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The medical examination of fitness

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Almost always asked by clubs, federations for the licensing and mandatory for the competition, the medical certificate of non-cons to the practice of sport is often seen as a consultation uninteresting or useless by the athlete.
So they are the reason for this visit to your doctor?
          it's the law !
r earch of against-indications especially for risk sports.
          prevent sudden death of the athlete.
In the absence of information, the medical certificate may be issued by your GP. Some federations or in the case of top athletes, you will be asked to go specifically to a sports doctor or a doctor approved by the same Federation.
usually different sports "at risk" of others. In this category are:
          motor sports
          combat sports with "KO" authorized
          air sports
          sports underwater
          mountaineering "cutting edge"
          sports using firearms
Skills and qualifications necessary for doctors are specified in the regulation of medical federations concerned.
The course of the consultation will be based on the age of the athlete, the sport practiced and the level of intended practice.
During this visit, the doctor is interested in personal and family history of the sport as well as popular sports and vaccination status. Medication must also be taken into account.
Clinical examination includes measuring height and weight, taking blood pressure and pulse rate at rest; cardiopulmonary auscultation and an examination of the musculoskeletal system adapted to the sport.
In children, one should check the height and weight growth curve and pubertal status. It is particularly interested in the study of the spine in static and dynamic. We often have to discuss upgrade (no problem in general for the simple but require examination and further questioning to double or even triple).
We study the cardiac adaptation to effort by the firm carrying out a test Ruffier-Dickson: 30 crunches 45 '' flat feet and arms outstretched. We take the resting pulse (P1) at the end of the effort (P2) and after a minute of rest (P3). Is then calculated:
 
The Index Ruffier = (P1 P2 P3) - 200/10
Depending on the results, one class diagram:
  • R <0: good adaptation to effort
  • 0 <R <5: good adaptation to effort
  • 5 <R <10: adaptation to the average stress
  • 10 <R <15: adaptation to the insufficient efforts
  • R> 15: poor adaptation to the effort with additional cardiac evaluation to achieve
The index of Dickson = ((P2-70) 2 (P1-P3)) / 10
 
the results are classified into:
  • D <0: excellent
  • 0 <D <2: very good
  • 2 <D <4: good
  • 4 <D <6: Average
  • 6 <D <8: low
  • 8 <D <10: very low
  • D> 10: mismatch with additional cardiac evaluation to achieve
The systematic implementation of an electrocardiogram (ECG) screening does not unanimously in France but is recommended by many sports associations and learned societies of sports medicine. It should be made ??upon delivery of the first sports license, regardless of age, and every 2 years.
It aims to reduce the "sudden death" of athletes seeking electrical signs of heart defects among younger and arrhythmias or cardiac signs of pain in older people. It is recalled that the sudden death affects 1 sports on 50,000 all sports and that's basically the casual rider over 45 years which is the victim ...
If ECG abnormalities or if you have cardiovascular risk factors, your doctor will probably ask other tests (stress test, echocardiography, etc.) and refer you to a specialist before you can issue the certificate.
It is true that all sports are not considered identical in terms of their potential risks but the medical fitness should not be treated as a simple administrative formality. This is an opportunity for the doctor, especially if it's the first time he sees the patient, to take stock, to look for cardiac risk factors and to discuss if necessary the relevance of chosen sport.

Doctor Charles AISENBERG. - 27 mars 2011.

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 Stéphane 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 Stéphane 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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