Biomechanics and Medicine in Swimming XI

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minutes, thereby determining the maximum lactic acid concentration at an intensity whose main source of energy was supplied by the anaerobic lactate as well as the aerobic system (Zamparo et al., 2000; Capelli et al., 1998). In this way, the swimmers did the R2 over a distance of 150 to 200 meters, or 300 to 400 meters, according to their swimming speed. In the same way, the duration of 60 seconds was selected for every swimmer in R1 to swim at maximum effort and so determine the maximum LA concentration at an intensity whose main source was supplied by the anaerobic lactate system (Zamparo et al., 2000; Capelli et al., 1998). Thus the swimmers carried out R1 over a distance of 50 to 100 meters according to their swimming speed. This decision meant that there were no significant differences (p>0.05) in the swimming time between groups in R2 (G1=212.82” ± 57.96; G2=248.02” ± 66.60; G3= 208.95” ± 67.33) y en R1 (G1=76.76” ± 16.61; G2=75.90” ± 21.02; G3= 67.33” ± 9.02) Roi & Cerriza (1992) studied the difference between disabled and non-disabled swimmers over the same distance for both groups (50 meters). The results obtained do not account for the fact that disabled swimmers required a swimming time of approximately 129% of the non disabled (26.66” vs 61.29”). One of the contributions of our study is to show the necessity of equating the swimming times and intensity, as opposed to selecting the same distance, when comparing the performance between swimmers with and without disabilities. The swimmers with disabilities showed similar values (G2) or lower (G1) to the swimmers without disability (G3). However, Pelayo et al. (1995) present higher LA concentration values in swimmers with disabilities than the swimmers without disabilities on intensities related to the maximum aerobic speed (similar to our R2), evidencing the difference in training programs for the swimmers with and without disabilities. If the LA accumulation depends on the musculature engaged during the effort (Ohkuma & Itoh, 1992), it seems reasonable to think that the characteristics of the different disabilities of the swimmers from lower classes, would limit the neuromuscular activation relative to the swimmers from higher classes and swimmers without disabilities. For example G1 was formed by 4 cerebral palsy and 3 paraplegic swimmers. Another aspect to analyze is the differences in LA between R1 and R2 in the different groups. Although the results obtained do not show differences between repetitions, the analysis for each swimmer shows whether the maximum LA concentration can be found in R1 or in R2 (Table 4). Table 4. Individual blood lactate levels for groups and conditions. Group 1 (n=10) Group 2 (n=9) Group 3 (n=10) R1 vs R2 (mmol/LA) R1 vs R2 (mmol/LA) R1 vs R2 (mmol/LA) 7.3 6.8 11.3 9.2 12.2 10.8 8.9 6.9 8.9 9.9 11 11.1 11 7.6 11 8.4 12.7 7 8.6 5.7 14.2 12.1 10.7 11.7 12 9.2 14.2 11.7 10.7 11.8 12 7 10.4 8.1 13.4 10.1 9 9.7 10.8 10 14.1 12 6.4 3.4 13.6 9 14.7 10 14 12 13 9.6 11.7 11.3 6.4 5.2 - - 10.1 9.7 As Table 4 shows, four swimmers obtained similar values between R1 and R2 (≤0.5 mmol/LA), three swimmers obtained greater values in R2 (>0.5 mmol/LA), while the rest of the swimmers obtained greater values in R1 (>0.5 mmol/LA). The LA concentration in aerobic-anaerobic intensities can vary as a function of the training carried out on the aerobic or anaerobic system, as indicated in the latest scientific results (Kirsten et al., 2008). Thus the concentration of LA in R1 with respect to R2 could be due to the physiological adaptations produced by the type of training; whether aerobic or anaerobic. chaPter6.medicineandwatersafety conclusIon To conclude, at anaerobic and aerobic-anaerobic intensities, the swimmers of the lower classes have a lower LA accumulation than the swimmers from higher classes and the swimmers without any functional impairment. However, the swimmers from the higher classes have a similar LA accumulation to those swimmers without functional disability. reFerences Avlonitou, E. (1996). Maximal lactate values following competitive performance varying according to age, sex and swimming style. J Sports Med Phys Fitness, 36, 24-30. Capelli C, Pendergast DR, Termin B. (1998). Energetics of swimming at maximal speeds in humans. Eur J Appl Physiol, 78, 385-93. Chin T, Sawamura S, Fujita H, Nakajima S, Ojima I, Oyabu H, Nagakura Y, Otsuka H, Nakagawa A. (2001). Effect of endurance training program based on anaerobic threshold (AT) for lower limb amputees. J Rehabil Res Dev 38, 7-11. De Aymerich, J. (2007). Paralympic swimmers training: Case study. “Swimming Science I”. Editorial Universidad de Granada. Granada ISBN: 978-84-338-4789-8 Denadai, S.B. (2002). Determinação do limiar anaeróbio em jogadores de futebol com paralisia cerebral e nadadores participantes da Paraolimpíada de Sidney 2000. Rev Bras Med Esporte, Vol. 8, Nº 3 – May/ Jun, 117-121 Esau, SP & Macintosh, BR. (2006). Post-race lactate levels and classification international level physically disabled swimmers. VISTA Conference 2006 Congress IPC: Classification and Solutions for the future. Boon: Federal Ministry of Interior Foster, C., Fitzgerald, D.J., Spatz, P. (1999). Stability of the blood lactate, heart rate relationship in competitive athletes. Med Sci Sports Exerc, 31, 578 – 582. Garatachea, N., Abad, O., García-Isla, F.J., Sarasa, F.J., Bresciani, G., González-Gallego, J., De Paz, J.A. (2006). Determination and validity of critical swimming velocity in elite physically disabled swimmers. Disability and Rehabilitation, 28(24), 1551 – 1556 Hellwing, T., Liesen, H., Mader, A., Hollmann, W. (1988). Possible means of sprint –specific performance diagnostics and training support using blood lactate concentrations. Abstract. International Journal oj Sports Medicine, 9 (5), 87 – 388 Burgomaster, K.A., Howarth, K.R., Phillips, S.M., Rakobowchuk, M., MacDonald, M.J., McGee, S.L., Gibala, M.J. (2008). Similar metabolic adaptations during exercise after low volume sprint interval and traditional endurance training in humans. J Physiol 586 (1), 151–160. Marliss, E. B., Kreisman, S.H., Manzon, A., Halter, J.B., Vranic, M., Nessim, S.J. (2000). Gender differences in glucoregulatory responses to intense exercise. J. Appl. Physiol, 88, 457–466. Ohkuma, T., Itoh, H. (1992). Blood lactate, glycerol and catecholamine in arm strokes, leg kicks and whole crawl strokes. J Sports Med Phys Fitness, 32, 32 – 38. Pelayo, P., Moretto, P., Robin, H., Sidney, M., Gerbeaux, M.; Latour, M.G., Lavoie, J.M. (1995). Adaptation of maximal aerobic and anaerobic tests for disabled swimmers Eul J Appl Physiol, 71, 512-517 Roi, G.S., Cerizza, C. (1992). Post-competition blood lactate in disabled swimmers. In: D. MacLaren, Thomas Reilly, A. Lees Eds. Biomechanics and medicine and swimming VI, 257–259. Telford, R.D., Hahn, A.G., Catchpole, E.A., Parker, A.R., Sweetenham, W.F. (1988). Post competition blood lactate concentration in highly ranked Australian swimmers. In: Swimming Science V Ungerechts, B.E.,Wilke, K., and Reischle, K., eds. Champaign, IL: Human Kinetics Publishers,. pp. 277–283. Zamparo, P., Capelli, C., Cautero, M., Di Nino, A. (2000). Energy cost of front-crawl swimming at supra-maximal speeds and underwater torque in young swimmers. Eur J Appl Physiol, 83, 487–91. 361
BiomechanicsandmedicineinswimmingXi Athletic Rehabilitation of a Platform Diver for Return to Competition after a Shoulder Dislocation Fujinawa, o. 1,2 , Kondo, Y. 3 , tachikawa, K. 1,3 , Jigami, h. 1,4 , hirose, K. 2 , Matsunaga, h. 5 1Medical Science Committee of Niigata Swimming Federation, Nagaoka, Japan 2Saitama Prefectural University, Koshigaya, Japan 3Yuyukenkomura Hospital, Nagaoka, Japan 4Niigata University of Health and Welfare, Niigata, Japan 5Himeji Dokkyo University, Himeji, Japan A high-school male diver was diagnosed with tendinitis of the left supraspinatus secondary to shoulder dislocation during the water-entry stage of a 10-m dive. Land-based athletic rehabilitation consisting of 15 sessions was initiated at a hospital on the 5 th day after the injury. After treatment with anti-inflammatory medication and immobilization by using a chest band, the patient performed stabilizing exercise of the glenohumeral joint and scapula abduction-adduction exercises from the 13 th to the 22 nd day. Aquatic rehabilitation (total, 6 times) was started on the 17 th day; joint mobilization of the glenohumeral joint and mobilization with movements and motor control exercises were applied until just before competition. He started diving practice on the 21 st day; then, he returned to the National Sports Festival competition and won the 2 nd prize for the 10-m platform dive on the 26 th day after injury. Key words: mobilization with movement, joint mobilization, PnF, impingement, motor learning IntroductIon Diving-related injuries among children and adolescents younger than 20 years were comprehensively examined, and the research showed that the percentage of upper-extremity injuries was 9.5% (Day et al., 2008). According to their report, the frequency of diving-related extremity injuries was relatively low. In this study, we describe the treatment and rehabilitation protocol for a high-school diver with an injury to the left supraspinatus tendon secondary to shoulder dislocation during the water-entry stage of a 10-m dive. He started athletic rehabilitation on day 5 after the injury, and he tried to dive on the 21 st day; then, he returned to the National Sports Festival in Japan and won the 2 nd prize for 10-m platform diving on the 26 th day after injury. The objective of this case study is to retrospectively analyze the rehabilitation program and to suggest effective physical therapy (PT) procedures with regard to the biomechanical aspect. Methods The patient’s medical records, including magnetic resonance imaging (MRI) scans, were evaluated, and the PT records for hospital and poolside rehabilitation were retrospectively analyzed with regard to the biomechanical, anatomical, and kinesiologic aspects. This study program was approved by the Saitama Prefectural University Ethical Committee. results History. The male patient, who was 17 years of age, experienced shoulder dislocation during diving practice for the Inter-High School Championships held outside his native city. He dislocated his left shoulder due to abduction of the arm during entry into the water. When a coach raised him from a supine to a sitting position to apply a sling at pool side, the dislocated shoulder was spontaneously reduced. He was admitted for emergency care to a local hospital because of joint swelling and severe pain. After the championship, he visited the orthopaedic department of a hospital in his native city and commenced land-based 362 rehabilitation (Table 1). Diagnosis and Medication. He was diagnosed with supraspinatus tendinitis, and MRI indicated swelling of the supraspinatus tendon and glenohumeral hydrarthrosis (fig. 1). Anti-inflammatory medication and immobilization by a chest band were prescribed. Land-based rehabilitation at a hospital commenced on the 5th day after injury and was completed on the 22nd day (15 visits total). During the immobilization period (from the 5th to the 12th day), PT programs consisted of the sound side and general conditioning exercises. From the 13th to the 22nd 24 BMS XI Chapter 6. Medicine, Rehabilitation and Prevention aspects. This study program was approved by the Saitama Prefectural University Ethical Committee. RESULTS History. The male patient, who was 17 years of age, experienced shoulder dislocation during diving practice for the Inter-High School Championships held outside his native city. He dislocated his left shoulder due to abduction of the arm during entry into the water. When a coach raised him from a supine to a sitting position to apply a sling at pool side, the dislocated shoulder was spontaneously reduced. He was admitted for emergency care to day, a local the hospital PT programs because of joint introduced swelling and stabilization severe pain. After exercises the of championship, the left glenohumeral he visited the orthopaedic joint using department isometric of a hospital rotator in his cuff native exercises city and and commenced land-based rehabilitation (Table 1). scapula Diagnosis abduction-adduction and Medication. He was exercises. diagnosed Concentric with supraspinatus and eccentric tendinitis, and rotator MRI cuff indicated exercises swelling of the of the glenohumeral supraspinatus tendon joint and using glenohumeral a rubber hydrarthrosis band were (fig. 1). Anti-inflammatory medication and immobilization by a chest band were also prescribed. used. The objectives of the scapula abduction-adduction exercises were Land-based to gain rehabilitation optimal scapular at a hospital mobility commenced and on stability the 5 for normal scapulohumeral rhythm and to prevent glenohumeral joint dysfunctions, such as abnormal stresses to the anterior capsular structures, increased possibility of rotator cuff compression, and decreased performance. Isometric, concentric, and eccentric rotator cuff exercises were applied to keep the optimal position of the glenohumeral joint and to improve adequate balance of internal and external rotator muscle strength (Niederbracht et al., 2008). th day after injury and was completed on the 22 nd day (15 visits total). During the immobilization period (from the 5 th to the 12 th day), PT programs consisted of the sound side and general conditioning exercises. From the 13 th to the 22 nd day, the PT programs introduced stabilization exercises of the left glenohumeral joint using isometric rotator cuff exercises and scapula abduction-adduction exercises. Concentric and eccentric rotator cuff exercises of the glenohumeral joint using a rubber band were also used. The objectives of the scapula abduction-adduction exercises were to gain optimal scapular mobility and stability for normal scapulohumeral rhythm and to prevent glenohumeral joint dysfunctions, such as abnormal stresses to the anterior capsular structures, increased possibility of rotator cuff compression, and decreased performance. Isometric, concentric, and eccentric rotator cuff exercises were applied to keep the optimal position of the glenohumeral joint and to improve adequate balance of internal and external rotator muscle strength (Niederbracht et al., 2008). Table 1. Process of Athletic Rehabilitation. Table 1. Process of Athletic Rehabilitation. Day* Situations Conditions Findings and Programs** 5 th Land-based Immobilizatio -General conditioning exercises such as stretching rehabilitation at n and strength training of the neck, trunk, and a hospital extremities except the affected left arm 13 th Detachment of -Left shoulder passive ROM: Flex 120, Abd 90, ER the 20, IR 35 immobilizing -Pain in the supraspinatus and middle deltoid area brace and -Program: 1) Stabilization of the glenohumeral joint exercises of the affected arm with isometric exercise; 2) Scapula Abd-Add exercise 15 th Swimming Walking in the -Passive ROM: Flex 145, ER 30, IR 30 team training pool -Program: 3) Concentric and eccentric rotator cuff camp exercises by using a rubber band 17 th Aquatic Breast Findings and programs after camp training 25 BMS XI rehabilitation at Chapter swimming 6. Medicine, -Resting Rehabilitation pain in and the Prevention anterior aspect of the shoulder pool side -Active movements: pain with Abd 90, ER 30, IE 80, Horiz Add 60 -Passive movements: Abd 90 with pain and restricted at 120 by pain and muscle guarding -Joint mobility test: could not be performed because of pain and muscle guarding -Palpation: muscle spasms and tenderness in all rotator cuff muscles -MWMS with posteroinferior glide: full Flex-Abd- ER without pain -Program: 4) MWMS; 5) Taping at the rotator cuff 18 th 2 nd Aquatic rehabilitation -Program: 6) Self MWMS 21 st 3 rd Aquatic Diving -Pain condition: no pain experienced during front rehabilitation dive; pain experienced during back dive -Program: 4) MWMS with a 300-g weight; 6) Self MWMS with a 300-g weight; 7) PNF (slow reversal, repeated contraction) 22 nd Completed landbased rehabilitation -Passive ROM: Flex 170, ER 60, IR 70 23 rd 4 th Aquatic -Rapid Abd-ER causes pain rehabilitation -Program: 4) MWMS with a 500-g weight; 6) Self MWMS with a 500-g weight; 7) PNF; 8) TFM and functional massage 25 th 5 th Aquatic 1 day before -The same programs were continued rehabilitation the competition 26 th 6 th Aquatic Before the -No shoulder pain rehabilitation competition -Same programs were continued *, Day after onset of the injury; ** Abbreviations: ROM, range of motion (numbers represent degrees); Flex, flexion; Abd, abduction; Add, adduction; ER, external rotation; IR, internal *, rotation; Day after Horiz onset Add, horizontal of the injury; adduction; ** MWMS, Abbreviations: mobilization with ROM, movements; range PNF, of motion proprioceptive neuromuscular facilitation; TFM, transverse friction massage (numbers represent degrees); Flex, flexion; Abd, abduction; Add, adduction; ER, external rotation; IR, internal rotation; Horiz Add, horizontal adduction; MWMS, mobilization with movements; PNF, proprioceptive neuromuscular facilitation; TFM, transverse friction massage Figure 1. MRI findings of the left Shoulder
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Figure 1. General biomechanical par
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average VO2 measured during resting
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Fourteen highly trained male swimme
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Figure 2. Repeatability of the LTin
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-ARM * 5 Biomechanicsandmedic
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