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Matthew D. Mecham, Richard M. Greenwald, James G. Macintyre and Stephen C. Johnson

A field study was performed using freestyle aerial ski jumpers to determine the incidence of head impact (slapback) and to record head acceleration data during slapback episodes for the 1994–1995 and 1995–1996 winter seasons. A total of 382 slapbacks were recorded from 2,352 jumps for an observed slapback incidence of 16.2%. Head acceleration data were recorded for 5 slapback events. Maximum head acceleration magnitudes for the 5 impacts ranged from 27 to 92 gs and impact durations ranged from 12 to 96 μsec. Standard severity indices including the Gadd Severity Index and Head Injury Criteria were calculated from the resultant acceleration signal and ranged from 57 to 223, and 21 to 159, respectively, which are considered low in terms of life threatening injury levels.

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Matthew W. Hoon, Nathan A. Johnson, Phillip G. Chapman and Louise M. Burke

The purpose of this review was to examine the effect of nitrate supplementation on exercise performance by systematic review and meta-analysis of controlled human studies. A search of four electronic databases and cross-referencing found 17 studies investigating the effect of inorganic nitrate supplementation on exercise performance that met the inclusion criteria. Beetroot juice and sodium nitrate were the most common supplements, with doses ranging from 300 to 600 mg nitrate and prescribed in a manner ranging from a single bolus to 15 days of regular ingestion. Pooled analysis showed a significant moderate benefit (ES = 0.79, 95% CI: 0.23–1.35) of nitrate supplementation on performance for time to exhaustion tests (p = .006). There was a small but insignificant beneficial effect on performance for time trials (ES = 0.11, 95% CI: –0.16–0.37) and graded exercise tests (ES = 0.26, 95% CI: –0.10–0.62). Qualitative analysis suggested that performance benefits are more often observed in inactive to recreationally active individuals and when a chronic loading of nitrate over several days is undertaken. Overall, these results suggest that nitrate supplementation is associated with a moderate improvement in constant load time to exhaustion tasks. Despite not reaching statistical significance, the small positive effect on time trial or graded exercise performance may be meaningful in an elite sport context. More data are required to clarify the effect of nitrate supplementation on exercise performance and to elucidate the optimal way to implement supplementation.

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Catriona A. Burdon, Matthew W. Hoon, Nathan A. Johnson, Phillip G. Chapman and Helen T. O’Connor

Purpose:

The purpose of this study was to establish whether sensory factors associated with cold-beverage ingestion exert an ergogenic effect on endurance performance independent of thermoregulatory or cardiovascular factors.

Methods:

Ten males performed three trials involving 90 min of steady state cycling (SS; 62% VO2max) in the heat (32.1 ± 0.9 °C, 40 ± 2.4% relative humidity) followed by a 4 kJ/kg body mass time trial (TT). During SS, participants consumed an identical volume (260 ± 38g) of sports beverage (7.4% carbohydrate) every 15 min as either ice slushy (–1 °C; ICE), thermoneutral liquid (37 °C; CON), or thermoneutral liquid consumption with expectorated ice slushy mouthwash (WASH).

Results:

Rectal temperature, hydration status, heart rate, and skin blood flow were not different between trials. Gastrointestinal (pill) temperature was lower in ICE (35.6 ± 2.7 °C) versus CON (37.4 ± 0.7 °C, p = .05). Heat storage tended to be lower with ICE during SS (14.7 ± 8.4W.m−2, p = .08) and higher during TT (68.9 ± 38.6W.m−2, p = .03) compared with CON (22.1 ± 6.6 and 31.4 ± 27.6W.m−2). ICE tended to lower the rating of perceived exertion (RPE, 12.9 ± 0.6, p = .05) and improve thermal comfort (TC, 4.5 ± 0.2; p = .01) vs. CON (13.8 ± 1.0 and 5.2 ± 0.2 respectively). WASH RPE (13.0 ± 0.8) and TC (4.8 ± 0.2) tended to be lower versus CON (p = .07 and p = .09 respectively). ICE improved performance (18:28 ± 1:03) compared with CON (20:24 ± 1:46) but not WASH (19:45 ± 1:43).

Conclusion:

Improved performance with ICE ingestion likely resulted from the creation of a gastrointestinal heat sink, reducing SS heat storage. Although the benefits of cold-beverage consumption are more potent when there is ingestion, improved RPE, TC, and meaningful performance improvement with WASH supports an independent sensory effect of presenting a cold stimulus to the mouth.

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Steven Malvasi, Brian Gloyeske, Matthew Johnson and Timothy Miller

Background:

Injury to the anterior cruciate ligament (ACL) is one of the most common orthopedic injuries in the United States, while injury to the patellar tendon (PT) is less common. A combined rupture to the ACL and PT is consequentially uncommon and increases the difficulty of a correct initial diagnosis. The purpose of this paper is to critically appraise the current peer-reviewed literature regarding multi-ligamentous knee injuries (MLKI) in sport.

Methods:

A systematic review was undertaken to identify all relevant peer-reviewed articles regarding MLKI from March 1980 to January 2015. All articles pertaining to simultaneous rupture of the ACL and PT were included for review.

Results:

A total of 27 cases presented in 15 articles were used. Findings suggest that the combination of a palpable gap over the PT, a positive Lachman test, inability to complete terminal knee extension, and a superior position of the patella are clinical examination markers for a possible MLKI involving the ACL and PT.

Conclusion:

Simultaneous rupture to the ACL and PT is incredibly rare within the sport population, making diagnosis and treatment of such injury challenging. A thorough examination of the extensor mechanism of the knee is important in making the proper diagnosis.

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Lawrence E. Armstrong, Elaine C. Lee, Douglas J. Casa, Evan C. Johnson, Matthew S. Ganio, Brendon P. McDermott, Jakob L. Vingren, Hyun M. Oh and Keith H. Williamson

Introduction:

Exertional hyponatremia (EH) during prolonged exercise involves all avenues of fluid-electrolyte gain and loss. Although previous research implicates retention of excess fluid, EH may involve either loss, gain, or no change of body mass. Thus, the etiology, predisposing factors, and recommendations for prevention are vague—except for advice to avoid excessive drinking.

Purpose:

This retrospective field study presents case reports of two unacquainted recreational cyclists (LC, 31y and AM, 39 years) who began exercise with normal serum electrolytes but finished a summer 164-km ride (ambient, 34±5°C) with a serum [Na+] of 130 mmol/L.

Methods:

To clarify the etiology of EH, their pre- and post-exercise measurements were compared to a control group (CON) of 31 normonatremic cyclists (mean ± SD; 37±6 years; 141±3 mmol Na+/L).

Results:

Anthropomorphic characteristics, exercise time, and post-exercise ratings of thermal sensation, perceived exertion and muscle cramp were similar for LC, AM and CON. These two hyponatremic cyclists consumed a large and similar volume of fluid (191 and 189 ml/kg), experienced an 11 mmol/L decrease of serum [Na+], reported low thirst sensations; however, LC gained 3.1 kg (+4.3% of body mass) during 8.9 hr of exercise and AM maintained body mass (+0.1kg, +0.1%, 10.6h). In the entire cohort (n = 33), post-event serum [Na+] was strongly correlated with total fluid intake (R2 = 0.45, p < .0001), and correlated moderately with dietary sodium intake (R2=0.28, p = .004) and body mass change (R2 = 0.22, p = .02). Linear regression analyses predicted the threshold of EH onset (<135 mmol Na+/L) as 168 ml fluid/kg.

Conclusions:

The wide range of serum [Na+] changes (+6 to -11 mmol/L) led us to recommend an individualized rehydration plan to athletes because the interactions of factors were complex and idiosyncratic.

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Matthew W. Hoon, Andrew M. Jones, Nathan A. Johnson, Jamie R. Blackwell, Elizabeth M. Broad, Bronwen Lundy, Anthony J. Rice and Louise M. Burke

Context:

Beetroot juice is a naturally rich source of inorganic nitrate (NO3 ), a compound hypothesized to enhance endurance performance by improving exercise efficiency.

Purpose:

To investigate the effect of different doses of beetroot juice on 2000-m ergometer-rowing performance in highly trained athletes.

Methods:

Ten highly trained male rowers volunteered to participate in a placebo-controlled, double-blinded crossover study. Two hours before undertaking a 2000-m rowing-ergometer test, subjects consumed beetroot juice containing 0 mmol (placebo), 4.2 mmol (SINGLE), or 8.4 mmol (DOUBLE) NO3 . Blood samples were taken before supplement ingestion and immediately before the rowing test for analysis of plasma [NO3 ] and [nitrite (NO2 )].

Results:

The SINGLE dose demonstrated a trivial effect on time to complete 2000 m compared with placebo (mean difference: 0.2 ± 2.5 s). A possibly beneficial effect was found with DOUBLE compared with SINGLE (mean difference –1.8 ± 2.1 s) and with placebo (–1.6 ± 1.6 s). Plasma [NO2 ] and [NO3 ] demonstrated a dose-response effect, with greater amounts of ingested nitrate leading to substantially higher concentrations (DOUBLE > SINGLE > placebo). There was a moderate but insignificant correlation (r = –.593, P = .055) between change in plasma [NO2 ] and performance time.

Conclusion:

Compared with nitratedepleted beetroot juice, a high (8.4 mmol NO3 ) but not moderate (4.2 mmol NO3 ) dose of NO3 in beetroot juice, consumed 2 h before exercise, may improve 2000-m rowing performance in highly trained athletes.