Irina Gretskaya a course of lectures on sports medicine for self-training of distance learning students. Sports medicine
Chapter iii basics of general human pathology
General pathology is the study of the most general patterns of pathological processes, their main features, which underlie any disease, regardless of the cause that caused it, the individual characteristics of the organism, specific environmental conditions, research methods (clinical, morphological, functional), etc. P.
General pathology serves primarily to study the biological aspects of medical problems and the very essence of human diseases. The main goal of both general pathology as a whole and its individual sections is to develop a coherent doctrine of the disease. First of all, practical medicine urgently needs this: only by relying on such teaching can one develop the scientific foundations for the prevention of diseases, give a correct assessment of the first clinical manifestations of the disease, clearly imagine the essence of its various periods, including relapses, and, as a result, increase rationality and effectiveness of medical intervention.
General pathology at the present stage of development consists of three sections. One of them includes information about such issues as the periodization of the disease, the causes of its occurrence (etiology), the mechanism of development (pathogenesis) and recovery, the significance of the constitution, heredity, reactivity, etc.
The study of pathology in the course of sports medicine is necessary for students of institutes and departments of physical culture of universities, primarily because athletes and schoolchildren (especially young athletes) often experience a variety of diseases and changes in the musculoskeletal system (MSA). In some cases, this is due to the fact that, with insufficient medical supervision, people who already have certain diseases or health conditions begin to engage in physical education and sports; in others, deviations in the state of health arise already in the process of playing sports. The occurrence of injuries and diseases in athletes (especially young ones) is facilitated by training without taking into account their health and functional status, age, gender and other factors.
In order to correctly decide the question of whether to continue training or stop it immediately, whether to consult a doctor or provide the athlete with some first aid, etc., it is important for the teacher (trainer) to know the main manifestations of pathology, to understand the causes and mechanisms of disease development.
Without knowing the general patterns of the occurrence of pathological processes (general pathology), it is impossible to understand the changes that occur in the body of athletes with certain diseases (particular pathology). Familiarity with specific pathology is also necessary when studying the use of physical culture means for therapeutic purposes in the rehabilitation system for various injuries and diseases, etc.
Knowing what health is, what disease is and under what conditions it occurs is an essential factor in the prevention of diseases and injuries during physical education and sports.
Health is a state of the body in which it is biologically complete, able to work, the functions of all its components and systems are balanced, and there are no painful manifestations. The main sign of health is the level of adaptation of the body to environmental conditions, physical and psycho-emotional stress.
High adaptability of the body to changes in the external environment (temperature, humidity, hypoxia, etc.) is necessary for athletes when training and participating in competitions.
It should be noted that there is no boundary between normal and pathological. There are various transitional stages between health and disease. The disease usually occurs in cases where the body is subjected to excessive physical and psycho-emotional stress or when adaptive functions are reduced. Then morphofunctional changes occur, often turning into disease or leading to injury to the musculoskeletal system.
Disease is a process of transformation of a normal state into a pathological one, associated with reactively determined changes in the degree of compensatory-adaptive self-regulation of living systems. The norm is a measure of the vital activity of an organism in given specific environmental conditions, within which changes in physiological processes are maintained at the optimal level of functioning of homeostatic self-regulation. The disease is associated with the transformation of the normal state of a living system into a pathological one, that is, with the transition to a new qualitative state.
Any disease is a damage to the entire body. According to the nature of the course of the disease, they are divided into acute, subacute and chronic. An acute illness begins suddenly, with pronounced symptoms immediately appearing. Subacute disease is more sluggish. Chronic illness lasts for many months or years. Sometimes an acute disease becomes chronic. This is facilitated by insufficiently active treatment, and in sports - early resumption of training or participation in competitions.
The concept of disease includes the idea of a pathological process and a pathological condition.
A pathological process is the body’s reaction to a pathogenic irritation, which is based on a violation of the function of an organ or its structure. During illness, various pathological processes can occur, for example, fever and inflammation of the glands with sore throat, fever and cough with pneumonia, etc.
A pathological condition is one of the stages of a pathological process or its consequence. An example of a pathological condition could be rheumatism, which subsequently leads to heart disease, myocarditis, etc.
Identifying and studying the causes of diseases serve as the basis for prevention. Most often, diseases arise as a result of exposure to external factors. However, diseases can also arise from internal causes within the body itself. External (exogenous) causes - hypothermia, overheating, radiation, malnutrition, etc. - change the internal state of the body, as a result of which immunity and resistance to pathogenic factors are reduced. Internal (endogenous) causes of the disease are associated with heredity, constitution, reactivity, immunity, etc.
Pathogenesis is the study of the mechanisms of occurrence, development and course of a disease. The pathological process can develop at various levels: molecular, tissue, organ, and finally, take over the entire system. It should be noted that in the body all cells, tissues and organs are inextricably linked. Therefore, there are no local diseases, the whole body is always sick. From this follows the basic principle of treatment: it is necessary to treat not the disease, but the patient (M.Ya. Mudrov).
During each disease, the following periods are distinguished: 1 - hidden, or latent; 2 - prodromal, or the period of harbingers of the disease; 3 - period of advanced course of the disease; 4 - period of completion of the disease.
The latent period is the time from the introduction of a pathogenic agent into the body until the first manifestations of the disease. In infectious diseases, the latent period is called the incubation period.
The prodromal period manifests itself in malaise, headache, chills, fever, etc.
The period of the developed course for each disease has certain manifestations and is characterized by a combination of certain symptoms. The set of symptoms is called symptom-tomocomplex or syndrome.
The period of completion of the disease can be different: recovery with restoration of functions, transition to a chronic form, complication or death.
When metabolic disorders occur in the body, various changes occur. It is known that all tissues require oxygen and nutrients for the timely elimination of metabolites. The process of absorption of nutrients is called assimilation, the process of decay is called dissimilation. Tissue nutrition is provided by the adaptive-trophic influence of the central nervous system.
Assimilation is a combination of the following processes of creating living matter: receiving substances necessary for the body from the external environment; transformation of substances into compounds acceptable to body tissues; synthesis of cells, enzymes and other regulatory compounds and replacement of obsolete ones with new ones; synthesis of simple formations into more complex compounds; deposition of reserves.
Dissimilation is a set of the following processes of decay of living matter: mobilization of the body's reserves; breaking down more complex compounds into simpler ones; decay of obsolete tissue and cellular elements; breakdown of energy-rich compounds along with the release of energy; elimination of waste products from the body.
Other sections of the fundamentals of human pathology are dystrophy, circulatory disorders, inflammation, regeneration, etc.
Dystrophy manifests itself in disruption of tissue (cellular) metabolism, leading to structural changes in tissues and cells. Therefore, dystrophy is considered as one of the types of damage. The direct cause of the development of dystrophy can be violations of cellular or extracellular mechanisms. Among them are the following: disorders of cell autoregulation, leading to energy deficiency and disruption of enzymatic processes in the cell; disruption of the trophic transport systems, causing hypoxia, which becomes leading in the pathogenesis of discirculatory dystrophies; disorders of the endocrine or nervous regulation of trophism, underlying endocrine and nervous (cerebral) dystrophies.
Dystrophies are divided (depending on the predominance of morphological changes in specialized elements of the parenchyma or in the stroma) into parenchymal, mesenchymal and mixed; (according to the predominance of disorders of one or another type of metabolism) into protein, fat, carbohydrate and mineral; (depending on the influence of hereditary factors) on acquired and hereditary; (according to the prevalence of the process) into general and local.
It is known that various injuries and diseases of the nervous system cause various changes in tissues. Atrophy is a decrease in volume and a decrease in the functional activity of organs and tissues due to the death of cellular and tissue elements during any pathological process due to impaired tissue nutrition or a long-term decrease in the degree of their involvement in the general physiological process.
Hypertrophy is an enlargement of an organ or part of it due to an increase in volume and (or) number of cells. There may be vicarious hypertrophy (of one organ when the function of another is turned off); hormonal (of some organs); true (hypertrophy of the organ, caused by an increase in the size and number of its functioning parenchymal elements); compensatory (of an organ or part of it, caused by increased activity that compensates for any disturbances in the body); corrective, when changing the function of another organ located with it in a single functional system (usually some endocrine gland); false (hypertrophy of an organ due to the predominant or exclusive growth of its interstitial tissue or surrounding tissue); neurohumoral (as a result of disruption of neurohumoral regulation of organ function); regenerative (true hypertrophy of a part of an organ, developing after resection or damage to another part); physiological (true hypertrophy due to increased organ function in physical workers, athletes, etc.).
Athletes who systematically train in cyclic sports may develop myocardial hypertrophy, that is, an enlargement of the heart muscle. Moreover: today it is believed that every athlete has myocardial hypertrophy in the initial stage. Myocardial hypertrophy, crossing certain boundaries, contributes to increased heart function, as was previously thought.
In the development of myocardial hypertrophy in athletes, various unfavorable factors play a decisive role: participation in competitions and training in a painful state or after illnesses (ARVI, influenza, tonsillitis, etc.), the presence of chronic foci of infections (dental caries, chronic tonsillitis, cholecystitis, furunculosis and etc.). The basis of pathological hypertrophy is the deterioration of blood supply to the heart muscle, dystrophic changes that lead to a deterioration in myocardial contractility and, consequently, to a decrease in athletic performance.
Quite often, when training in areas with a hot and humid climate, or excessive use of baths (saunas), a violation of water and mineral metabolism occurs in the athlete’s body. This is manifested in changes in the acid-base state (ABC), electrolyte, water-salt and other indicators of homeostasis.
The acid-base state (ALS) ensures the normal functioning of the cell with a constant volume, composition and pH of body fluids. The acidity or alkalinity of solutions depends on the concentration of H4; an increase in it makes the solution acidic, a decrease makes it alkaline. The extracellular fluid is slightly alkaline, and its pH is in the range of 7.35-7.45.
Water-salt metabolism is a set of processes of distribution of water and electrolytes between the extracellular and intracellular spaces of the body, as well as between the body and the external environment. The distribution of water in the body is inseparably linked with electrolyte metabolism.
Water-electrolyte homeostasis is the maintenance of constancy of osmotic volumetric and ionic balance of extracellular and intracellular fluids of the body using reflex mechanisms.
Water balance is the relationship between the amounts of water entering and leaving the body.
Athletes, especially those training in cyclic sports (stayers, cross-country skiers, cyclists, etc.), experience marching (spontaneous) bone fractures, convulsions, etc. Athletes who lose weight (wrestlers, boxers, weightlifters, etc.) using pharmacological agents and baths often experience serious disturbances in mineral (salt) metabolism.
Necrosis is the death of a part of a living organism, the irreversible cessation of the vital activity of its elements. This is not just a local reaction of a cell, tissue or organ to damage, but a complete cessation of their vital activity (Scheme I).
Necrosis as a biological phenomenon cannot be considered only a pathological process, since it is a necessary moment in the development and functioning of the body. Cells of the epidermis of the skin, the epithelium of the mucous membrane of the gastrointestinal tract, and some glandular organs are constantly dying. Physiological autolysis is widespread in the body as a necessary part of the self-renewal of the system at the cellular, tissue and organ levels, but having different biological significance (organism development and morphological processes, tissue regeneration and growth, aging, physiological changes, etc.).
Necrosis as a pathological phenomenon can cause irreversible changes in the body, including death. Clinically, necrosis is expressed in specific diseases: myocardial infarction, gangrene of the limb, etc. In addition, necrosis can be an integral part, a pathogenetic link of another process (inflammation, allergy) or disease (viral hepatitis, diphtheria, etc.).
The transition of an organ, tissue or cell from one qualitative state (life) to another (death) should be considered as a whole, cumulatively, and not by assessing and recording changes in a part.
There are two types of circulatory disorders: general, or central, affecting the level of blood pressure, blood flow speed, and local, or peripheral, caused by resistance to blood flow in the small vessels of individual organs and tissues, as well as blood filling of the capillaries.
The determining factors for circulatory disorders are: damage to the heart, lungs, chest and diaphragm, affecting the filling of the heart chambers; skeletal muscles and ligamentous apparatus, disrupting the flow of blood to the heart through the veins; endocrine glands, affecting blood pressure and the exchange of electrolytes in the vascular wall; renal cortex and medulla, influencing blood pressure through the renin and prostaglandin system. Changes in the tone of arterioles and venules, affecting the resistance to blood flow, and changes in the rheological properties of blood, its viscosity, caused by disturbances in the blood coagulation system or the properties of its formed elements, their relationship with plasma, also have a great influence on blood circulation.
Various periods of life and death of an organism and its elements
In morphofunctional terms, vessels of distribution, resistance, metabolism, shunting and capacitance are distinguished. Regulation of blood circulation in the vascular system is carried out by both nervous and humoral mechanisms. When the regulatory mechanisms of blood circulation are disrupted, compensatory mechanisms are activated.
Mechanisms of compensation in the vascular system depend on changes in the lumen of blood vessels, blood deposition, collateral blood flow, veno-arterial reaction (spasm of arterioles and small arteries when outflow is impaired).
When analyzing the state of blood circulation in tissues, it is necessary to take into account the restructuring of vessel walls and the width of the lumen in relation to vessels of all calibers, and not to individual vessels.
The pathological anatomy of circulatory disorders varies depending on the rate of development, the severity of the process, the angioarchitecture of organs and the sensitivity of tissues to oxygen starvation.
Hyperemia is an increase in blood supply in any part of the peripheral system (small arteries, capillaries and veins), caused by an increase in blood flow into the microcirculatory system (arterial hyperemia) or a weakening of blood outflow (venous hyperemia). Arterial hyperemia can occur under normal conditions (as a manifestation of adequate regulation, i.e. corresponding to the metabolic need for blood supply to the tissue) and pathological (as a manifestation of compensatory regulation of blood circulation in certain disorders).
Types of arterial hyperemia: working (functional); post-ischemic (reactive, post-occlusion, post-compression); collateral (around the ischemic focus); inflammatory. Venous hyperemia is a pathological change in blood circulation that occurs when the outflow of venous blood is disrupted.
Arterial congestion is often active and acute;
in a healthy person it quickly disappears, which is explained by the peculiarities of the reaction of blood vessels to stretching. Collateral arterial hyperemia lasts longer due to the opening of previously poorly functioning arteries or arterioles.
In the pulmonary circle, arterial hyperemia of the shunt is possible, due to the presence of interatrial and especially interventricular defects during the discharge of blood from left to right. In this case, arterial blood also enters the lungs along with venous blood. Large branches of the pulmonary artery of the elastic and elasto-muscular type undergo expansion, and the vessels of the muscular type undergo narrowing. With the simultaneity of these processes, precapillary arterial hypertension of the small circle develops. Long-term arterial hyperemia in any organ can cause vascular rupture, diapedetic bleeding, and tissue edema.
Venous congestion is often called stagnant or passive, since it occurs due to a violation of the outflow of blood through the veins due to a decrease in cardiac activity, compression or obstruction of the veins. Along with this, venous hyperemia is also active, in particular, in areas of collateral venous congestion (for example, in the mucous membrane of the esophagus, rectum, when opening cova-portal anastomoses in conditions of cirrhosis of the liver).
Venous hyperemia during blood deposition is active. In humans, blood is deposited in the liver, spleen, subcutaneous tissue, etc. Long-term venous hyperemia is accompanied by pronounced hypertrophy of the muscular layer of the veins. Depending on the architectonics of the veins in different organs, venous congestion manifests itself differently.
The consequences of venous hyperemia include varicose veins, hypoxic damage to tissues, blood cells, and impaired lymph circulation.
Stasis is a nonspecific phenomenon; it can occur without previous venous congestion, under the influence of intoxication, as a result of the action of various physical and chemical agents on tissue. There are hemostasis and lymphostasis.
Hemostasis is a multicomponent system, the constituent elements of which are blood, vessel walls and organs that increase or decrease the ability to clot blood and form vascular-active substances. This system helps maintain the required blood consistency in the vessels and stop bleeding when they are damaged, and also affects the rheological properties of blood, microcirculation, vascular permeability, wound healing processes, and immunological reactions. Hemostasis is effective with close interaction between the coagulation, anticoagulation, fibrinolytic and kinin systems of the body.
Lymphostasis is the stagnation of lymph that occurs as a result of mechanical, resorption or dynamic failure of lymphatic movement. Mechanical insufficiency of lymph circulation is caused by an increase in venous pressure, as well as compression or blockage of lymphatic vessels, spasms of collectors, etc. Dynamic insufficiency is explained by a discrepancy between excess interstitial fluid and the rate of its removal.
Pastiness is diffuse swelling and a decrease in the elasticity of any area of the skin.
Bleeding is the process of blood leaving blood vessels. Hemorrhage is a consequence of internal bleeding - the accumulation of blood in tissues and cavities. According to morphology, three types of hemorrhages are distinguished: hematoma - hemorrhage with the formation of a cavity; hemorrhagic infiltration - saturation of tissue with blood; petechiae and ecchymosis - pinpoint hemorrhages.
There are three causes of bleeding: rupture; corroding the walls of the vessel and not damaging the wall - through diapedesis. The rupture of a vessel is often accompanied by the development of a hematoma, that is, a cavity containing liquid or coagulated blood.
Bleeding by diapedesis usually occurs from venules and capillaries. The reason is a violation of tone and permeability, most often arising as a result of hypoxia, intoxication, as well as due to vitamin deficiencies, blood clotting disorders, which underlie the so-called hemorrhagic diathesis, that is, a tendency to bleeding. Diapedetic bleeding underlies the development of petechiae, ecchymosis, and apoplexy.
Ischemia - a decrease in blood flow to an organ - occurs when the resistance to blood flow in the arteries bringing blood to a given area increases significantly and there is no or insufficient collateral blood flow. Circulatory ischemia is called tissue anemia caused by a decrease or absence of blood flow to it, which can be caused by vasospasm, arterial obstruction, thrombus, embolus, atherosclerotic plaque, sclerosis of the inner lining of blood vessels of various origins, etc. In the zone of anemia, there is a sharp slowdown in the metabolic process, which affects the immune system.
A heart attack is necrosis of a part (less commonly, a whole) organ caused by a violation of the blood supply. There are infarctions of the heart, lungs, spleen, kidneys, etc. The most common is myocardial infarction, which occurs when the coronary artery is obstructed in conditions of insufficient collateral function, as well as when the increased functional load does not correspond to the level of blood supply to the organ. Cardiovascular failure (myocardial infarction) often occurs during intense physical activity, overload, especially during training in mid-mountain areas.
Thrombosis is a pathological manifestation of hemostasis, that is, intravital blood coagulation with the formation of a clot called a thrombus in the lumen of the vessel. It can completely or partially close the lumen of the vessel and cause serious circulatory disorders.
Embolism is a pathological process that is characterized by circulation in the vessels of the pulmonary and systemic circulation of foreign bodies that do not mix with blood, and blockage of blood vessels by them. These can be pieces of a detached blood clot, air or gas bubbles, droplets of fat, pieces of tissue, in particular tumors, etc.
Inflammation is a complex local response of the body to tissue damage by various pathogenic stimuli. Inflammation is the result of the body’s interaction with various pathogenic factors of the external and internal environment. External factors, or aggressive stimuli that can cause inflammation, include microorganisms, animal organisms, toxic and chemical substances, mechanical and thermal irritants, medicinal substances, ionizing radiation, etc. Internal (autogenic) irritants that cause inflammation include nitrogenous products metabolism, tumor breakdown (inflammatory reaction of the stroma), effector cells, mediators and immune complexes precipitating into the tissue.
Inflammation is a multiphase process (alteration, exudation, proliferation), the development of which, in addition to pathogenic factors, is greatly influenced by mediators. Inflammation consists of interconnected and sequentially developing phases: 1) damage or alteration of tissues and cells (initial processes); 2) the release of mediators (triggers) and the reaction of the microcirculatory bed with a violation of the rheological properties of the blood; 3) manifestation of increased vascular permeability (exudation and emigration); proliferation.
The first phase - damage or alteration (dystrophy, necrosis) of tissues and cells (initial processes) with the release of mediators (triggers) - is biochemical. The second phase is the reaction of the microvasculature with a violation of the rheological properties of the blood, manifestations of increased vascular permeability in the form of plasmatic exudation and cell emigration, phagocytosis, and exudate formation. The third phase is cell proliferation with tissue repair or scar formation.
Trophism is a set of metabolic processes that underlie cellular nutrition and ensure the preservation of the structure and function of tissues and organs, regulated by the nervous system. The trophic function of the body ensures the full course of metabolic processes, tissue nutrition, constant adaptation of tissue structures to the requirements of the function and physiological tissue regeneration.
Regeneration is the renewal of structures that were lost as a result of pathological processes. There are two types of regeneration: 1) physiological, that is, the restoration of structures that die off during the normal functioning of the body; 2) reparative - restoration of structures after damage. Regeneration provides a wide range of adaptive reactions of the body, being the structural basis of its normal functioning. The timing of tissue regeneration varies; it depends on the blood supply to the tissue, the age and activity of the person. Thus, muscle tissue regenerates from 7 days to 12 days, bone tissue - from 2-3 weeks to 4-6 months, tendons - from 4 weeks to 6 weeks or more, etc. The trainer needs to know the timing of tissue regeneration, since if they are not observed, early resumption of training leads to repeated injuries, sometimes even more serious, and more often to their transition to a chronic form. Regeneration is a biological process and cannot be accelerated. To improve the course of the regeneration process, massage, oxygen therapy, physiotherapy, hydrotherapy, exercise therapy, hydrokinesitherapy, etc. are used.
The desire to accelerate the process of muscle tissue regeneration using massage and thermal procedures often leads to the occurrence of myositis ossificans.
A tumor is an atypical organoid formation that arose from the original germ (regardless of the interests of the organism) through the proliferation of its own elements, for which reproduction is an end in itself. Biochemically, a tumor cell differs from a normal cell in the nature and activity of enzyme systems. The tumor is characterized by unresponsiveness of growth, its infinity, as well as the lack of ability to differentiate its cellular elements.
All tumors are divided into benign and malignant. Benign tumors are just malformed tissue. These are uterine fibroids, breast fibroadenoma, congenital angiomas, prostate adenoma, neuroma, etc.
Malignant tumors appear as a result of a special qualitative change in cells, their militia. Malignant tumors are characterized by metastasis, that is, the transfer of tumor cells beyond the boundaries of the primary tumor with the formation of a tumor node in the distance. Cancer is characterized by a lymphogenous route of metastasis to regional lymph nodes. Sarcomas are characterized by a hematogenous route of metastasis.
Many questions of the etiology and pathogenesis of tumors are already close to being clarified. Thus, a connection has been established between the occurrence of tumors and radiation, with chemical carcinogens, viruses, with hormonal imbalances, with hereditary factors, etc.
Allergy is an abnormal (increased) sensitivity of the body to the effects of certain environmental factors (chemicals, microbes and their metabolic products, food products, etc.), called allergens. Allergic diseases (bronchial asthma, hay fever, urticaria, allergic rhinitis, dermatitis, drug and food allergies) are widespread throughout the world and tend to increase.
The reason for this, first of all, is considered to be the widespread use of antibiotics and other drugs, as well as the appearance of a large number of synthetic materials, dyes, washing powders, many of which can cause an allergic reaction.
Allergens can be various compounds, from simple chemicals (bromine, iodine) to the most complex (proteins, polysaccharides), and combinations of both. Some of them enter the body from the outside (exogenous), others are formed in the body itself (endogenous or autoallergens). Exogenous allergens can be of non-infectious origin (household dust, animal hair, medications, chemicals, pollen, animal and plant foods) and infectious (bacteria, viruses, fungi and their metabolic products). Entering the body in various ways, exogenous allergens can cause damage to various organs and systems.
Exogenous allergens are divided into the following groups:
Biological allergens - microbes, viruses, fungi, helminths, serum and vaccine preparations.
Drug allergens. Almost any drug can cause an allergic reaction. The intensity of allergic reactions depends on how often and in what quantities the drugs are used. It must be remembered that taking any medications without a doctor’s prescription is extremely dangerous.
Household allergens: house dust, fungi, mold on the walls of damp rooms, dead organs of domestic insects (cockroaches, bedbugs, bed mites). This group also includes the so-called epidermal allergens - hair, fur, animal dander, etc.
In recent years, the number of allergic reactions to household chemicals, especially washing powders, has increased.
Pollen allergens. Most often this is pollen from wind-pollinated plants, causing a runny nose, conjunctivitis, etc.
Food allergens. In practice, they can be almost all food products. Most often, milk, eggs, meat, tomatoes, citrus fruits, chocolate, strawberries, wild strawberries, and crayfish cause allergies. When allergens enter the body through the gastrointestinal tract, food allergies occur. Its symptoms: vomiting, diarrhea, urticaria, fever, etc.
Overfeeding contributes to the development of food allergies in children. Food allergens often cause diathesis. Food intolerance is not always an allergic reaction. It may be caused by a lack of certain enzymes in the digestive juices, which leads to impaired digestion of food and disorders similar to food allergies.
Industrial allergens. Nowadays, the number of various substances has increased, upon contact with which allergic reactions occur, mainly in the form of skin lesions - allergic occupational contact dermatitis.
In hairdressing salons and beauty salons, allergens may include dyes for hair, eyebrows and eyelashes, perfumes, etc.
Physical factors make up a special group of allergens: heat, cold, mechanical irritation. It is believed that in many cases, under the influence of these factors, certain substances are formed in the body, which become allergens.
The development of allergies is facilitated by dysfunction of the nervous and endocrine systems, as well as brain injuries, negative emotions, and decreased adrenal function.
Prevention of allergic diseases consists of following measures to prevent repeated contact with substances that have a pronounced sensitizing effect, and measures to prevent violation of the body's protective reactions.
Do not allow accumulation of house dust in apartments. One of the measures is the elimination of foci of infection in the body that are sources of sensitization (dental disease, inflammation of the paranasal sinuses, cholecystitis and other inflammatory processes). Normalizing the function of the gastrointestinal tract also reduces the possibility of developing food allergies.
In real life, athletes are more allergic than ordinary healthy people. Excessive physical activity contributes to a decrease in immunity, especially in mid-mountain conditions, zones with a tropical climate, etc.
Allergies are caused by uncontrolled intake of large amounts of medications (vitamins, protein preparations, panangin, potassium orotate, riboxin, etc.). Allergies occur when taking fortified chocolate, pollen, intravenous administration of protein drugs, etc. When amino acids are administered, athletes sometimes experience bronchospasm, Quincke's edema, positive Pasternatsky's sign, and muscle pain.
When applying ointments to a sore area of skin or massaging with ointments, contact urticaria sometimes occurs - a special variant of allergic dermatitis. It usually appears a few minutes after a massage with some ointments and is characterized by the appearance of an urtic rash, itching, and hyperemia. An allergic reaction sometimes appears in a massage therapist: sneezing, coughing, flushing and a rash on the hands (forearms).
Athletes often react to taking medications with urticaria, one of the varieties of which is acute angioedema. It is characterized by the sudden development of limited swelling of the skin (mucous membrane) and subcutaneous fatty tissue (lips, cheeks, eyelids, etc.). With edema developing in the larynx, asphyxia is possible; if the edema is localized in the orbital area, deviation of the eyeball in the medial direction and decreased visual acuity may be observed.
Allergic rhinitis (rhinitis) is characterized by paroxysmal nasal congestion with copious watery mucous discharge and sneezing.
If an allergic reaction occurs, the athlete is given plenty of fluids, and sometimes an enema or laxative is indicated. They give antihistamines: tavegil, suprastin, diphenhydramine, pi-polphen, etc. Antiallergic drugs (ointments) are used locally for dermatitis, eye drops for conjunctivitis, cold for itching and scratching.
To prevent possible reactions, hardening of the body, treatment of vegetative-vascular dystonia, etc. are carried out. It is important to maintain a healthy lifestyle, proper work and rest schedule.
Immunity is the body’s immunity or resistance to the action of pathogenic microorganisms and their toxins. It should be considered as a biological defense mechanism that allows the body to maintain a normal internal state (homeostasis), protecting it from exposure to infectious agents or any substances that have the properties of antibodies.
In addition to phagocytic cells, chemical compounds also take part in the immune reaction - antibodies, which are soluble protein substances - immunoglobulins (IgA, IgM, IgG, IgE), produced in response to the appearance of foreign proteins in the body. In blood plasma, antibodies glue foreign proteins together or break them down. Antibodies that neutralize microbial poisons (toxins) are called antitoxins. All antibodies are specific: they are active only against certain microbes or their toxins. If the human body has enough specific antibodies, it becomes immune to certain infectious diseases.
There are innate and acquired immunity. Innate immunity provides the body with immunity to a particular infectious disease from the moment of birth. Immune bodies can penetrate through the placenta from the vessels of the mother's body into the vessels of the embryo, or newborns receive them with mother's milk. This passively acquired immunity provides newborns with immunity to certain infectious diseases.
Acquired immunity appears after suffering an infectious disease, when in response to foreign proteins entering the body, specific antibodies are formed in the blood plasma. In this case, natural, acquired immunity occurs.
Immunity can be developed artificially by introducing into the human body weakened or killed pathogens of any disease (for example, diphtheria, scarlet fever, smallpox, etc.). Antibodies are produced against weakened microorganisms, neutralizing the waste products of living organisms. This immunity usually lasts for years. Immunity acquired by introducing immune serum from the blood of animals or humans into the body is called passive.
In protecting the body from pathogens of infectious diseases, in addition to acquired immunity, so-called nonspecific protective factors play a significant role. These include the impermeability of healthy skin and mucous membranes to most microorganisms, the presence in skin secretions and stomach enzymes of substances that adversely affect microorganisms, the presence in the blood and body fluids (saliva, tears, etc.) of enzyme systems that irritate microorganisms (for example, lysozyme, properdin, etc.).
It has also been established that viruses, toxins and decay products of microorganisms are eliminated from the body through sweat, sputum, urine, and feces.
Nonspecific protective factors also include an increase in the patient’s body temperature, which promotes recovery, for example, in viral diseases (influenza, ARVI), since the reproduction of some viruses is delayed at temperatures above 37 °C.
It is known that psycho-emotional overload (disorders) in athletes during preparation for important starts (competitions) reduce the body’s resistance to infections. Insufficient consumption of animal proteins and microelements negatively affects the immune system and leads to disruption of the production of immunoglobulins.
During intense physical activity, a number of athletes experience a breakdown of adaptive mechanisms. Hypoxemia and tissue hypoxia are also associated with the functioning of the immune system in elite athletes. A decrease in immunoglobulins leads to an increase in the level of infectious (cold) diseases and an increase in the number of injuries and diseases of the musculoskeletal system.
Thermoregulation - maintaining body temperature within a limited range when the level of internal heat generation and ambient temperature changes - is provided by means of autonomous thermoregulation.
Autonomous thermoregulation - a reaction to a decrease or increase in the temperature of the internal and external environment, consists of controlling the processes of heat production and heat transfer (changes in peripheral vasomotor tone, sweating, thermal tachypnea, cold shivering). Autonomous thermoregulatory reactions can be carried out without the participation of consciousness.
Body heat balance is a stationary state of heat exchange between the body and the environment, in which the heat content does not change.
Heat stroke is a painful condition caused by overheating of the body. Expressed by headache, nausea, vomiting, fainting. The main cause of overheating of the body is a violation of thermoregulation, which occurs during prolonged exposure to high ambient temperatures, especially in humid air, when sweating is ineffective. With heatstroke, body temperature can reach 40-41 °C.
Heat exchange in physiology is the exchange of thermal energy between the body and the environment. It is carried out by heat conduction (conductive heat transfer), convection (convective heat transfer), radiation (radiation heat transfer) and evaporation (evaporative heat transfer).
Heat transfer in physiology is the process of heat dissipation into the environment through convection, radiation, evaporation or a combination of these per unit body surface area per unit time (W m-2).
Heat production in physiology is the formation of heat in the body due to metabolic processes. Total heat production is equal to the amount of metabolic energy minus external work.
Violation of thermoregulation during training and especially during competitions in areas with hot and humid climates is a fairly common occurrence.
Thermoregulation disorder is also observed in many diseases.
Desynchronosis occurs during international competitions, in different climatic and time zones, which place increased demands on the athlete’s functional state. If they are not followed, various undesirable changes may occur that worsen the performance and health of the athlete.
It is well known that during the day there are rhythmic fluctuations in the activity of the physiological systems of the body. It has been proven that almost 50 physiological functions change in the human body during the day. Thanks to their rhythm, the long-term performance of individual organs and the body as a whole is maintained. The main daily cycle, the basis, the background for the existence of all other rhythms is the alternation of sleep and wakefulness, which are inextricably linked.
When flying across several time zones, one can observe a mismatch of rhythms, which forces the athlete’s organs and systems to rearrange their functions, adapting to the influence of external factors. But it takes some time to adapt. The timing of acclimatization depends on the functional preparation (training) of the athlete, his age, etc. floor. Since modern sport creates extremely high physical and psycho-emotional stress for athletes, changing climatic and geographical zones (zones) often leads to desynchronosis, or dysrhythmia.
Desynchronosis is changes in the body due to disturbances in its circadian (circadian and daily) rhythms. The physiological state directly depends on the coherence of the body’s circadian system; rhythm disturbance is expressed in various deviations from the norm.
The main causes of desynchronosis: 1) mismatch between time sensors and the body's circadian rhythms - a) change of time zones (transmeridian flights, movements over significant distances in the latitudinal direction); b) a stable mismatch between sleep and wakefulness with the local system of time sensors (alternating day and night work shifts); 2) exposure to various physical factors (heat-cold, radiation, etc.), mental (especially emotional) stress, muscle (physical) stress, etc.
Symptoms of desynchronosis boil down to sleep disorders, decreased appetite, mood, mental and physical performance, various neurotic disorders, etc. In some cases, there is an exacerbation of diseases.
Most people experience wave-like changes in performance during the day with two “peaks”: the first - from 8 hours to 13 hours, the second - between 16 hours and 19 hours. At other hours, the functional level of the body is significantly reduced. This is directly related to planning the educational and training process and recreation of athletes. When training twice a day, higher (intensive) loads should be assigned to hours of increased performance (activity), and lower loads should be assigned to hours of reduced performance.
Each flight to a different time zone requires a restructuring of metabolic processes in the body. Since metabolic processes (rhythms) are genetically determined, their “breaking” does not pass without leaving a trace. A sudden change in diet is harmful; foods should also not differ sharply from the usual ones, especially in the first 5-7 days.
An athlete’s adaptation to a time zone depends on the time difference, age, functional status and health of the athlete.
^Sports pathology
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9.1. GENERAL CHARACTERISTICS OF DISEASES IN ATHLETES
Behind In recent years, sports medicine has accumulated convincing data on the great importance of physical activity for strengthening human health, preventing cardiovascular diseases, increasing the body’s nonspecific resistance to a variety of adverse factors, and slowing down the aging process.
D Indeed, if we compare the incidence in athletes and non-athletes in the same age and professional groups, we see that athletes get sick less often and in a milder form. According to N.D. Graevskaya, 137 chronic diseases were identified in 1000 students who were active athletes, and 193 in 1000 students not involved in sports (of the same age, with the same living conditions, examined according to the same program).
WITH comparison of the morbidity structure in athletes and non-athletes showed that it is significantly different. For example, among athletes, diseases of the cardiovascular system accounted for 66%, and among non-athletes - 23.5%; injuries and diseases of the musculoskeletal system in the former accounted for 45% of the total incidence, and in the latter - only 8%. As can be seen from table. 47, among various types of pathology in leading athletes, chronic inflammatory and degenerative diseases of the musculoskeletal system are most often found (35.1%). If we take into account that injuries also mainly affect the musculoskeletal system, then it accounts for 66.8% of all diseases and injuries among athletes (for more details, see 9.2). Among other diseases among athletes, ear, nose and throat diseases are the most common.
Table 47. Distribution of diseases and injuries among 100,000 qualified athletes under medical observation (according to G. M. Kukolevsky)
| Type of pathology | Number of cases as a percentage of the total number of sick athletes |
| Chronic diseases of the musculoskeletal system | 35,1 |
| Injuries | 31,7 |
| Surgical diseases | 1,3 |
| Other diseases: | 31.9, of which: |
| ear, throat, nose | 26,1 |
| gastrointestinal tract | 22,6 |
| of cardio-vascular system | 11,2 |
| teeth | 11,1 |
| peripheral nervous system | 7,0 |
| respiratory organs | 4,2 |
| overtraining, overexertion | 3,1 |
| cutaneous | 2,2 |
| other | 12,5 |
ABOUT The specific type of motor activity and the external environment in which this activity is carried out have a very great influence on the manifestations of pathology in athletes. Thus, chronic diseases of the musculoskeletal system are relatively rare among swimmers and much more common among representatives of speed-strength sports and martial arts. Diseases of the peripheral nervous system are more common in jumpers, throwers, hurdlers, weightlifters, wrestlers and football players than in other athletes. The largest number of diseases of the ENT organs, according to V. A. Levando, occurs in those involved in shooting (71.5%), water sports (40-45%) and winter sports (40%). At the same time, hearing pathology (auditory neuritis) dominates among shooters, and diseases of the pharynx, nasal cavity and paranasal sinuses dominate among swimmers and skiers. The percentage of athletes with chronic cholecystitis is on average 2.1; at the same time, this disease accounts for 0.4 - 0.6% among gymnasts, and 8.5% among skiers, skaters and runners (Yu.M. Shap-kaits). The percentage of athletes with low and high blood pressure also varies in different sports. For example, high blood pressure is very common among weightlifters, and low blood pressure is very common among gymnasts (N.I. Bolnov).
A Analysis of morbidity among athletes indicates that an athlete, like any person, can get sick with almost any disease, but athletes get sick much less often than those who do not engage in sports. This is due not only to the fact that physical training increases the body’s resistance to various adverse factors, but also to careful medical selection.
Under under the influence of systematic training, the compensatory capabilities of the athletes’ body become so wide that many diseases in them proceed differently than in those who do not engage in sports: diseases often begin very unnoticed by the person himself, those around him, and the doctor; sometimes when an athlete becomes ill, not only does their health not worsen, but they even show high athletic results; very often the clinical picture of the disease is unclear, erased and abortive forms of the disease are observed.
N It is important, however, to keep in mind that a disease that goes unnoticed or is not given serious importance (which is completely unacceptable), for which treatment is not carried out, and training and competitive loads for which are not removed or reduced, may end unfavorably. No matter how great the adaptive capabilities of a trained athlete’s body are, they become insufficient, pre-pathology turns into pathology, acute disease into chronic, various complications arise, sometimes very dangerous, incompatible with life.
ABOUT The study of sports pathology suggests that there are some specific causes of the development of diseases in athletes. Thus, an illness in an athlete can occur during sports activities due to the influence of various environmental factors. At the same time, the specificity of the sport plays a significant role in the occurrence of the disease. This is well confirmed, as already noted, by the large percentage of diseases of the ENT organs in swimmers and water polo players.
B Illness in an athlete often occurs as a result of incorrect training methods, when using loads for which the athlete is not sufficiently prepared: with a forced increase in loads, 2- and 3-times sessions a day with large volumes and intensity of load, highly specialized, monotonous work, absence of fasting days, etc. Often, at first, sudden fatigue, overwork, overtraining, overexertion occurs, and only then a disease develops, the nature of which is determined by the specific impact of the sport or the characteristics of the body.
N Correct training methods and excessive load are especially dangerous if they are combined with an irrational regime and conditions of work, life, nutrition, bad habits, the presence of foci of chronic infection, a weakened state of the body as a result of a previous illness (for example, influenza) or injury. Foci of chronic infection (carious teeth, chronic tonsillitis and cholecystitis) pose a great danger, even in the absence of complaints, because compensation, quite sufficient for the body’s functioning under normal conditions, is often disrupted when performing heavy physical activity.
P overtraining, overexertion, various prepathological and pathological conditions occur in athletes with foci of chronic infection 2-3 times more often than in athletes who do not have them. Numerous data indicate that foci of infection that do not manifest themselves at rest and during normal exercise, under conditions of intense exercise, often provoke damage to the most intensively working organ - the heart.
N It is often not taken into account that an athlete who has suffered even a mild illness has a different functional state than before the illness. Therefore, shortening the period of admission to training sessions after illness, using the same loads as before illness, often causes new diseases. For example, a large percentage of chronic diseases of the musculoskeletal system in qualified athletes is largely associated with premature resumption of training after injury, rapid expansion of training means even before the required degree of anatomical and functional recovery. In general, it should be noted that incorrect training methods during the rehabilitation period after injuries and diseases often cause the development of new pathologies in athletes.
IN During the process of sports training, especially during the competitive period and in a state of sports form, athletes often experience a change in the secretion of 11-hydroxycorticosteroids, a decrease in blood protein and a decrease in almost all indicators of humoral and cellular immunity. This is apparently associated with an increase in morbidity (acute respiratory infections, other viral diseases).
U For low-skilled athletes, acute morbidity varies insignificantly throughout the year. For highly qualified athletes, it increases 2.5 times during the competitive period compared to the preparatory period, and for highly qualified athletes - 3.5 times. All this indicates that the incidence of illness in athletes largely depends on the immunobiological restructuring of the body.
A Analyzing the causes of diseases in athletes, it is also necessary to consider the issue of the causes of sudden death associated with sports. This term denotes (Zipelli) death that coincides in time with sports activity (immediately before the start, during competition and training, immediately after the finish) in the absence of external factors that themselves could be its cause (for example, the death of divers due to malfunctions in the operation of equipment, etc.). Despite the fact that such tragedies in sports are an extremely rare occurrence, the predominant role of strength exercises in their origin has been noted (Vuori et al.). The main etiological mechanism of sudden death in athletes is pathology of the cardiovascular system. In this case, special attention is paid to atherosclerosis of the coronary arteries and heart rhythm disturbances. However, recent studies point to a wider range of etiological factors. Thus, according to Zhinet’s data, published in 1982, out of 20 cases of sudden death, 7 are associated with vascular diseases, 6 with heart defects, 5 with strokes, 4 with coronary artery thrombosis, 4 with doping, 2 with rupture of aortic aneurysm, 1 with myocarditis and 1 with hypertrophic myocardiopathy. Only in 3 cases were no visible causes found at autopsy. In other observations, more attention is paid to mitral valve prolapse, WPW syndrome, and cardiac arrhythmias. It is very likely that excessive catecholamine stimulation of the myocardium can lead to contractures and ruptures of individual muscle fibers (A.G. Dembo). All this points to the extremely important role of medical supervision of athletes. The coach and teacher must actively involve the doctor in resolving the issue of the athlete’s health in case of any complaints that arise. It is equally important to use the most advanced medical equipment in sports, since diagnosing the initial manifestations of cardiac pathology is extremely difficult.
Year of issue: 2003
Genre: Physiotherapy
Format: PDF
Quality: Scanned pages
Description: The textbook “Sports Medicine” outlines the basics of general and specific pathology in the aspect of sports medicine, the principles of stage-by-stage, ongoing and urgent medical and pedagogical control over representatives of various sports specializations, issues related to medical support for competitions, as well as pre-pathological and pathological conditions in athletes, including emergency ones. Special sections are devoted to the peculiarities of medical supervision of young athletes, female athletes and older people involved in health-improving forms of physical education. The publication contains a brief dictionary of medical terms necessary for better assimilation of the material.
The textbook “Sports Medicine” is intended for students and teachers of secondary and higher educational institutions of physical education, as well as secondary and higher educational institutions of medical profile.
Chapter 1. DOMESTIC SPORTS MEDICINE: HISTORY OF DEVELOPMENT, GOALS, TASKS AND PRINCIPLES OF ORGANIZATION
1.1. History of the development of domestic sports medicine (N.D. Graevskaya)
1.2. Goals and objectives of domestic sports medicine
1.3. Principles of organization of domestic sports medicine
Chapter 2. BASICS OF GENERAL PATHOLOGY
2.1. Concept of health and illness
2.2. The main forms of occurrence, course and end of the disease. Disease outcomes
2.3. Terminal states
2.4. Etiology and pathogenesis
2.5. Clinical understanding of the constitution
2.6. Pathological heredity
2.7. Body reactivity
2.8. Immunological reactivity
2.8.1. The concept of immunity
2.8.2. Factors of natural resistance
2.8.3. The concept of immunodeficiency
2.8.4. Acquired immunodeficiency syndrome (AIDS)
2.8 5 Allergies
2.9. Typical pathological processes
2.9.1. Circulatory disorders
2.9.2. Metabolism disorders in tissues
2.9.3. Necrosis
2.9.4. Inflammation
2.9.5. Atrophy
2.9.6. Hypertrophy
2.9.7. Tumors
Chapter 3. CLINICAL AND PARACLINICAL METHODS OF EXAMINATION
3.1. Clinical examination methods
3.2. Paraclinical examination methods
3.2.1. Anthropometry (E.K. Ermolenko)
3.2.2. Body thermometry
3.2.3. Instrumental and functional examination methods
3.2.4. Radiation diagnostic methods
3.2.5. Ultrasound diagnostic methods
3.2 6. Radioisotope diagnostics
3.2.7. Thermal imaging
3.2.8. Endoscopic research methods
3.2.9. Laboratory research methods
3.2.10. Functional testing
3.3. Nervous system Basic examination methods. Selected syndromes in diseases of the nervous system
3 3 1. Neurological examination
3.3.2. Selected syndromes in diseases of the nervous system
3.4. The cardiovascular system. Basic examination methods Selected syndromes in diseases of the cardiovascular system
3.4.1. Cardiovascular examination
3.4.2. Selected syndromes in diseases of the cardiovascular system
3.5. External respiration system. Basic examination methods. Selected syndromes in respiratory diseases
3.5.1. Examination of the external respiratory system
3.5.2. Selected syndromes in respiratory diseases
3.6. Digestive system. Basic examination methods. Selected syndromes in diseases of the digestive system
3.6.1. Digestive system examination
3.6.2. Selected syndromes in diseases of the digestive system
3.7. Urinary system. Basic examination methods. Selected syndromes in diseases of the urinary system
3.7.1. Examination of the urinary system
3.7.2. Selected syndromes in diseases of the urinary system
3.8. Blood system. Basic research methods. Selected syndromes in blood diseases
3.8.1. Blood system examination
3.8.2. Selected syndromes in diseases of the blood system
Chapter 4. MEDICAL AND PEDAGOGICAL CONTROL OF THOSE ENTERED IN PHYSICAL EDUCATION AND SPORTS
4.1. Primary and annual in-depth medical examinations
4.1.1. Principles for organizing primary and annual in-depth medical examinations
4.1.2. Principles of health assessment in the practice of sports medicine
4.1.2.1. Major diseases and pathological conditions that are contraindications to sports
4.1.2.2. Athlete Health Questionnaire (Injury and Medical History Recording System)
4.1.2.3 Principles of admission to sports for persons with borderline conditions
4.1 3. Principles of examination of the musculoskeletal system in athletes (E.K. Ermolenko)
4.1.4. Somatotyping
4.2. Staged medical and pedagogical control over representatives of various sports specializations
4.2.1. Principles of organizing stage control
4.2.2. Principles of studying the functional capabilities of the central nervous system
4.2.3. Principles of studying the functional capabilities of the neuromuscular system
4.2.4. Principles of studying the functional capabilities of the vestibular analyzer
4.2.5. Principles of studying the functional capabilities of the visual analyzer
4.2.6. Principles of studying the functional capabilities of the cardiorespiratory system
4.2.7. Principles of studying the functional capabilities of the external respiration system
4.2.8. Principles of studying general physical performance
4.2.9. Principles of studying the energy capabilities of the body.
4.3. Current and urgent medical and pedagogical control over representatives of various sports specializations
4.3.1. Principles of organizing current control
4.3.2. Principles of organizing urgent control
4.3.3. Indicators of the current and urgent functional state of the central nervous system
4.3.4. Indicators of the current and urgent functional state of the autonomic nervous system
4.3.5. Indicators of the current and urgent functional state of the neuromuscular system
4.3.6. Indicators of the current and urgent functional state of analyzers
4.3.7. Indicators of the current and urgent functional state of the cardiovascular system
4.3.8. Current changes in the morphological and biochemical composition of blood
4.3.9. Indicators of the urgent functional state of the body
4.4. Principles of self-control
Chapter 5. FEATURES OF MEDICAL AND PEDAGOGICAL CONTROL OF YOUNG ATHLETES
5.1. Pathological hereditary predisposition and high risk of hidden pathology
5.1.1. Minor developmental anomalies in children and adolescents
5.1.1.1. Anomalies of the spine (0.0. Lagoda)
5.1.1.2. Cryptorchidism in male children and adolescents
5.2. Diseases of the musculoskeletal system, typical for childhood and adolescence
5.3. Principles for assessing the level of physical development and puberty in children and adolescents
5.3.1. Assessment of the level of physical development
5.3.2. Somatotyping of children and adolescents
5.3.3. Principles for assessing the degree of puberty in children and adolescents
5.4. Principles for assessing the functional state of the cardiorespiratory system in children and adolescents
5.4.1. Methodology and principles for assessing functional tests with physical activity in children and adolescents
5.5. Principles for assessing general physical performance in children and adolescents
5.6. Features of organizing physical education and sports in childhood and adolescence (together with O.O. Lagoda)
5.7. Terms of admission to physical education and sports for children and adolescents and age stages of sports training
Chapter 6. Features of organizing medical and pedagogical control over female athletes
Chapter 7. MEDICAL AND PEDAGOGICAL CONTROL DURING THE TRAINING PROCESS IN DIFFERENT CLIMATE, GEOGRAPHICAL AND WEATHER CONDITIONS
7.1. Medical and pedagogical control in mid-mountain conditions
7.1.1. Stages of adaptation to barometric hypoxia
7.1.2. Pedagogical aspects of constructing the training process in mid-mountain conditions
7.1.3. Sports performance during the reacclimatization period after training in mid-mountains
7.1.4. Medical support for the training process in mid-mountain conditions
7.1.5. Altitude diseases
7.2. Preparation and competitions in high and low temperatures
7.2.1. Sports activity in high temperatures
7.2.2. Sports activity in low temperatures
7.3. Resynchronization of the circadian rhythms of the athlete’s body after long-distance flights
7.3.1. Flight to the West
7.3.2. Flight to the East
Chapter 8. MEDICAL SUPPORT FOR SPORTS COMPETITIONS
8.1. Principles of organizing medical support for sports competitions (L.N. Markov)
8.2. Features of medical support for martial arts competitions
Chapter 9 Principles of organizing anti-doping control
Chapter 10. Medical support for health-improving physical culture
10.1. A set of medical examinations for admission to recreational physical education classes
10.2. Principles for determining the level of physical condition of persons involved in sports culture
10.2.1. Methods! rapid assessment of the level of physical condition
10.2.2. Principles for determining the level of general physical performance in middle-aged and elderly people
10.3. Motor modes in the system of health-improving physical culture
10.4. The amount and content of physical exercises for the development and maintenance of physical condition
Chapter 11. BASIC TOOLS USED TO OPTIMIZE THE PROCESSES OF RECOVERY AND INCREASED PHYSICAL PERFORMANCE OF ATHLETES
11.1. Compensation for fluid and electrolyte deficiency during sports activities
11.1.1. Rehydration directly during prolonged muscle activity
11.1.2. Post-exertion compensation of fluid deficiency in the body
11.2. Optimizing sleep in athletes
11.3. Optimization of nutrition and elimination of factors that impede the maximum implementation of the detoxification function of the liver in conditions of intense muscle activity
11.4. The use of pharmacological agents to optimize post-exertional recovery processes and improve physical performance
Chapter 12. CHRONIC OVERSTRESS OF LEADING ORGANS AND BODY SYSTEMS IN ATHLETES
12.1. Overwork
12.2. Overtraining
12.2.1. Type I overtraining
12.2.2. Type II overtraining
12.3. Chronic physical overexertion
12.3.1. Chronic physical overstrain of the cardiovascular system
12.3.2. Chronic physical overstrain of the nonspecific defense and immune system
12.3.3. Periodically occurring acute manifestations of chronic physical overstrain
12.3.3.1. Overstrain of the digestive system
12.3.3.2. Overstrain of the urinary system
12.3.3.3. Overstrain of the blood system
Chapter 13. CHRONIC STRAIN, SPECIFIC DISEASES AND ACUTE DAMAGE TO THE MUSCULOSKETAL SYSTEM DURING SPORTS
13.1. Chronic overstrain of the musculoskeletal system
13.2. Acute injuries of the musculoskeletal system in athletes
13.2.1. Injuries to muscles, tendons and auxiliary apparatus of joints
13.2.2. Bone fractures
13.3. Sports and pedagogical direction of prevention of injuries and diseases of the musculoskeletal system in athletes
13.3.1. Techniques for applying tape bandages to various parts of the body
13.3.2. Acceptable time limits for resuming training sessions after injuries to the musculoskeletal system
Chapter 14. DISEASES AND INJURIES IN ATHLETES
14.1. Structure of morbidity among athletes
14.2. Diseases most frequently encountered in the clinical practice of sports medicine
14.2.1. Central and peripheral nervous system
14.2.2. The cardiovascular system
14.2.3. Respiratory system
14.2.4. Digestive system
14.2.5. Urinary system
14.2.6. Musculoskeletal system
14.2.7. ENT organs (nose, throat, ear)
14.2.8. Organ of vision
14.3. Diseases that can cause sudden death during physical education and sports
14.3.1. Heart disease
14.3.2. Myocardial infarction
14.3.3. Cardiomyopathies
14.3.4. Acute cerebrovascular accidents
14.4. Acute injuries in athletes
14.4.1. Closed head injury
14.4.1.1. Brain concussion
14.4.1.2. Brain contusion
14.4.1.3. Brain compression
14.4.1.4. Features of traumatic brain injury in boxers
14.4.1.5. Traumatic brain injuries during martial arts practice
14.4.2. Closed injuries of the spine and spinal cord
14.4.3. Internal organ injuries
14.4.4. Injuries to the nose, ear, larynx, teeth and eyes
Chapter 15. SUDDEN DEATH IN SPORTS
Chapter 16. EMERGENCIES
16.1. Anaphylactic shock
16.2. Sudden cessation of blood circulation
16.3. Hypoglycemic state. Hypoglycemic coma
16.4. Myocardial infarction
16.5. Chest compression
16.6. Fainting
16.6.1. Psychogenic syncope
16.61.2. Vasovagal syncope
16.6.3. Orthostatic syncope
16.6.4. Gravity swoon (shock)
16.7. Acute physical stress
16.8. Hypothermia
16.9. Heat injuries
16.9.1. Heatstroke (sunstroke)
16.9.2. Thermal collapse
16.9.3. Heat cramps
16.9.4. Heat exhaustion
16.9.5. General dehydration
16.9.6. Thermal swelling of the legs and feet
16.10. Drowning
Chapter 17. ACCIDENTS AND EMERGENCIES IN SPORTS: LEGAL FRAMEWORK (A.L. Vlasov)
17.1. Managers' Responsibilities
17.2. Responsibility of the coaching, teaching and instructional staff
17.3. Responsibility of those involved
17.4. The procedure for considering and analyzing the causes of emergencies and accidents in sports
A brief dictionary of medical terms
Literature
I INTRODUCTION TO SPORTS MEDICINE
I.1. Sports medicine, its goals and objectives
Physical culture and sports in any civilized society are an objective need and perform important social functions, including the functions of preventive medicine. Their healing effect is associated with strengthening the biological mechanism of the body’s protective and adaptive reactions and with the training effect of physical activity. In modern society, replete with emotional stress against the background of progressive hypokinesia, increasing the level of health and functional state of a person is impossible without the widespread and comprehensive use of physical education, which should become an integral, mandatory part of the lifestyle. Sports activities, i.e. performing exercises of large volume and intensity, with a specific focus, pursue the goal of not only improving health, but also achieving high results, increasing sportsmanship in a particular sport. And in this regard, it is very important that sports achievements grow due to improved health, and not at the expense of health. It is no coincidence that medical and biological knowledge forms the basis for the professional training of a future teacher (trainer), without mastering which he will not be able to competently build the process of physical education. Professionally, both teachers (trainers) and doctors are very close to each other, since the object of their attention is a living person, and both of them in their work must adhere to the principle (non nocere - do no harm).
SPORTS MEDICINE is a science that studies the positive and negative effects of physical activity of varying degrees (from hypokinesia to hyperkinesia) on the body of a healthy and sick person in order to determine optimal physical activity for: a) strengthening and restoring health, b) increasing the level of functional state, c) growth in sports achievements, d) prevention and treatment of various diseases (A.G. Dembo, 1980).
primary goal sports medicine: promoting the rational use of means and methods of physical culture and sports for the harmonious development of a person, preserving and strengthening his health, increasing performance and achieving high sports results, prolonging the active, creative period of life (V.L. Karpman, 1987).
The main goal and content of sports medicine determine the objectives of the sports medicine course studied by students of the Academy of Physical Education:
1) deepening and expanding general biological and general medical training of future teachers and trainers;
2) training in accessible methods of monitoring the health and functional state of people involved in physical education and sports, assessing the data obtained and their use in constructing the training process;
3) training in the use of knowledge and skills in the field of medical supervision, exercise therapy, massage in future activities;
4) fostering the need to work in contact with a sports and attending physician.
Sports medicine in its current form was not formed all at once, but went through several stages in its development.
Currently, sports medicine is an established independent branch of medicine with its own tasks, organization, material and scientific base. All medical institutes and FC academies have departments of sports medicine. In the depths of sports medicine, its sections have been formed: sports cardiology, traumatology, endocrinology, pharmacology, immunology, pediatric sports medicine, etc. The scientific potential of sports medicine has increased significantly, represented today by established schools and scientific directions of professors A.G. Dembo, V.L. Karpman, Z.S. Mironova, N.D. Graevskaya, R.D. Dibner, S.V. Khrushev, etc.
I.2 Dispensary method of observation of athletes and athletes
MEDICAL CONTROL– the main section of sports medicine. Contents and tasks of medical supervision:
– assessment of health status, resolving the issue of admission and sports orientation, taking into account indications and contraindications;
– monitoring health status during classes or the training process;
– assessment of physical development and its dynamics;
– diagnostics of the functional state;
– identifying the effect of training regimen and methods on the body;
– treatment of sports injuries, diseases and injuries in people involved in physical activity and sports, studying the causes of their occurrence and developing preventive measures;
– control over compliance of conditions and organization of classes with accepted sanitary and hygienic standards;
– medical support for competitions; sanitary-educational and educational work.
The main form of organizing medical supervision over persons involved in physical education and sports is DISPANSERIZATION. The essence of the medical examination method is systematic medical observation of the health of a certain category of people - healthy or sick. Medical examination of healthy people is carried out in relation to children, pregnant women, certain groups of production workers, as well as athletes. For a certain group of patients, tuberculosis, oncology, skin and venereal diseases, etc. have been created. dispensaries. The Medical and Physical Education Dispensary (VFD) is a scientific and practical center that provides guidance and direct medical care to people involved in physical education and sports. First of all, highly qualified athletes, members of national teams of the city, district, region, and country are assigned to the dispensary. At the same time, the WFD is the organizing center for the physical education of children and adolescents, and manages the work of school doctors in this area, doctors of children's and youth sports schools, and health groups. At the same time, the VFD is entrusted with the responsibility of managing all therapeutic physical culture on the scale of the territory served by the dispensary. As a medical institution, VFD is under the authority and subordination of health authorities. Medical and physical education dispensaries are medical and preventive institutions that include therapists who supervise certain sports, doctors of narrow specializations (surgeon, ophthalmologist, otolaryngologist, dentist, gynecologist, etc.), offices and departments of functional diagnostics, physiotherapy, physical therapy, clinical and biochemical laboratory, x-ray room.
I.3 Medical examination, its goals and objectives
During a medical examination of persons involved in physical culture and sports, it is consistently decided the following tasks:
1) determination of health status,
2) determination and assessment of the level of physical development,
3) assessment of the functional state of the body.
KINDS medical examination:
– Primary is carried out for everyone who wants to engage in physical education or sports. At the same time, the issue of admission to classes is resolved. Recommendations are given about the type of sport, taking into account the age, morphological and functional characteristics of the person.
– Repeatedly, this is the essence of clinical observation – determining the impact (both positive and negative) of physical exercise on the body. If they are used irrationally, repeated examinations make it possible to promptly identify pre-pathological and pathological changes that require timely treatment.
– Additional exercises are carried out after breaks in training caused by illness, injury or any other reasons. Additional examinations include medical examinations performed before competitions in some sports (for example, boxing).
The basic principles of medical examination are:
– The systematic nature of medical examinations involves carrying out examinations according to plan, systematically, at certain intervals, established by the doctor, regardless of the well-being of the athlete or physical athlete. Thus, persons subject to medical examination are required to undergo a full medical examination at least once or twice a year.
– The complexity of a medical examination involves a comprehensive examination of the body using a wide range of medical examination methods.
– the functional focus of medical examinations means the need to study the body not only under resting conditions, when an idea of functional capabilities is formed, but mainly under the influence of various dosed factors (functional tests). In this case, the functional abilities of the organs and systems of the body as a whole are determined, i.e. the ability to use one's capabilities.
I.4 Methods of medical examination, their classification
CLASSIFICATION OF METHODS OF MEDICAL EXAMINATION:
1) clinical,
2) instrumental,
3) laboratory,
4) functional tests.
TO CLINICAL METHODS relate:
– Anamnesis (translated from Greek anamnesis - memory) is a set of information reported by the patient to the doctor and used in establishing the diagnosis and prognosis of the disease. Information about passport data, marital status, place of residence, living conditions, education, profession belongs to the so-called general medical history. When collecting medical history find out what diseases, injuries, surgical interventions the subject suffered and when it happened. Data on diseases in the family and among relatives are analyzed in order to determine hereditary predisposition. Bad habits (smoking, drinking alcohol) are revealed. A significant part of the medical history consists of complaints from sick patients or subjective sensations of objective ill health in the body. Sports history collected from individuals involved in physical education and sports, includes information about the type of sport, the duration of classes, the sports category, the nature of the training loads used, their volume and intensity, the number of training sessions per week. Of particular interest to the doctor is information about the growth of sports achievements or their absence (from what time, what preceded this, the supposed reason), whether there were any training sessions in a painful state, whether signs of overwork and overexertion showed up (if there were, then when and what were taken measures to eliminate them). To a certain extent, both the teacher and the trainer should be proficient in the history-taking technique, since the data obtained from this is of significant interest to them and should be used in planning and organizing the training process.
– Somatoscopy – external examination of the body is one of the methods for determining physical development, allowing one to assess posture, the condition of the musculoskeletal system, and body type. During a medical examination, an external examination also allows one to determine the patient’s facial expression, the color and condition of the skin and mucous membranes (for example, pallor, redness or yellowness of the skin, cyanosis - cyanosis - of the mucous membranes of the lips), the degree of fatness (obesity, emaciation), the presence of varicose veins etc.
– Palpation – feeling. Using touch, they determine the turgor (elasticity) of the skin, various painful points in the tissues, vibrations of arterial walls (rhythm, pulse filling, heart rate), the presence and degree of enlargement of the lymph glands, the condition of the abdominal organs (presence of seals, soreness), etc. .
– Percussion – tapping. This research method is based on the fact that the nature and intensity of the sound that occurs when a finger taps an area of the subject’s body depends on what is located under the tapping site - a dense body, liquid or air. For example, when percussing the chest over healthy lungs filled with air, a clear sound is heard, but if the lungs are inflamed or there is a tumor in them, percussion will dull the sound. The method allows you to identify foci of inflammation, the presence of fluid, tumors, and determine the size and position of some organs.
– Auscultation listening. Using this research method, sound vibrations that occur during the functioning of internal organs are listened to (for example, heart sounds and murmurs, respiratory sounds and wheezing heard in the lungs as air passes through the bronchial tree, etc.).
INSTRUMENTAL METHODS Research used in medical and sports practice allows for a more in-depth and accurate assessment of the condition of human organs or systems. Thus, when studying the functional state of the circulatory system, devices for measuring blood pressure (sphygmomanometers) and devices for studying the functioning of the heart (electrocardiographs, phonocardiographs, echocardiographs) are used. The study of the functional state of the external respiration system involves the use of spirometers and spirographs, pneumotachometers, pneumotonometers, oximeters, etc.
TO LABORATORY METHODS studies include:
– Biochemical studies of liquid media and body secretions
– Microscopic analyzes of liquid media and body secretions (blood, urine, gastric juice, bile, sputum, feces, etc.)
– Histological studies of tissues (study of cellular composition)
– Bacteriological methods (determining the presence of bacteria, viruses, fungi, etc. in liquid media and body secretions)
FUNCTIONAL TESTS constitute the content of a special section of sports medicine - functional diagnostics. Functional tests allow you to assess the functionality of organs and systems under conditions of additional external influences on the body (physical stress, hypoxia, high or low temperature, etc.)
I.5 Questions for self-control
1. Sports medicine as an integral part of general medicine, its goals and objectives.
2. Dispensary method of monitoring athletes and athletes. The structure of the physical education and medical dispensary, its tasks.
3. Medical support for physical education and sports in schools, vocational schools, universities, youth sports schools. Dividing schoolchildren into medical groups.
4. Medical examination, its goals and objectives.
5. Methods of medical examination, their classification.
II. BASICS OF GENERAL PATHOLOGY
II.1 General doctrine of illness
General pathology- translated as the general doctrine of diseases (Pathos - disease, logos - teaching), about their most general patterns of origin, development and termination. For coaches, knowledge of the section of general pathology is associated with the need for a deep understanding of the processes of adaptation of the body to physical and emotional stress in sports, understanding the importance of the principle of individualization of the training process when working with a very different contingent (young athletes and members of the “Health” group, healthy and sick, etc.). etc.), prevention of overvoltage conditions, etc.
Pathological process– a combination of pathological and protective-adaptive reactions in damaged tissues, organs or systems in response to a damaging effect. The simplest forms of pathological processes are called pathological reactions. For example, when a foreign body enters the eye, a tearing reaction occurs. Sneezing, coughing are examples of pathological reactions of a protective nature, etc.
Pathological condition– this is either a slowly developing pathological process, or one of the stages of the pathological process, or a consequence of the pathological process. A pathological process can develop into a pathological state. For example, after an athlete tears a muscle, a scar forms on the muscle (replacement of muscle with connective tissue), which lasts for many years. In scar tissue, as in any living tissue, metabolism occurs and collagen and elastic fibers are formed. A scar is a slowly occurring pathological process, i.e. pathological condition. Conversely, a pathological condition can develop into a pathological process. For example, the degeneration of birthmarks into a tumor.
When playing sports, various pathological processes and pathological conditions can be observed that cause disruptions in vital activity and, in some cases, pose a danger to the life of the athlete. These include: cardiac arrest, overexertion, acute disorders of vascular regulation (gravitational fainting, orthostatic collapse), shock, knockouts, hypoglycemic conditions, hypoxia, muscle tears and ruptures, etc. Knowledge of the causes and mechanisms of development of pathological conditions and pathological processes allows the trainer to ensure their prevention and, if necessary, provide first aid.
II.2 Definition of concepts: health, illness, their differences and relationships
Health and illness- these are two forms of the body’s vital activity and its adaptation to changing environmental conditions with the help of physiological mechanisms existing in the body. But this life is qualitatively different. Health is a free life, with full adaptability to changing environmental conditions, with the absence of painful manifestations, maintaining ability to work, etc.
As defined by the World Health Organization health– this is complete physical, mental and social well-being, and not just the absence of painful manifestations
Disease– cramped life, as the body does not adapt well to changing conditions, painful symptoms appear, and ability to work is impaired. In other words illness– is a disorder of the normal functioning of the body that occurs under the influence of any damaging influence, characterized by limited adaptation to the external environment, the presence of painful changes and decreased performance. When a disease occurs, physiological processes continue, but physiological regulation takes on a new character: mechanisms aimed at eliminating the pathogenic origin take first place. If these reactions are not enough, the body mobilizes additional regulatory mechanisms. Thus, illness is a dialectical process. On the one hand, processes of destruction take place, and on the other, restoration processes take place. Some of the reactions that occur in the body are useful, because are adaptive, others are harmful.
Between health and illness there is third intermediate state when the body is not yet sick, but no longer healthy. In such an intermediate state, the organism can exist for years. The reasons for the formation of the third state are various adverse effects on the body or exogenous hazards. These conditions include:
– change of time and climate zones
– poor nutrition
- bad habits
– occupational hazards
– psycho-emotional overload
– hormonal changes in the body (menopause, pubertal changes, etc.)
– pregnancy, etc.
In an intermediate state, exposure to additional hazards or pathogenic factors can lead to failure of adaptation, i.e. to illness. The body's stay in the third state should be considered as an opportunity to optimize adaptive mechanisms in order to maintain health. That is, during this period, health-saving measures are necessary. Such activities, for example, include vaccination, vitamin supplementation, health-improving physical education, good nutrition, sleep, etc.
II.3 Concept of etiology
Etiology– (aitio – cause) the study of the causes and conditions for the occurrence of diseases.
The cause of the disease- they call a factor that causes a disease and gives it specific features, and without which the occurrence of this disease is impossible. For example, the cause of pneumonia is pneumococcus, tuberculosis is Koch's bacillus. By eliminating the cause of the disease and treating them with specific drugs, recovery can be achieved. But the causative factor does not always cause the disease. For example, during a flu epidemic, the virus enters the body of almost every person, but not everyone gets sick. That is, one reason in itself may or may not cause a disease. Often the occurrence of a disease can be attributed to the influence of not one, but several factors. For example, the flu is caused by cold (cold), fatigue, negative emotions, and poor nutrition. Thus, in addition to the cause of the disease, the human body is influenced by factors that contribute to the disease or, conversely, prevent its development. Such factors are called conditions for the occurrence of the disease. The differences in the cause and conditions of the disease are:
1) there is one reason, but the conditions are diverse,
2) the reason is obligatory, and the conditions may or may not exist,
3) the cause determines the specificity of the disease.
Causes of diseases are external and internal environmental factors. External (exogenous) factors are divided into:
Physical - factors of a mechanical nature, temperature factors, radiant energy, electric current, low and high atmospheric pressure, etc.
– Chemical – acids, alkalis, poisons of organic and inorganic origin, chemical warfare agents (mustard gas, phosgene, tabun, soman, sarin, etc.), alcohol, nicotine, drugs – cause burns, poisoning
– Nutritional – nutritional factors (malnutrition, overeating), lack of essential nutrients (including vitamins), can cause illness
– Mental – these are primarily excessive negative emotions, which can lead to the development of emotiogenic diseases (neuroses, myocardial infarction, gastric ulcer, etc.)
– Social are wars, epidemics, hunger, unemployment, hypokinesia and hyperkinesia and other influences caused by society and human labor activity.
Hypokinesia- one of the consequences of scientific and technological progress. Translated, the word means a decrease in human motor activity. Automation of production, development of vehicles, media (cinema, television) determine the fact that the motor activity of modern man is less than that of people of the last century. Hypokinesia is a global social problem that affects the entire population of civilized countries. It is considered one of the reasons for the increase in diseases of the cardiovascular system.
Hyperkinesia– excessive physical activity, use of excessive physical activity, i.e. those that exceed the functional capabilities of the body. Hyperkinesia occurs during irrational physical education and sports, when excessive stress is the cause of a number of specific diseases associated with physical overexertion.
Internal (endogenous) etiological factors include:
1. constitution
2. heredity
