Page 12 - Summer 2020

TEAM PHYSICIAN’S CORNER
sports medicine physicians to understand but competed in wheelchair sports. The bowel dysfunction seen in spinal cord
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the injury and illness patterns of these authors theorized one reason that limb injury athletes. Complications of
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athletes as well as unique medical deficiency patients may have had a higher neurogenic lower tract dysfunction
considerations in these athletes. severe injury rate compared to athletes include neurogenic detrusor over activity
with other impairments such as those with and urinary tract infections secondary
Injuries cervical spinal cord patients is that the limb to catheterization. Neurogenic bowel
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deficient athletes may compete at a higher dysfunction results in prolonged GI and
The overall percentages of Paralympians 7
injured in the last two Paralympics, in intensity level in wheelchair sports. colorectal transit caused by poor mobility,
London and Rio, were 15.0 percent and Another concerning finding of the which can lead to chronic constipation
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4,5
12.1 percent, respectively. In the London study was that a majority of these athletes and abdominal distention. So, these
Games, there was no differences in overall reported feeling upset and guilty if they athletes need to work with medical and
injury rates between pre-competition and missed an exercise training session, training staff in developing safe bowel and
competition periods; although, there were resulting in them continuing to train bladder programs pre-competition and
high injury rates in the pre-competition despite being injured, thus leading to during competition.
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time period for females compared to the worsening severity of the injury. This is a
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competition time period. In contrast, in similar problem with able-bodied athletes Unique Considerations
the Rio Games, there was a significantly whose psychologic well-being is tied to Cardiovascular
higher overall incidence of injuries in their compulsory training, but it may be Paralympic athletes have been shown to
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pre-competition activities. This may have magnified in Paralympic athletes who have have a high incidence of cardiovascular
been secondary to the fact that the Russian been shown to have lower levels of self- (CV) disease. Pelliccia et al. performed
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team was suspended from the Games, acceptance and body-image perception history and physicals, 12-lead and
and 267 athletes from other countries and whose well-being may be tied even exercise ECGs, and echocardiography
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were recruited at the last minute, which greater to their mastery of a sport. on Italian Paralympians and found that
could have resulted in these athletes over- 33 of 267 (12 percent) athletes had CV
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training to prepare for competition. Illnesses abnormalities including 3 arrhythmogenic
In contrast to the results of similar The incidence proportion of illness cardiomyopathies, 3 aortic root dilations,
epidemiological studies of injuries in was almost twice as high in Paralympic 7 valvular diseases, and 11 cases of systemic
Olympic athletes and in other able-bodied athletes (12.4–14.2 percent) compared hypertension. Furthermore, ventricular
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athletes where lower extremity injuries to Olympic athletes (5–7 percent) in the and supraventricular tachyarrhythmias
predominate, upper limb injuries were more past two Games. 4,8,9 Respiratory illnesses were found in 9 other athletes. Of the CV
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common in Paralympians than lower were the most common, followed by
limb injuries, with the shoulder (17–18 disorders of the skin and subcutaneous abnormalities, 55 percent were identified by
percent) being the most commonly injured tissue, gastrointestinal tract (GI), and history and physical examination, and the
region. 4,5,6 The predominance of upper limb genitourinary tract (GU). 4,8,9 addition of ECG resulted in identification
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and shoulder injuries in these athletes is not Older age and type of impairment are of 91 percent of the CV abnormalities. A
8,9
surprising due to the fact that wheelchair associated with increased risk of illness. majority of the affected athletes, though,
athletes comprise a large proportion of Athletes with spinal cord injury had the denied symptoms or impairment in
the Paralympian population. Finally, highest proportion of illness (29.9 percent) physical performance and were among
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factors associated with higher rates of followed by athletes with amputation or the top competitors in their respective
injury in the Games include participation limb deficiency and athletes with visual sports, so a high level of performance
in 5-a-side football, older athletes, and impairment in the London Games. In does not rule out the presence of CV
4
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athletes with limb deficiency, visual the Rio Games, athletes with spinal cord abnormalities. Therefore, this study
impairment, and spinal cord injury. 4,5,6 injury similarly had the highest proportion provides evidence that, perhaps, routine CV
In a year-long study of the Swedish of illness (30.8 percent), followed by screens, including routine ECGs, should
Paralympic team, it was found that there those with limb deficiency and central be performed on Paralympic athletes to
was 31 percent prevalence of severe injuries, neurological injury. help identify treatable cardiac disorders.
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and the most severe injuries were associated The high incidence of skin problems
with athletes aged 18–25 years of age, not can be attributed to prosthesis use Thermoregulation
using an assistive device (limb deficiency in athletes with limb deficiency and Thermoregulation in sports is of utmost
patients), having pain during the sport, athletes with reduced sensation sitting in importance in climate extremes, in
using analgesics, continuing training while wheelchairs for prolonged periods. The particular the heat experienced in
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injured, and feeling guilt when missing high incidence of GI and GU disorders is the Summer Games venues, to avoid
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exercise. Most of the limb deficiency most likely secondary to neurogenic lower hyperthermia and heat illness, which
athletes wore a prosthesis in daily life, urinary tract dysfunction and neurogenic occur when heat production is greater

 10 SPORTS MEDICINE UPDATE | Summer 2020, Issue 3