are rare in the school-age athlete, but much more common in older endurance athletes. The majority are felt to be benign, with prognosis relating to type of specific rhythm disturbance and presence or absence of underlying heart disease.Atrial fibrillation can account for up to 9% of rhythm disturbances in elite athletes, and up to 40% in those with long-standing symptoms. In athletes with premature ventricular beats (PVCs), underlying heart disease is more likely to be present in those with a high PVC burden, defined as ≥2000 PVCs/24 hours. Choice of monitoring device is crucial in making a proper diagnosis of the specific rhythm disturbance. For symptoms occurring within a 24-hour period, simple Holter monitoring is adequate to make a diagnosis. However, if symptoms occur less frequently, clinicians must choose one of the other available monitoring devices. Most importantly, choice of device should depend on which device is most likely to detect the rhythm disturbance. Other cardiac testing such as echocardiography, stress testing, endomyocardial biopsy, genetic testing, electrophysiologic testing, or cardiac magnetic resonance imaging may be indicated as well. The majority of palpitations in athletes will be first identified by screening examination, or by a complaint from the athlete. The third and most current preparticipation examination monograph recommends asking the athlete if he/she has palpitations with exercise.The assumption has been made that palpitations occurring at rest in athletes are benign, but this theory has not been validated prospectively in a large cohort of the athletic population. Specific rhythms can often be treated with radiofrequency ablation, with return to sports provided there is no significant high risk underlying heart disease present. Athletes with known malignant ventricular rhythm disturbances, or underlying substrate for such, who have undergone implantation of an automatic implanted cardioverter-defibrillator are not recommended to return to sport because there is no data on the safety and efficacy of defibrillators in this clinical setting, and certain athletic activities may result in damage to the device.

Foot and ankle injuries in the barefoot sports

Playing sports barefoot has been contested since the very beginnings of athletic competition. Even today, some data suggest that shoes may limit the adaptive pronation that occurs after footstrike during running gait. This pronation likely protects runners from injury. Boardsport participants who perform their sports barefoot on the water seem to be at risk for foot and ankle injuries. The high-impact forces in gymnastics place participants at risk for foot and ankle injuries, as well. Swimming and diving have a low rate of foot and ankle injuries. The risk of ankle sprain in beach volleyball, which is played barefoot, seems to be lower than that for indoor volleyball, played wearing shoes. Martial arts place competitors at risk for injuries to the foot and ankle from torsional and impact mechanisms. Athletes who hope to return to barefoot competition after injury should perform their rehabilitation in their bare feet.

Exercise-induced anaphylaxis

Exercise-induced anaphylaxis (EIA) is a unique form of physical allergy that has been recognized with increasing frequency in recent years. The hallmarks of this syndrome are generalized pruritus with a flushing sensation, a feeling of warmth, and the development of urticaria in association with vigorous physical exertion. These symptoms tend to occur variably with exercise, but not with passive warming. Most patients report typical giant urticarial eruptions. Skin mast cells degranulate, and serum histamine increases during symptomatic attacks. Treatment is often problematic, but cessation of exercise with onset of symptoms and self-administration of epinephrine are recommended.

Case report : 30-yr-old female with exercise induced anaphylaxis

This case describes a 30-yr-old white female who presented with a 2-wk history of pruritic rash with exercise. This rash occurred with each bout of exercise and was accompanied by one episode of light-headedness. A bicycle ergometer exercise challenge resulted in a fine wheal and flare rash of the trunk and upper extremities that was associated with symptomatic hypotension. She was diagnosed with exercise induced anaphylaxis, and initial treatment with hydroxyzine was instituted. Side effects from the drug were poorly tolerated, and she was switched to inhaled cromolyn sodium. She had noted resolution of her symptoms while she took cromolyn as recommended. Two months after her initial presentation, she also began to experience the same rash with hot showers. Exercise induced anaphylaxis is a well-described form of physical allergy that may be underdiagnosed. As the fitness boom continues and clinicians see more exercising patients, it will be important to recognize and understand this condition. It is a true anaphylactic reaction and, as such, certainly has the potential for significant morbidity and mortality.

Introduction: exercise and allergy.

At a time when the American public is committed to health through exercise, a variety of allergic conditions related to activity are being recognized with increasing frequency. Conditions such as cholinergic urticaria, bronchospasm, and even anaphylaxis have occurred as a consequence of exercise. Thus, a symposium has been developed to examine the role of exercise in association with such conditions. Several of the physical allergies are discussed in overview fashion. Exercise-induced anaphylaxis, the most serious form of allergic response to exercise itself, is considered in greater detail. The etiology, clinical features, and therapy for these physical allergies are addressed. Exercise-induced bronchospasm (EIB) has been well categorized in the literature. This is another exercise-related condition with an allergic component. The current concepts with respect to proposed etiology, epidemiology, and clinical features are discussed. EIB is an important condition to screen for, and techniques for identifying patients who should be screened are also addressed. Allergic rhinitis may also affect athletes. Accurate diagnosis and effective management of all these conditions may help greater numbers of people to enjoy the full benefits of exercise.