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The wounds of the marathon

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A figure 4.1 injuries per 1,000 hours of practice in competitive runners.

Hold back :
- Avoid too rapid increase in training volume.
- Importance of quality footwear.
- Do not neglect stretching and warming up.
- Ensure good hydration and adequate food.

The main locations:

- Stress fractures of the second and third metatarsals, but all the foot bones may be involved.
- Plantar fasciitis.
- Achilles tendonitis.

The tibia
- Stress fracture.
- Shin medial tibial.

- Syndrome wiper.
- Chondromalacia patella (or patella syndrome).

The stress fracture

This is an adaptation bone disease during exercise.
Main contributing factor: too rapid increase weekly mileage.
It concerns all the bones but especially the tibia and the metatarsals 50% to 20%.
Treatment: some localizations (anterior tibial) require drastic measures, others a mere compliance with indolence.

The internal tibial shin

A separate stress fractures of the tibia.
The pathophysiology is still hypothetical: pain of the periosteum or muscle fascia, tendon sheaths see.

Contributing factors:
- Too fast Increase weekly mileage.
- Running on hard surfaces.
- Bad damping shoes.
- Feet pronator.

Treatment :
- Corrective insoles.
- Physiotherapy (deep transverse massage and physiotherapy).
- Respect indolence needed rest and sports gradual recovery in good conditions.

Achilles tendonitis

It is a condition of hyperutilisation responsible for repetitive strain injury to the tendon.

To distinguish :
- The body of the tendon tendinitis
- The tenosynovitis
- The insertion tendonitis
- The retro pr├ęachill├ęennes bursitis

Three evolutionary stages:
Stage 1 pain after sport, easily yielding to rest.
Stage 2 pain in the warm-up, disappearing only to reappear to fatigue.
Stage 3 constant pain resulting in a decrease or stopping training.

Contributing factors:
- Too fast Increase weekly mileage.
- Running on hard surfaces.
- Bad damping shoes.
- Stretches of failure or overheating.
- Feet pronators hollow and achilles courts.
- Poor hydration, poor diet.
- Metabolic disorders (uric acid, cholesterol ...).

Treatment :
A set off early to avoid chronicity.
Sports Recreation until disappearance of pain, in everyday life, and when hopping on the tip of one foot.
Enjoy this forced rest to correct any predisposing factors (stretching, footwear ...).
Physiotherapy (deep transverse massages, physiotherapy and stretching).
corrective insoles.
very gradual resumption of training.

plantar fasciitis

This is the most common injury to the foot of the rider.
It is a micro-traumatic pathology of the inner part of the plantar fascia, which may progress to rupture.

Contributing factors are the same as those responsible for Achilles tendonitis.

The 3 stages of evolution are also found.

Radiography sometimes shows a heel spur.

Treatment :
- Sports Recreation.
- Correction of predisposing factors.
- Corrective insoles.
- Physiotherapy (MTP and stretching).
- If necessary infiltration.
- Gradual recovery training.

Syndrome of the wiper or the iliotibial band.

It is a disease linked to repeated rubbing of the iliotibial tract on the lateral femoral condyle. It applies only to online sports (running, cycling, power walking).

Contributing factors:
Genu Varum, supination attack.
Exaggerated projection of the lateral condyle.
excessive internal rotation of the tibia.
too rapid increase weekly mileage.

Diagnostic :
Pain lateral compartment of the knee, appearing for mileage, upper bound is progressively persistent 24 to 48 hours in activities of daily living especially on stairs.

Treatment :
- Sports Recreation time to make corrective insoles.
- Local anti-inflammatory treatments or generals.
- Stretching of the tensor fascia lata, if necessary at the physiotherapist.
- Gradual recovery training.

chondromalacia patella.

It is a condition of the patellar cartilage essentially patellofemoral hypertension.

Contributing factors:
Genu valgum, hypermobility, recurvatum.
Insufficiency of the quadriceps (vastus) or hamstring.
traumatic history (patella ligament ...).
rapid increase in training volume.

Diagnostic :
knee pain, anterior, mechanical, plus the sport, down stairs, prolonged sitting (cinema, car) or getting up from that position.

Treatment :
- Sports Recreation minimum, respecting the pain.
- Anti-inflammatory.
- Physiotherapy (strengthening of the vastus).
- Gradual recovery training.

Doctor Yves GUGLIELMETTI. - 30 janvier 2009.

Conflicts of interest: the author or authors have no conflicts of interest concerning the data published in this article.


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The Iroman lack of iron, the other sports too!

Doctor St├ęphane CASCUA.

Iron is essential to your health and performance. It is a central component of hemoglobin. The latter is contained in red blood cells and gives it color. It is the iron that captures oxygen when blood passes through the lungs. It carries the precious gas to muscles. When they arrived, it drops its cargo which then allows the burning of energy substances and muscle contraction.

When you run or when you jump, your heels hit the ground and the fat pad of the foot of the plant is crushed. It is through many blood vessels. These red blood cells burst and release their hemoglobin. Iron is released into the blood and pass into urine.

Muscle contains a twin sister of hemoglobin, myoglobin. The latter also contains a lot of iron which sets some oxygen. This small local reserve allows starting the contraction before the blood vessels do not provide the necessary complement. When you experience aches, your muscle membranes are victims of micro-fissures. Myoglobin and iron leaves the muscle and gaining the blood. The precious metal is eliminated in the urine.

When you make an effort, the majority of blood flow is directed towards your muscles. There remains very little to the digestive tract and the bladder wall. These organs suffer from lack of oxygen and are shaken with every stride. Small areas are damaged and start to bleed. Red blood cells and iron are lost in the feces and in urine.

You enter the assiduous why athletes often lack iron, especially if they do not take care to concoct "menus and recipes" adapted. Sports are even more concerned since all these iron losses are added the massive elimination of blood during menstruation!

That is why it is good to occasionally perform a blood test to assess the stock in body iron. This levy is necessary when it comes to review a state of fatigue. It unnecessary to dose iron in the blood because the body is able to keep within the limits of normal while the reserves are at their lowest! It is necessary to measure levels of "serum ferritin" because this structure is the storage form of iron.

The bone is strengthened or crack in contact sports

Doctor St├ęphane CASCUA.

Each sports movement constitutes a solicitation for the bone structure. At each reception process, the tibia runner undergoes vibratory impacts. Unrolling not, the hiker twists slightly small bone in his foot. Even the body-builders, powerfully contracting its muscles, pulls on his bone.

Each strain injures a little bone of sports. Fortunately, during the rest period, the bone trying to rebuild. If time allows, if they bring him the necessary food, it is repaired! It reconstructs even louder than before as if to prepare for new mechanical attacks. This phenomenon is called by coaches cycle decompensation / overcompensation. This process has been described in many body organs and functions: muscle, stock energy, hormones, etc. It is a key driver of growth.

Thus, it was shown that the well-trained marathoner had stronger bones than sedentary. Indeed, its more dense bone structure, higher in fiber and calcium. In addition, the microscopic architecture of the bone is perfectly oriented along the axis of mechanical stresses.

Indeed, the chemical structure of the bone is comparable to reinforced concrete. The protein network is the steel rods. Calcium is comparable to concrete mired these metal axes. At the hip and pelvis direction of the bone structure is very characteristic. On a radiograph, it is found that the fibers leave the femur, the thigh bone, tilt in, come from hip to withstand the weight of the body resting on the hips. The lines of force from the right leg and left leg meet in the middle of the basin and support each other in the manner of the nave of a church.

Physical activity associated with a sufficiently high protein diet, vitamin D and calcium is a great engine of bone construction. This cocktail is particularly useful to hinge periods of life. During growth, it is necessary to eat 4-5 dairy products every day to build strong bones. It should also move: it is essential to practice a sport requiring the running and jumping at least 3 times a week for 30 minutes. In the absence of impact, bones harden less. It has been shown that a young competitive swimmer had lower bone density than sedentary because he was deprived of gravity during those long hours of pool training. In addition, bone densification stops 25 years. At this age you have made up your bone capital for life!

In adulthood, sport reinforces very hard bone and the amount of calcium necessary for the maintenance of bone is still debated. In case of fracture, the rest of the broken area needed a few weeks to allow to "ensnare" the broken area. In addition, gradually increasing mechanical stress are indispensable to "mechanize" the callus. Again, they help to guide the fabric of the bone in the center of the constraints to prepare him for his mission. An increase in calcium intake in consolidation period is proposed by some doctors without that interest has been really shown.

After menopause, the bone structure is gradually degraded to make the brittle bones is osteoporosis. Ladies, remember, your resistance to hip fracture depends on your diet and your sport for 25 years! If physical activity after menopause can no longer denser bones, reduces the loss of bone tissue. So it is advisable to go see jumping around or jog. It is also good to make the soft gym to maintain bone strength to strength. To make the most of this stimulation, it is again necessary to take 4-5 dairy products daily. It should also go out every day to enjoy the sun and make the vitamin D essential for the absorption and calcium binding. Fresh coordinating sports such as Thai Chi or "balance workshops" have proven effective in reducing the risk of falls and fractures.

If the sporting activity is excessive, the micro-cracks caused by impacts on the bones fail to consolidate over the rest. Rather, these lesions worsen in the next workout. Finally the splits right through bone, it breaks without any violent trauma. It is the stress fracture. In a postmenopausal woman, it was demonstrated that 6 hours of sport load per week may be sufficient to break insidiously bones. Among younger adults, this type of injury is favored by dietary deficiencies and hormonal disorders. Lack of calcium, vitamin D and protein alters the rebuild bone victim of microcracks in the exercise. Insufficiency sex hormones reduces the stimulation microscopic chemical plants be responsible for the synthesis of bone tissue. Functional changes occur when the deep depletion of the body. That kind of burnout is most often diagnosed in women because it causes menstrual irregularities and a cessation of menses. The victim is found in a state of "early menopause". In humans this hormone suffering is more insidious but it exists and its effects on bone density are comparable. The sports overwork cocktail, dietary deficiencies and disappearance of rules typically found in young women anorexic. Faced with a stress fracture, the sports physician must remain vigilant. It should not simply treat a "bone". It has an obligation to support a whole person, he is responsible for seeking overtraining or behavioral disorders.

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