Sports clinic Paris
Metro: Saint Marcel
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The information provided on this website is provided by medical professionals: sports doctors, rheumatologists, functional rehabilitation doctors, orthopedic, clinical surgeons sport, podiatrist sports meeting within the group "chirurgiedusport.com"
Tendon injuries are significantly favored by physical activity. Over 20% of sports medicine consultations devoted to it.
Tendinopathy is caused by:
- Muscle strength and / or
- Conflict with a joint structure
The effect of vibrations and dehydration remains controversial.
In the absence of metabolic disease, diet appears without influence.
The "tendonitis" of the child does not exist. These are bone lesions.
Physical activity involved in the treatment of tendinopathy:
- Rehabilitation is a "retraining tendon"
- A "muscle rebalancing" is often necessary.
- Painless physical activities are allowed and encouraged.
Sport has demonstrated its aggressiveness for the tendons.
An epidemiological study involving 7,000 sports medicine consultation was carried out. It shows that the tendon is the most frequent pathologies, just behind sprains. Ligament injuries represent 25% of trauma and suffering tendon 22%. Tennis is the sport in which predominates tendinopathy. Most often, they are located at the elbow or shoulder. In this discipline, they represent 56% of consultations. Running also shows very purveyor of tendinopathy. This time, 38% of medical examinations devoted to it.
Among the sedentary, 2% of individuals 42 to 46 years complain of tendon shoulder pain. They are 22% between 56 and 60 years and 30% after 65 years. According to the authors, 3-80% of swimmers suffering from rotator cuff. Mac Master has followed North American competitive swimmers (3). He points out that 35% of them had, during their sports career, interrupted their training program because of shoulder pain. Can we then afford to compare the shoulder of a swimmer in 20 years to that of a pensioner?
Why sport he causes tendon injuries?
Muscle pulls seek the tendon. The braking work called "eccentric contraction" is particularly aggressive to the tendon tissue. Indeed, each receiving jump or stride, knee bends slightly to dampen the movement and accumulate elastic energy recovery. In these circumstances, the quadriceps mission is to slow and control the motion. It then contracts as the joint is flexed. It is as if the muscle pulled in one direction while the bone pieces were moving away. The tendon is particularly abused. Many fibrous lacerations can occur. It is the same for all joints and in particular at the elbow. When playing tennis during the setback, the forearm muscles are trying to stabilize the wrist. The epicondyle tendon is severely involved. The suffering of the latter is called epicondylitis or "tennis elbow".
The inherent tendon ischemia anaerobic exertion probably helps reduce the ability of the tendon to assume these mechanical stresses. Furthermore, research conducted by the sports footwear industry raise the influence of impacts on the ground (1). It would seem that insufficient or inadequate damping causes vibrations at high frequencies of about 20Hz. These could resonate with structures tendon, ligament or bone and cause responsible amplification of histological or vascular lesions.
In athletes, particularly at the shoulder, tendon pain are favored by a conflict with articular structures. According to Neer, the anterior inferior border of the acromion shows particularly aggressive to the rotator cuff (4). For Jobe, these tendon friction is increased in case of glenohumeral laxity (2). This hypermobility is sometimes facilitated by a degeneration of the rotator, a vicious circle is quick to install. These strain are repeated on the occasion of sporting gestures large amplitudes as the serve in tennis or swimming in the movement of arms.
In children, in the chain muscle / tendon / bone, the bone insertion area is the weak link. The latter is particularly sensitive in periods of growth. The excess mechanical stress causes osteochondrosis. The best known is on the tibial tuberosity, occurs between 12 and 15 years and carries the disease name Osgood Shlatter. Sever's disease is equivalent to Achilles tendinitis and touches the calcaneus children aged 9 to 11 years.
Can the doping favor tendinitis?
Of course, there are no openly study including doped athletes. However, common sense pathophysiological and anecdotes of "land" suggest an answer. Unlike tendons, muscles have an intense metabolic activity. Anabolic significantly stimulate the production of contractile proteins and less synthesis tendon fibers. Thus, doping would cause an imbalance between muscle and tendon structure. The mechanical stresses imposed are disproportionate to the tendon and sources of injury. In addition, the tendon brittleness is surely accentuated in case of use of cocktail "anabolic / steroids."
What are the effects of hydration and sports nutrition?
Sufficient water intake generating always clear urine probably contributes to the prevention of tendinitis. Proper hydration tendons improve the mechanical qualities of these fibrous structures and poorly vascularized. Gout and high cholesterol can cause tendon pain. It is highly recommended to look for these pathologies in case of tendinopathy in athletes mature. However, in the absence of metabolic disease, diet has not demonstrated its influence on the injuries of the tendons. The acidity provided by a serving of meat is 20 times lower than that caused by a very intense workout.
Physical activity involved in the treatment of tendinopathy
Strength training humeral depressors, pectoralis and latissimus involved in the treatment of scapular pain. Strengthening these muscles helps reduce conflict tendons with acromial vault. This "rebalancing muscular" shoulder joins correction often imperfect technical movement in case of damage to the rotator cuff.
Stanish has shown that eccentric contractions and stretching prove particularly useful in the rehabilitation of chronic tendinopathy (5). He concluded by even a provocative slogan: "no pain, no gain" (No pain, no benefit). In fact, stretching and work muscular braking mechanized tendon structure. Gradually, it adapts to the constraints inherent in the specifically sporting mission. This is a real retraining tendon. However, in practice, the therapist must avoid pain as the coach was careful not to cause aches at the end of each session.
More than hinder scarring, the pursuit of physical activity in the pain threshold contributes to the tendon mechanization. If there is discomfort in the beginning of effort, it must gradually subside during the warm up. If she returns to cold, after training, it is necessary that the next meeting be shorter or less intense. In case of persistent pain in running, cycling devoid of eccentric contraction is often possible and beneficial!
1 - The 200 Follachier Mr. keyword sports chausure. Lyon. Ed CTC. 1991.
2 - Jobe et al: pain in the Schoulder overhand or throwing athlete: relationship of anterior stability and rotator cuff impingement. Orthop. Rev. 18 963 1989.
3 - Mac Master et al: Shoulder torque exchange in the swimming athlete. Am J Sports Med. 20, 3: 323-7, 1992.
4 - Neer CS: Impingement lesions. Orthop Clin. 173: 70, 1983.
5 - Stanish and neck: Eccentric exercise in chronics tendinitis. Clin. Orthop 208: 265-8, 1986.
Around a recent need, the treatment of pathologies related to the sport, the former Clinique Saint-Fran├žois, now Sport Clinic, was taken over by General of Health in 2002. The renewal of the medical staff with surgical team renowned helped to design and implement a medical and scientific project based on the quality of practice. G├ęn├ęrale de Sant├ę has worked to support this project, including through an intense program of renovation and careful management of human resources.
Today, the sport of Clinic is a hyper-specialized private institution under agreement in orthopedics, traumatology and sports medicine.
Medical and surgical consultations highly specialized, a reference imaging and functional rehabilitation recognized competence guarantee our patients the best care for diseases of the musculoskeletal system, either degenerative or related to physical activity.
The rupture of the Achilles tendon in athletes, is a rare event that usually occurs during the 3rd decade in athletes and 4th among the sedentary. The break often occurs when an eccentric effort (Work together a muscle elongation instead of the normal shortening) as a startup, acceleration or landing from a jump. Read more ......
Attention! This is no shock absorbing soles, type "ready to wear" sold in stores. No, they are "haute couture", tailored to your injury and imperfections of your stride. They are made ??"to measure" by a podiatrist sports. He knows the injuries encountered in sports. It does not use cork or leather. It uses synthetic materials flexibility cleverly distributed, which tolerate sweat and mechanical stress.
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.
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.