Swelling in athletes
Currently, most sportsachievements are associated with colossal physical and psychological and emotional stresses that athletes experience, both in training and during the competition. To preserve the health of the athlete is called sports medicine, which, according to a number of authors (Pavlov SE 1998, Blair AN Chistova NA Kuznetsova TN Pavlov SE 2001), does not fully cope with their tasks. The goal for an athlete, trainer and sports body is one - a high sports result, the first or prize place, the medal received. And all this at any cost, even at the expense of health (Vlasov AA 2001).
Speaking of occupational diseases of athletesdealing with weights - one can not help but dwell on such a widespread disease as varicose dilation and chronic lymphovenous insufficiency of the veins of the lower extremities.
Publications on the Internet in no way helpto reveal the essence of this vascular pathology in athletes: "Until recently, very little attention was paid to diseases of the veins of athletes. However, varicose veins are common in athletes often. This is a primary varicose veins of the lower extremities, mostly superficial, and the veins of the spermatic cord. As is known, the primary varicose veins are an independent disease in contrast to the secondary one, which is the consequence of some pathological condition (deep vein thrombosis, thrombophlebitis, etc.). Literature on the diseases of veins in athletes, is small. " Excessive stresses of all physiological systems of the athlete's body, including the venous system of the lower limbs.
Varicose veins or varicose veins(WB) of the veins of the lower limbs in athletes today is very widespread. More than 50% of athletes have vein changes, and often they are manifested in athletes at the initial stage of the training process. At 50-70% of the sportsmen who are in a hospital or address in an out-patient department on absolutely other occasions, doctors find out the changed superficial veins. Most often, athletes with WB are concerned about the cosmetic appearance of the legs (usually girls), or other clinical manifestations of chronic lymphovenous insufficiency (leg fatigue, swelling, pain syndrome, and finally trophic leg ulcers).
1. The causes of varicosity in athletes
When practicing weightlifting, rowing,Greco-Roman and freestyle wrestling, boxing, tennis and other kinds of athletes not only have significant loads on their legs, but also a significant increase in intra-abdominal pressure. If you recall the structure of the human venous system, it becomes clear that the tension of the abdominal muscles will inevitably lead to an increase in pressure in the inferior vena cava - the venous blood collector from the lower half of the trunk. Different muscular loads in sports depend on the sport. The available research results show that, depending on the weight of the lifted cargo, the magnitude of the dynamic and static load, the number of movements per workout, the time it takes and the posture (standing, lying). There are various pathological disorders of the peripheral nervous system and musculoskeletal system, as well as orthostatic stress-the tension of the mechanisms of regulation of the heart and vessels, caused by significant or progressive deposition of blood in the lower half of the body. Especially in weightlifting, in particular, in powerlifting. In occupations in professional sports, these loads can cause occupational diseases. And physical exercises themselves should be treated as occupational hazards.
The reasons for the development of varicose veins are many, butgenetic predisposition is the main "Achilles' heel" of athletes whose hard work is accompanied by excessive loads on the muscles of the lower extremities, high traumatization of tissues and "ragged", at times, non-physiological loads. The main factor of varicose veins of the lower extremities is the hereditary weakness of the connective tissue of the body, the walls and valves of the veins themselves, as well as high pressure in the veins of the lower extremities. Hereditary weakness of the connective tissue is manifested by hernias, varicocele, hemorrhoids, deformities of the spine and extremities, flatfoot and other diseases, which, according to S.A. Zarubina (1962), K. Zaloga (1972), N. Dodd and F.V. Cockett (1976), etc. are observed in 50-70%, and according to our data - in 33% of patients with varicose veins.
A pronounced tendency tovaricose veins. N. Hach (1967) points out that in a varicose disease of one of the parents, 68% inherit this disease, and in the case of both parents' diseases, 24 - 78.6% of children. Heredity of varicose veins, we noted in 78%, N. Dodd, I.F. Cockett (1976) - in 70%, and N.I. Krakowski et al. (1973) - in 85% of patients. There are cases of varicose veins in several members of the same family. Often, with varicose veins, hemorrhoids, flat feet or other pathology associated with congenital weakness of connective tissue.
Varicose disease is a polyethica disease in the development of which a significant role is played by genetic predisposition, hormonal effects (pregnancy, estrogen intake), gender (women are more likely to suffer), work activity (standing work, sports activities (heavy physical activities). subcutaneous veins and perforators, as a result of which relative failure of the valves develops, which leads to venous reflux of the vertical (from top to bottom) and horizontally (from deep veins to superficial), the pathogenesis of the WB consists in the gradual degradation of the smooth muscle and elastic fibers of the wall of the subcutaneous veins and perforators, which leads to their gradual expansion.This is the background of the relative insufficiency of the valves (they remain intact, but the valves do not completely close ) Venous reflux occurs from the top down the subcutaneous veins (vertical) and from the deep veins into the superficial (horizontal) .In rare cases, there may be valvular insufficiency of the deep veins with the occurrence of tion of vertical reflux. The basis of pathological changes in hemodynamics in varicose veins are violations of the basic structures of the venous wall, affecting all three membranes.
Increase in vein volume with varicose veinsbe in direct proportion to the pressure. The tonus of the wall is lost and it "crawls" like a thin-walled rubber tube. This is confirmed by histological studies of the veins of the lower extremities macroscopically altered in varicose veins. Thus, varicose veins usually develop on the basis of congenital weakness of the connective tissue, muscles and walls of the veins themselves. Vein enlargement in such people is facilitated by high venous pressure in an upright position, largely dependent on large anastomoses between the systems of the hollow veins through the unpaired and semi-unpaired veins. These anastomoses increase the hydrostatic pressure in the entire system of the inferior vena cava, including in the veins of the lower extremities. Congenitally underdeveloped walls of veins hardly withstand the increased pressure and under the influence of other additional unfavorable factors (heavy physical load, improper training, "ragged" training, lack of restorative measures) gradually varicose. We believe that all healthy people with increased venous pressure of the lower extremities are prone to varicose veins. If phlebohypertension is accompanied by congenital maldevelopment and weakness of connective tissue, vein walls and valves or other factors contributing to phlebocytotension and damaging veins (heavy physical work, pregnancy, infectious diseases, thrombophlebitis, endocrine disorders, etc.), then varicose disease develops. Thus, the etiology and pathogenesis of varicose disease is a complex complex of internal and external factors affecting the body.
2. Signs of varicosity in athletes
The first signs of varicose disease inathletes are swelling of the lower leg and feet at the end of the day, a feeling of heaviness and bursting in the calves, which appears with prolonged stays in a sitting or standing position. Shoes, comfortable in the morning, begin to reap in the evening; Socks leave deep marks on the skin. Characteristically, these symptoms decrease with walking and after an overnight rest. Quite often the first manifestation of venous insufficiency is night cramps in the gastrocnemius muscles. Varicose veins appear. As the varicose progresses, the shin skin becomes dry, sensitive to various injuries. Then on the skin there are small islets of brown color, gradually merging into a single archipelago. In its center, a patch of skin resembling a stearin is formed, and then a trophic ulcer is opened. However, it should be borne in mind that varicose veins can "not make themselves felt" for a long time and appear only as a cosmetic defect. But this does not mean the absence of disease! Despite the apparent well-being, the disease gradually seizes new and new vessels, which ultimately leads not only to the expansion of the subcutaneous veins, but also to the development of serious, hardly reversible changes in the skin and subcutaneous fat of the lower extremities (dense swelling, pigmentation and ulceration).
Important: varicose disease of the lower extremities is a disease that is steadily progressing and only mandatory preventive measures and timely treatment guarantees an effective solution to this problem. The veins are varicose and the first signs of venous insufficiency appear: the edema of the shin and foot at the end of the day, the sensation of heaviness and bursting in the calves, appearing with prolonged stays in the "sitting" or "standing" position, pain in the calf muscles, convulsions. It is the early diagnosis of varicose veins that makes it possible to select the most effective treatment and a set of preventive measures aimed at slowing the progression of the pathological process and preventing complications. Edema of the extremity or its segment is characteristic for diseases of the venous and lymphatic system. However, its cause may be circulatory insufficiency, inflammation of the soft tissues of renal and hepatic insufficiency, etc. For the differential diagnosis, it is necessary to take into account the time of edema (morning, evening), its nature (dense, soft), localization (tibia of the periarticular region) communication with physical loads, etc.
Pain in the extremities is the most vivid symptom,indicating a pathological process. Depending on the lesion of the arterial or venous system, the nature of the pain syndrome and the factors provoking it may differ. With arterial insufficiency, the pain syndrome is intense, arises or intensifies during physical exertion and lifting of the limb above the horizontal. The pathology of the venous system is indicated by the pain of a bursting nature with a decrease in intensity during walking, after resting with raised legs, and when compressive jersey is applied. Changes in the intradermal and subcutaneous veins are characteristic for various forms of phlebopathology. It can both a simple enhancement of the venous pattern, and of varying degrees of variability, the varicose transformation of these vessels. All chronic vascular diseases in one way or another affect the trophic skin and its appendages. With arterial pathology, the most common complaints are lowering the temperature of the limb, brittleness and fungal lesions of the nail plates, easily arising and poorly healing skin wounds. In chronic venous insufficiency, attention is paid to hyperpigmentation and induration of the skin of the shin or the formation of chronic ulcers.
3. Methods of prevention of varicose disease in athletes
The current state of the problem of preventing varicose disease in athletes.
According to data presented at the XIV WorldCongress of the International Society of Phlebology (2001), in Europe and North America, 25% of the working population suffers from chronic lymphovenous disease. With the pathology of the veins, the function of the lymphatic system is always violated to some extent, but its violation is most pronounced in athletes who underwent erysipelas. Therefore, there is a sense to talk about a combined lesion, i.e. about chronic lymphovenous insufficiency.
In Russia, more than 35 million people suffervarious forms of HCVL. In 15% of them, CVI is complicated by trophic leg ulcers. Considering that "heavy" sport is an industrial risk for athletes in the field of violation of venous circulation of the lower extremities, the urgency of this pathology becomes even more acute.
HCV reduces the patient's ability to work, oftenleads to its temporary loss, is the cause of disability. The problem of treating such patients is of medical and social importance. In this regard, the need remains to develop new and improve old methods of prevention and conservative treatment.
Methods of preventing chronic lymphovenous insufficiency of the lower extremities in athletes.
We have substantiated the evidence of necessityuse of athletic compressive knitwear (compressport) for the prevention of varicose veins of the lower extremities. It is necessary to familiarize trainers and sports physicians who are interested in this problem with modern ideas on recommendations for athletes with initial manifestations of chronic lymphovenous pathology. The main tasks are formulated taking into account the clinical and functional data obtained during the survey.
Modern preventive measures aimed at solving the set tasks:
1. changes in lifestyle,
3. application of sports compression knitwear (compressport) - ("functional venous dentures"),
4. Physiotherapy exercises - "venous walking", "
It should be specially noted that the highesteffectiveness is noted when a combination of different groups of funds. Differential diagnosis of CHLV is carried out with diseases manifested by chronic edema of the lower extremities (dimfostasis) and trophic skin disorders. The main differential diagnostic criteria are characteristic complaints, the appearance and growth of which provoke static loads, varicose veins of the subcutaneous veins, as well as the results of ultrasound examination methods. The greatest difficulties arise with combined chronic arterial and venous pathology. Here the main criterion, which allows to establish the prevailing pathology, should be considered an ankle-brachial index. With an ankle-brachial index greater than or equal to 0.8, CVI is the priority. An ankle-brachial index less than 0.8 determines the need for priority treatment of chronic arterial insufficiency (AI Kirienko, VM Koshkin, V.Yu. 2009). At the Department of Theory and Methods of Athleticism of the National State University of Physical Culture, Sport and Health, P.F. Lesgaft (St. Petersburg), we tested the experimental group, which included 12 athletes (age from 18 to 25 years, 1st category 6 athletes, KMS - 4 athletes, MS - 2 athletes, length of time for powerlifting from 1 up to 3 years) with the use of sports compression knitwear on the lower extremities, mainly used golfs. The testing had a dual orientation, in which technical skill was improved in the experimental group using the athlete's functional state index (ISSF), developed at the Department of Theory and Methods of Athleticism at the NSU of Physical Culture, Sport and Health. Lesgaft, and preventive maintenance of LVLN of the lower extremities was carried out. The control group in which sports jersey was not used was 12 sportsmen (age of participants from 18 to 25 years, 1st class - 7 people, KMS - 5 people, length of employment from 1 to 3 years). The training in powerlifting included working out bench press lying down and becoming traction. The next lesson was training with compression knitwear and squats with a barbell. In total 48 lessons were conducted.
The study was carried out in accordance with the Helsinki Declaration on Human Rights with the voluntary consent of the participants.
For athletes, "working" with weights, extremelyit is important to use equipment, in particular for powerlifters - a bandage on the abdominal wall in the form of athletic belts. Athletic shirts, the use of suspensions in the field of wrist and knee joints, during exercise, compression knitwear on the lower limbs (Naumenko EV Platonova LN Butov A.Y. Dalsky DD 2012). The pressure in the deep veins of the lower extremities is the same as in the subcutaneous veins. With the vertical position of the person, the hydrostatic pressure acts in the direction opposite to the venous blood flow, and is the main cause of high venous pressure of the lower extremities, which dramatically burdens the return of blood to the heart. A small (about 1.18 kPa, or 12 cm H2O) hydrostatic pressure remaining after overcoming the network of arterioles and capillaries, is unable to overcome the resistance of high hydrostatic pressure of the lower limbs. Return of blood to the heart from the lower limbs is helped by a number of extracardiac mechanisms:
- Muscle limb cuts - "muscular pump";
- sucking action of the heart;
- pulsation of the arteries near the veins.
Sports compression knitwear (compressport)for athletes is mandatory in both physiological and strategic relationships! To date, the best methods of prevention are the use of compression knitwear to create a pressure of 12-17 mm Hg and a therapeutic physical culture. The use of compression therapy leads to the following 10 effects:
- reduction of diameter of veins,
- an increase in the rate of venous blood flow,
- improvement of central hemodynamics,
- a decrease in venous reflux,
- improvement of the function of the venous pump,
- influence on the arterial blood flow,
- increased drainage function of the lymphatic system.
Special compression knitwear (knee socks,stockings, tights) are made with the help of machine knit by seamless technology. The principal features of these products are porous binding, which provides favorable conditions for the water and temperature balance of the skin, and also allows its use even in hot climates and in hot seasons. No less important are the high aesthetic properties of modern compression knitwear, allowing athletes to maintain the usual level of training and quality of life when using it.
It should be borne in mind that a frequent mistake assports doctors, and some coaches, as well as the athletes themselves, is the identification of sports, medical, preventive and antithrombotic knitwear. These products and the ideology of their application have fundamental differences. Preventive knitwear from everyday distinguishes only physiologically distributed pressure and more dense mating, increasing its longevity. The degree of compression is much lower than necessary to compensate for violations of venous outflow (compression less than 18 mm Hg) developing with chronic venous insufficiency. This knitwear prevents chronic venous insufficiency in risk groups (pregnancy, sedentary lifestyle, long-term static loads, hormonal contraceptive use, hereditary predisposition, significant body weight fluctuations). Therapeutic compression knitwear in accordance with a single European standard is divided into 4 classes, with mandatory indication of pressure at the level of the ankles in mm Hg from 15 mm Hg. Art. up to 49 mm Hg. Its features are: lack of seams, hypoallergenicity and high strength. Medical compression knitwear is selected strictly individually, taking into account the nature of the pathology and features of limb anatomy. It is advisable to remove the measures in the morning, before the appearance or strengthening of the edema of the extremity (AI Kirienko, VM Kozhkin, V.Yu. Bogachev, 2009). Antithrombotic knitwear with a pressure of 18 mm Hg. serves to prevent deep vein thrombosis in patients during surgery and who are on prolonged bed rest. Products can be subjected to thermal sterilization. But sometimes both athletes and coaches use normal elastic bandages, not knowing and not knowing how to use them. Thus, sometimes, exacerbating the already existing lymphovenous insufficiency of the lower limbs.
In addition, one should not forget the well-proven physiotherapeutic treatment of LVLN of the lower extremities. These techniques can be used for both treatment and prevention.
Given that the lymphatic system iscompensatory link in venous hypertension of any origin, and the more pronounced it is, the greater the changes the lymphatic channel. All this makes it necessary in the treatment of venous hypertension in the lower limb system to carry out appropriate correction of lymphatic drain disorders, which certainly can improve the overall results of treatment (Stoiko Yu.M. Lytkin MI Shaydakov EV 2002).
In the process of pedagogical observation at thea preliminary stage of the study and a pedagogical experiment for diagnosing lower limb LVLN in athletes, a questionnaire was used with a subjective interpretation of clinical symptoms and an objective methodology for assessing the permeability of veins, the state of the valvular apparatus, and the evaluation of the blood flow through the veins-ultrasonic vascular diagnostics (triplex vascular scanning). 8 athletes from the experimental group had a subjective feeling of lightness in their legs after training with compression knitwear, two athletes used non-systematic jerseys, 2 athletes did not notice a significant effect from the use of knitwear. The control group, in which sports compression knitwear was not used, was 12 athletes. On subjective sensations, all of them noted a feeling of heaviness in the legs towards the end of the working day and in 5 - there were nocturnal cramps and swelling of the legs at the end of the "working day", and 2 athletes had a varicose disease in the basin of the large saphenous vein. Moreover, the athletes themselves noted these phenomena as a positive post-training effect.
Examination of athletes of the control group by the sports doctor did not reveal positive trends in their clinical and functional data.
It should be noted that the use of the complexphysiotherapy exercises and compression knitwear allowed to achieve significant improvements in shorter terms. Along with the reliably determined effectiveness of the use of compression knitwear and exercise therapy, we should also note the timing of achieving positive results. So, a clearly pronounced positive effect begins to appear already from the 4th day of training with exercise therapy and compression knitwear, and in 82.5% of athletes edematous syndrome was stopped on the 12th day of training. It is also noteworthy that the number of athletes experiencing such symptoms as pain, feeling of heaviness, discomfort in the lower extremities against the backdrop of complex exercise therapy and compression knitwear has almost halved.
varicose athlete lymphovenous
The first signs of varicose disease inathletes are swelling of the lower leg and feet at the end of the day, a feeling of heaviness and bursting in the calves, which appears with prolonged stays in a sitting or standing position.
The reasons for the development of varicose veins are many, butgenetic predisposition is the main "Achilles' heel" of athletes whose hard work is accompanied by excessive loads on the muscles of the lower extremities, high traumatization of tissues and "ragged", at times, non-physiological loads.
Application of methods of medical rehabilitationathletes with CHLVN using preformed physical factors will improve the efficiency of the rehabilitation process, actively contribute to the restoration of impaired function of the lower extremities. In the treatment of athletes with LVLN of the lower limbs, individual tactics based on the use of a wide range of modern drugs, physiotherapy techniques, therapeutic gymnastics, limfodrenating massage of the lower extremities, and, of course, the use of sports compression knitwear, both for prevention and treatment, are justified. leads to an improvement in the quality of life of athletes.
The use of a complex of physiotherapy exercises and compression knitwear allowed to achieve significant improvements in shorter terms.
To date, the best methods of prevention are the use of compression knitwear to create a pressure of 12-17 mm Hg and a therapeutic physical culture.
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