THE RELATIONSHIP OF BREASTSTROKE TRAINING
ON KNEE PAIN AND Q ANGLE OF BREASTSTROKE AND CRAWL SWIMMERS
Mehrdad Hefzollesan,
1, A, B, CAsghar Tofighi,
2, B, C, D, EBahram Jamali Qarakhanlou,
3, A, B, C, D, ESohrab Ghalehgir
1, A, B, E1 'HSDUWPHQWRI([HUFLVHDQG6SRUWV6FLHQFHV6DKQG8QLYHUVLW\RI7HFKQRORJ\7DEUL],UDQ 2'HSDUWPHQWRI([HUFLVHDQG6SRUWV6FLHQFHV8UPLD8QLYHUVLW\8UPLD,UDQ
3'HSDUWPHQWRI([HUFLVHDQG6SRUWV6FLHQFHV7DEUL]8QLYHUVLW\RI0HGLFDO6FLHQFHV7DEUL],UDQ A Study Design; B Data Collection; C Statistical Analysis; D0DQXVFULSW3UHSDUDWLRQ E Funds Collection
Address for correspondence:
Bahram Jamali Gharakhanlou, PhD student Tabriz University of Medical Science 'HSWPHQWRI3K\VLFDO(GXFDWLRQ (PDLO MDPDOLE#WE]PHGDFLU
Abstract.
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4DQJOHZKLSNLFNXQLYHUVDOJRQLRPHWU\Introduction
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SUREDELOLW\RINQHHLQMXULHVIRUEUHDVWVWURNHDQGFUDZOVZLPPHUV6WDWLVWLFDOPHWKRGV 5HIHUULQJWR7DEUL]6KDQG VZLPPLQJSRRODQGZLWKDLGVRI7DEUL]SURYLQFHVZLPPLQJWHDPPHQWRUVZLPPHUVRIEUHDVWVWURNHDQGFUDZO swimmers were selected randomly. All subjects were training under investigation of mentioned mentor. Average DJHRIVZLPPHUVZDVDQGDOORIWKHPKDGSDUWLFLSDWHGDWOHDVWDQGDWWKHPRVW\HDUVLQSURYLQFHVZLPPLQJ WHDPWUDLQLQJSURJUDPV$PRQJHDFKJURXSRIVZLPPHUVVZLPPHUVZHUHVHOHFWHGDVVXEMHFWJURXSDQGRI WKHPZHUHVHOHFWHGDVFRQWUROJURXS3HUIRUPLQJWUDLQLQJZDVFRQWLQXHGPRQWKVXQGHULQYHVWLJDWLRQRIFRDFKDQG UHVHDUFKHU7KHVHWUDLQLQJZHUHLQFOXGLQJEUHDVWVWURNHVZLPPLQJHPSKDVL]LQJRQZKLSNLFNWHFKQLTXHLQWHQVLW\ RI±SHUFHQWRIWKHPD[LPXPDELOLW\RIVZLPPHUV7UDLQLQJFRXUVHZDVVHVVLRQVLQD week each session KROGLQJKRXU&RQWUROOLQJJURXSVZLPPHUVGLGQRWSHUIRUPHGDQ\NLQGRIWUDLQLQJGXULQJWKLVFRXUVH:HDVVHVVHG VZLPPHUV¶NQHHSDLQWKURXJKD questioner before starting training. Moreover their Q angle was measured by a ruler DQGJRQLRPHWHUXVLQJUDGLRJUDSKLFDOSKRWRVRIVZLPPHUV¶EDFNKLSLQULJKWSRVLWLRQ,QRUGHUWRPHDVXUH4DQJOH ILUVWRIDOOZHGHWHUPLQHGSODFHRIQRGHRISULFNOHRIEDFNKLSPLGGOHRINQHHFDSDQGQRGHRIUDZERQH$IWHUWKDW GHWHUPLQLQJSRLQWVZHUHFRQQHFWHGWRHDFKRWKHUE\UXOHUDQGFRQWLQXHGWLOODQJOHSURGXFHGE\FRQWLQXDWLRQRIWZR OLQHVFRQQHFWLQJSULFNOHRIKLSEDFNERQHWRFHQWUDOSRLQWRINQHHFDSERQHDQGXVLQJD goniometer the connecting OLQHRIUDZERQHQRGHWRFHQWUDOSRLQWRINQHHFDSUHJLVWHUHGDV4DQJOH0F*LOOTXHVWLRQHUZDVFRPSOHWHGE\ VZLPPHUVGXULQJPRQWKVWUDLQLQJFRXUVHRQFHHYHU\PRQWKVWRDVVHVVWKHLUSDLQ7KLVTXHVWLRQHUZDVGHVLJQHG E\GRFWRU0HO]DFNLQ0F*LOOXQLYHUVLW\RI0RQWUHDO &DQDGD ZKLFKFDQEHXVHGWRGHWHUPLQHGHJUHHRISDLQDQGLWV FKDQJHVWKURXJKWLPHSDVVLQJ4XHVWLRQVRIWKLVTXHVWLRQHUZHUHGLYLGHGLQWRSDUWV KRZQHVVRISDLQIHOWSDLQ FKDQJHWKURXJKWLPHSDVVLQJDQGLQWHQVLW\RISDLQIHOW0LQLPXPSRLQWRIWKLVTXHVWLRQHULVDQGWKHPD[LPXPSRLQW LV+LJKSRLQWVKRZVPRUHSDLQ 0HO]DFN 6WHLQDQG0HQGO
In this study all of the measurements were done investigator and one assistant was just registering them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uann test.
Results
5HVXOWVRILQYHVWLJDWLRQRINQHHSDLQRIVZLPPHUVHDFKPRQWKVGXULQJD 6 months course can be seen in Table 1.
$VLWLVVKRZHGVXEMHFWV¶NQHHSDLQGXULQJWUDLQLQJFRXUVHWKURXJKWLPHSDVVLQJKDVEHHQLQFUHDVHGDQGWKLV LQFUHDVHLQEUHDVWVWURNHVZLPPHUVZDVPRUHWKDQFUDZOVZLPPHUV&RQVLGHULQJSRLQWVRIFUDZOVXEMHFWV¶SDLQ TXHVWLRQHUVKRZHGWKDWNQHHSDLQRIWKHVHVZLPPHUVLQFUHDVHGLQDFFRUGDQFHZLWKLQFUHDVHLQWLPHGXUDWLRQRI training, but this increase was slowly in a ZD\WKDWDIWHUSDVVLQJPRQWKVRIWUDLQLQJDOWKRXJKNQHHSDLQRIWKHVH VZLPPHUVLQFUHDVHGWKLVLQFUHDVHLQFRQWUDVWWRGHJUHHRISDLQEHIRUHVWDUWLQJWUDLQLQJKDGLQVLJQLILFDQWGLIIHUHQFH S ,QVSLWHRIWKLVZKHQFUDZOVZLPPHUVWUDLQLQJUHDFKHGDWPRQWKVSDLQRILQWHUQDOSDUWVRINQHHLQ FRPSDULVRQ ZLWK NQHH SDLQ EHIRUH VWDUWLQJ WUDLQLQJ LQFUHDVHG VLJQLILFDQWO\ S $OWKRXJK EHIRUH WUDLQLQJ
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Table 1.
$YHUDJHRINQHHSDLQUDWHRIVZLPPHUVGXULQJWUDLQLQJWLPHBefore studying After 2 months After 4 months After 6 months
Breaststroke subjects 11 16 25 49 Crawl subjects 7 18 32 &RQWUROOLQJJURXSRIEUHDVWVWURNH 11 9 &RQWUROOLQJJURXSRIFUDZO 9 9 8 %HIRUHWUDLQLQJ 7ZRPRQWKV
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Figure 1.
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Table 2.
Average of Q angle before and after trainingBefore After ([SHULPHQWDOW Meaningful area
([SHULPHQWDOEUHDVWVWURNH 16.7 16.9
([SHULPHQWDOFUDZO 15.2 1.354
&RQWUROOLQJJURXSRIEUHDVWVWURNH 15.4 15.3
Although the average Q angle size of knees of crawl and breaststroke swimmers increased, calculation results VKRZHGWKDWWKLVLQFUHDVHZDVQRWVLJQLILFDQWVWDWLVWLFDOO\ S %HIRUHWUDLQLQJ 7ZRPRQWKV
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Figure 2.
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Figure 3.
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Table 3.
&RPSDULQJGLIIHUHQFHVRISDLQUDWHEHIRUHWHVWDQGLQVHFRQGDQGVL[WKPRQWKVBefore test and 2nd month %HIRUHWHVWDQGVL[WKPRQWK
([SHULPHQWDOEUHDVWVWURNH 7 38
([SHULPHQWDOFUDZO 3 24
([SHULPHQWDOW 1.541
Meaningful area
Conclusion and Discussion
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¶NQHHVKDYH OHVVPHFKDQLFDOEDODQFHLQFRPSDULVRQWRFUDZOVZLPPHUVNQHHVDQGWKLVLQVWDELOLW\PD\KDYHDSSHDUHGGXULQJ ORQJWHUPEUHDVWVWURNHUVZLPPLQJWUDLQLQJ.DVNHQLQHWDO DQG5RYHUHDQG1LFKROV KDYHSRLQWHG WRUHODWLRQVKLSEHWZHHQEUHDVWVWURNHVZLPPLQJDQGSDLQRILQWHUQDOSDUWVRINQHHRIVZLPPHUV*HQHUDOO\LQWKLV study we concluded that increase in distance and increase in intensity of breaststroke swimming training increases WKHFKDQFHRILQMXULHVLQVZLPPHUVDQGWKHPDLQFDXVHRISDLQLVZKLSNLFNWHFKQLTXH%LRPHFKDQLFDODQDO\VLV RIVZLPPHUV¶NQHHMRLQWGXULQJSHUIRUPLQJZKLSNLFNWHFKQLTXHZKLFKKDVEHHQGRQHE\RWKHUUHVHDUFKHUVOLNH 9L]VRO\LHWDO 6WXOEHUJHWDO KDVVKRZQWKDWZKLOHSHUIRUPLQJZKLSNLFNWHFKQLTXHVZLPPHUV¶NQHH MRLQWFDXVHVUDZERQHURWDWLRQLQYHUWLFDOSODWH7KLVFDQLPSRVHPD[LPXPSUHVVXUHRQNQHHMRLQW 2PROROXHWDO GLYHUWVDQNOHLQIURQWDOSODWHWRRXWZDUGVLGHRIERG\DQGLQWKHVDPHWLPHKLSLVSUHGLVSRVHGLQWHUQDOURWDWLRQ DQGSHUIRUPLQJWKLVDFWLYLW\LQORQJWHUPDQGLQWHQVLYHO\WKURXJKSDVVRIWKHWLPHFDXVHVWHQVLRQLQLQWHUQDOWLVVXHV RINQHHMRLQWSDLQLQLQWHUQDOSDUWVRINQHHDQGSUREDEO\PHFKDQLFDOFKDQJHVLQNQHHMRLQW.HQQHG\DQG+RZNLQV :DU\DV]DQG0F'HUPRWW EHOLHYHWKDWNQHHRIEUHDVWVWURNHVZLPPHUVLVFUHDWHGDVD result of weak aside internal ligament which is resulted from frequent tension during swimming. They believe that these tensions in H[WHQVLRQSDUWRIIRRWNLFNDORQJZLWKH[FHVVLYHSUHVVXUHRIYDOJRVRQNQHHMRLQWDUHDSSHDUHGLQILQDOVWDJHRIIRRW NLFN7KHH[HUWHGSUHVVXUHRQVLGHLQWHUQDOOLJDPHQWZKLFKLVWKHPDLQVXSSRUWLYHVWUXFWXUHRILQWHUQDONQHHDQGLV DOVRFDOOHGUDZERQHGXULQJNQHHDFWLYLW\IURPIOHFWLRQPRGHWRH[WHQVLRQPRGHLQFUHDVHVDQGWKLVLVWKHVDPH WKLQJWKDWKDSSHQVGXULQJIRRWNLFNRIEUHDVWVWURNHVZLPPLQJ :DU\DV]DQG0F'HUPRWW
5HVXOWV RI NQHH 4 DQJOH PHDVXUHPHQW RI VZLPPHUV EHIRUH DQG DIWHU PRQWK WUDLQLQJ FRXUVH VKRZ WKDW DOWKRXJK SHUIRUPLQJ FRPSHWLWLYH WUDLQLQJV RI EUHDVWVWURNH VZLPPLQJ FDXVHV NQHH SDLQ ERWK LQ FUDZO DQG breaststroke swimmers, during this course no significant change observed in Q angle size of swimmers. This
LQIOH[LELOLW\RI4DQJOHVL]HPLJKWZDVREVHUYHGGXHWRVKRUWWLPHGXUDWLRQRIUHVHDUFKLQZKLFKWKHVLJQLILFDQW ELRPHFKDQLFDOFKDQJHVZDVH[SHFWHGDQGLWPLJKWEHWKDWLIWKHGXUDWLRQRIVWXG\ZDVORQJHU4DQJOHRIVZLPPHUV ZRXOGEHDIIHFWHGE\WUDLQLQJV,WKDVEHHQVKRZQWKDWLI4DQJOHRIUXQQHUDWKOHWHVEHZLGHUWKH\PLJKWH[SHULHQFH LQWHUQDONQHHSDLQ7KHVHUHVXOWVKDYHEHHQUHSRUWHGE\RWKHUUHVHDUFKHUVIRUDWKOHWHVRIRWKHUILHOGV:HFRPSDUHG LQFUHDVLQJSURFHGXUHRISDLQIRUWKRVHVXEMHFWVZKRVH4DQJOHZDVKLJKHUWKDQQDWXUDOSRVLWLRQ 4! ZLWK those whose Q angle was natural in order to determine differences of knee vulnerability of these athletes and it ZDVFRQFOXGHGWKDWLQFUHDVLQJNQHHSDLQLQVZLPPHUVRIPRUHWKDQQRUPDO4DQJOHVL]HLVIDVWHUWKDQWKRVHRI QRUPDO4DQJOHVL]HVXFKWKDWNQHHSDLQSRLQWVRIVZLPPHUVZLWK4DQJOHRIKLJKHUWKDQQRUPDOVL]HLQnd, 4th and
6thPRQWKVZDVVLJQLILFDQWO\PRUHWKDQWKRVHRIQRUPDO4DQJOHVL]H)URPWKHVHUHVXOWVZHFDQSUHGLFWWKDW4DQJOH
size for swimmers was a GHWHUPLQLQJIDFWRULQGHJUHHRINQHHYXOQHUDELOLW\ZKHQSHUIRUPLQJEUHDVWVWURNHVZLPPLQJ 1HYHUWKHOHVVFRQVLGHULQJ4DQJOHVL]HRIVZLPPHUVDVDQHIIHFWLYHIDFWRULQSUREDELOLW\RIYXOQHUDELOLW\VKRXOGQRW be ignored.
*HQHUDOO\VSHDNLQJLWZDVFRQFOXGHGWKDWLQRUGHUWRDYRLGNQHHSDLQRIEUHDVWVWURNHVZLPPHUVWKHWLPH RIFRPSHWLWLYHWUDLQLQJFRXUVHVVKRXOGEHVKRUWOLQNHGZLWKUHVW,WLVUHFRPPHQGHGWKDWWKLVUHVWWLPHEHOHVV than 2 months. Although 6 months of breaststroke swimming did not change Q angle of swimmers, taking into FRQVLGHUDWLRQWKHLQFUHDVLQJSURFHGXUHVRILQWHQVLYHNQHHSDLQLQVZLPPHUVRIPRUHWKDQQRUPDOVL]H4DQJOH UDWKHUWKDQVZLPPHUVRIQRUPDO4DQJOHVL]HZHFDQDYRLGNQHHLQMXULHVRISURIHVVLRQDOEUHDVWVWURNHVZLPPHUV E\SUHDVVHVVLQJWKH4DQJOHVL]HRIVZLPPHUVDQGSURYLGLQJVZLPPHUVRIPRUHWKDQQRUPDO4DQJOHVL]HZLWK corrective trainings and also by correcting breaststroke swimming technique in order to decrease internal rotation of NQHHMRLQWVDQGE\GRLQJVRZHFDQJXDUDQWHHSHUSHWXDOSUHVHQFHRIWKHVHDWKOHWHVLQFRPSHWLWLRQILHOGV
References
%DN.%OXH32OVVRQ',QMXU\SDWWHUQVLQ'DQLVKFRPSHWLWLYHVZLPPLQJ ± &RVWLOO'+DQGERRNRI6SRUWV0HGLFLQHDQG6FLHQFH6ZLPPLQJ2[IRUG %ODFNZHOO6FLHQWLILF3XEOLFDWLRQV *URWH./LQFRO7/*DPEOH-*+LS$GGXFWRU,QMXU\LQ&RPSHWLWLYH6ZLPPHUV$P-6SRUWV0HG ± -RKQVRQ-(6LP)+6FRWW6*0XVFXORVNHOHWDOLQMXULHVLQFRPSHWLWLYHVZLPPHUV0D\R&OLQ3URF ± -RKQVRQ-1&RPSHWLWLYHVZLPPLQJLOOQHVVDQGLQMXU\ FRPPRQFRQGLWLRQVOLPLWLQJSDUWLFLSDWLRQ ± .DZDáHN.*DUV]WND7$QDQDO\V\VRIPXVFOHEDODQFHLQSURIHVVLRQDOILHOGKRFNH\SOD\HUV766 .HQDO.$.QDSS/'5HKDELOLWDWLRQRILQMXULHVLQFRPSHWLWLYHVZLPPHUV ± .HQQHG\-+DZNLQV5%UHDVWVWURNHU¶VNQHH3K\VLFLDQDQG6SRUWV0HGLFLQH ±Keskinen K., Eriksson E., Komi P. Breaststroke swimmer’s knee. A ELRPHFKDQLFDODQGDUWKURVFRSLFVWXG\ ± .QREORFK.<RRQ8.UDHPHU59RJW30±PEUHDVWVWURNHHYHQWGRPLQDWHDPRQJNQHHRYHUXVHLQMXULHVLQHOLWHVZLPPLQJ DWKOHWHV6SRUWYHUOHW]6SRUWVFKDGHQ ± /LQ<)-DQ0+/LQ'+&KHQJ&.'LIIHUHQWHIIHFWVRIIHPRUDODQGWLELDOURWDWLRQRQWKHGLIIHUHQWPHDVXUHPHQWVRISDWHOODWLOWLQJ $QD[LDOFRPSXWHGWRPRJUDSK\VWXG\ '2, ; /LYLQJVWRQH/6SDXOGLQJ6237275$.0HDVXUHPHQWRIWKH4XDGULFHSV$QJOH8VLQJ6WDQGDUGL]HG)RRW3RVLWLRQV 252–255. 0F0DVWHU:&6ZLPPLQJLQMXULHV $Q2YHUYLHZ6SRUWV0HG ± 0HO]DFN57KH0F*LOOSDLQTXHVWLRQQDLUH 0DMRUSURSHUWLHVDQGVFRULQJPHWKRGV3DLQ ± 1JX\HQ$'%ROOLQJ0&/HYLQH%6FKXOW]6- 5HODWLRQVKLSVEHWZHHQORZHUH[WUHPLW\DOLJQPHQWDQGWKHTXDGULFHSVDQJOH ± 2PROROX%%2JXQODGH62*RSDOGDVDQL9.1RUPDO4DQJOHLQDQ$GXOW1LJHULDQ3RSXODWLRQ&OLQLFDO2UWKRSHGLFVDQG5HODWHG 5HVHDUFK
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6WXOEHUJ6'6KXOPDQ.6WXDUW6&XOS3%UHDVWVWURNHU¶VNQHH SDWKRORJ\HWLRORJ\DQGWUHDWPHQW ± Vizsolyi P., Taunton J., Robertson G., Filsinger L., Shannon H.S., Whittingham D., Gleave M. Breaststroker’s knee. An analysis of
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