by the pool chlorine so transmission via pool is rare.
Goggle wear will help prevent chemical conjunctivi-
tis, which is a self-limiting problem.SUN DAMAGE
•For those swimmers training in open water, close
attention to the skin is important to prevent sun burn.
•Twenty to 30 min prior to swimming, waterproof sun-
screen should be liberally applied. There is no con-
sensus on timing of reapplication of sunscreen.
SWIMMER’S XEROSIS
- After hours submersed in the water, the skin becomes
dehydrated and pruritic. - Prevention is the key. Swimmers should apply lotion
or body oil to their lightly patted skin after showering.
The postswim shower should be short and with warm
instead of hot water (Basler et al, 2000).
GREEN HAIR
- Though not harmful, green hair can cause the swim-
mer undue anxiety. - Application of 2% hydrogen peroxide to the hair and
rinsing this out in 30 min will help remove the discol-
oration.
REFERENCES
Basler R, Basler G, Palmer S et al: Special skin symptoms seen
in swimmers. J Am Acad Derm 43(2):299–305, 2000.
Johnson J, Gauvin J, Fredericson M: Swimming biomechanics and
injury prevention. Phys Sportsmed31(1):39–56 Jan 2003.
McMaster W, Troup J: A survey of interfering shoulder pain in
United States competitive swimmers. Am J Sports Med
21(1):67–70, 1993.
Pink M, Tibone J: The painful shoulder in the swimming athlete.
Clin Orthop 21(2):247–261, 2000.
Pink M, Perry J, Browne A et al: The normal shoulder during
freestyle swimming: An electromyographic and cinemato-
graphic analysis of twelve muscles. Am J Sports Med
19:569–576, 1991.
Rodeo S: Knee pain in competitive swimming. Clin Sports Med
18(2):379–387, April 1999.
Schubert, M: Competitive Swimming: Techniques for Champions.
New York, NY, Winner Circle Books, 1990.
Stocker D, Pink M, Jobe FW: Comparison of shoulder injury in
collegiate and master’s level swimmers. Clin J Sport Med
5(1):4–8, 1995.
Weiler J, Edward R: Asthma in United States Olympic athletes
who participated in the 1998 Olympic Winter Games. Clin
Allergy Immunol106(2):267–271, August 2000.
Weldon E, Richardson A: Upper extremity overuse injuries in
swimming. Clin Sports Med20(3):423–438, July 2001.91 TENNIS
Robert P Nirschl, MD, MSEPIDEMIOLOGY•Tennis injuries are equally divided between the upper
and lower body. The most celebrated are tendon over-
use of the shoulder and elbow (e.g., rotator cuff tendi-
nosis and tennis elbow).
•Lower extremity problems are typical of other run-
ning sports: examples include ankle sprains, leg issues
(such as medial gastroc rupture, medial tibial stress
syndrome, and Achilles tendinosis), and knee abnor-
malities such as meniscal cartilage tears and chondro-
malacia patellae.- The etiology of the common shoulder and elbow ten-
donopathies is primarily repetitive overuse and heredity.
•Repetitive overuse in tennis elbow and rotator cuff
tendinosis are related to tennis technique and equip-
ment, as well as frequency, duration, and intensity.
PATHOPHYSIOLOGY- The exact mechanisms of tendon failure are not
defined. Mechanical tendon failure is presumed to
occur by mechanical collagen disruption, a chemical
inflammatory cascade, and vascular distress resulting
in tendon degeneration (angiofibroblastic tendinosis). - The histopathology of angiofibroblastic tendinosis is
characterized by nonfunctional vascular and fibrob-
lastic elements, as well as collagen disruption and dis-
organization. There are no noted inflammatory cells in
the histopathology of tendinosis.
CLINICAL FEATURES- The key symptom in tennis elbow include various
stages of pain—pain phases (Nirschl):- Mild pain after exercise activity—resolves within
24 h. - Pain after exercise activity—exceeds 48 h and
resolves with warm-up.
3.Pain with exercise activity that does not alter the
exercise.
- Mild pain after exercise activity—resolves within
534 SECTION 6 • SPORTS-SPECIFIC CONSIDERATIONS