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Muscle Damage and Recovery During a Basketball Competition- Juniper Publishers

Juniper Publishers- Journal of Physical Fitness, Medicine & Treatment in Sports

Introduction

Basketball match can be thought as eccentric and slow-speed exercise when compared to high-speed ones in current muscle damage studies. The adaptation to eccentric exercise can be achieved without damaging the muscles [1].Recovery and reversible muscle damage effects, compression garments, cold-water dipping method, ice application, massage after match, ergogenic aids and peak performance are important components of the post-play activities today. Within the domain of recovery strategies, there is little knowledge relevant to studies on minimizing the muscle damage effects or clearing the present waste products.In literature researches, it is observed that intensively loaded eccentric loading protocols that enhance muscle damage are applied to most of the muscle damage recovery exercises[2].
There are a limited number of studies about post-match recovery stage [3,4].Recovery after exercise can be in form of absolute recreation or active recovery.Gentle exercises during the recovery phase after heavy exercises like jogging causes lactic acid such as (35-40 % Max Vo2) to be removed more quickly. This type of recovery is called recovery with exercise or active recovery. Cool-down exercises after the actual exercise is an example to that and have great contributions to removing the lactic acid [3].
Every sportsman is exposed to oxygen debt when he plays at maximal capacity during the contest and creates some amount of lactic acid. It is necessary to apply recovery protocol for the loadings during the contest or at least 10-minute Cool-down exercise in terms of restoring for the next trainings and contests. Cool-down after a high-speed exercise includes the movements the intensity of which decrease gradually to revert the blood circulation and body functions to the condition before the exercise. The restoration process soon after the load stimulation is an intensive one and it can be generally said that two third of restoration is completed within the corresponding time in which one third of recreation is completed[5].The present study,in view of these considerations, has been planned to investigate the effects of the basketball contests on successive days and the repeated movements in such intensive contests on muscle damage and recovery phase.

Methods

After ethics committee approval,(Clinical Research with Turkish Republic Ministry of Health General Directorate of Medicine and Pharmacy No. and B-10-0-IEG-0-15-00-01 Issue complies with the decision of Non-Pharmacological Clinical Researches dated 17thSeptember 2010). Twenty healthy male volunteer basketball players attended in this study and divided into two groups as Group 1(A) and Group 2(B).The research was designed to last for 7 days in 2 sections.1st section is the tournament that includes 4 contests after and before which the values are measured. (1st, 2nd, 3rd, 4th days).2nd section is the recovery that consists of measuring the values in 24-48-72hours after the contests. (5th, 6th, 7th days).
The subjects involved in the research were informed not to take any drug one week before the research, not to use alcohol, not to do high-speed exercise except trainings, to inform any injuries and bleedings as these probable conditions may have effects on the analysis results. Twenty healthy male volunteer basketball players attended in this study and divided into two groups as Group 1(A) and Group 2(B).The first subject group was put to 10-minute recovery protocol after the contest. Recovery protocol included jog-trot and stretching exercises. Active rest is; 1-2minute active breathing, 30-60 seconds jogging, 3-5 minutes walking and finally stretching. Inorder to identify the variables in the hematological values of the subjects, venous blood samples were taken from the forearms 11 times. The blood samples were placed in two separate 10-20ml tubes with EDTA and immediately delivered to the laboratory.
*1: Pre-1st contest,2: Post-1st Contest,3: Pre-2nd contest,4: Post-2nd Contest,5: Pre-3rd contest,6:Post-3rd Contest,7: Pre-4th contest,8: Post-4th Contest,9: hours following the tournament,10: hours following the tournament,11: hours following the tournament.
Creatine kinase and Lactate dehydrogenase was measured using the method of Autoanalyzer Spectrophotometer with a device of Japanese brand Olympus AU 2700.Myoglobin was measured using the method of Edia (Electroc hemilumine scenceimmu noassay) with a device of Japanese brand Elecsys 2010.Hemogram was measured using the method of Flow Sitometer with a device of USA brand Bekman Coulter LH 750 Analyzer. Centrifuge operations were conducted with a device of German brand Rotanta 460.Unit: CK-U/L(Unit/litre), LDH-U/L, MYB-NG/ML(Nanogram/ Millilitre)Descriptive statistics was applied to the basketball players in the study. Two-factor mixedmodel ANOVAs, with repeated measures on time were used and t test were applied so as to compare the biochemical values before and after the contest. In the analysis of the research data, Windows XP based SPSS 13 statistics program was used(Figures 1-3).

*1: Pre-1st contest,2: Post-1st Contest,3: Pre-2nd contest,4: Post-2nd Contest,5: Pre-3rd contest,6:Post-3rd Contest,7: Pre-4th contest,8: Post-4th Contest,9: hours following the tournament,10: hours following the tournament,11: hours following the tournament.

*1: Pre-1st contest,2: Post-1st Contest,3: Pre-2nd contest,4: Post-2nd Contest,5: Pre-3rd contest,6:Post-3rd Contest,7: Pre-4th contest,8: Post-4th Contest,9: hours following the tournament,10: hours following the tournament,11: hours following the tournament.

Results

Statistical significance has been observed between contests and groups in terms of pre-contest and post-contest MYB values during the tournament (p<0, 01). In recovery period, there isn’t a statistically significant difference in the values measured 24- 48-72 hours later (Tables1-3).CK values were found statistically different in pre-contest and post-contest measurements. In recovery period, there hasn’t been a significant difference between the groups in terms of the values measured 24-48-72 hours following the tournament. LDH values have been found statistically different in inter-contests, pre-contest and postcontest measurements (p<0, 01). In recovery period, a significant difference has been observed between the groups in LDH values measured 24-48-72 later (p<0, 01) (Tables1-3).
*1MÖ: Pre-1st contest, 1MS: Post-1st Contest, 2MÖ: Pre-2nd contest, 2MS: Post-2nd Contest, 3MÖ: Pre-3rd contest, 3MS: Post-3rd Contest, 4MÖ: Pre-4th contest, 4MS: Post-4th Contest, 24h: hours following the tournament, 48h: hours following the tournament, 72h: hours following the tournament.
A statistically significant difference has been recorded between the group applied 10-minute recovery protocol and passive recreation after contest (p<0, 01). Although MYB values of ‘Group A’ applied recovery protocol was higher during exercise, but very close to those of other group in recovery period. Additionally, on the other days, the first peak values couldn’t be reached in players. As for MYB values measured 24- 48-72 hours later, they remained at lower rate compared to the other group (Tables 1-3).

Discussion

The homogeneity of the male basketball player groups in terms of age, height, weight and training age is of essential in respect to the analysis of the effects of the contest on biochemical parameters and the effects of the 10-minute recovery protocol after the contest which group A was applied through biochemical parameters.
In the studies in literature, skeleton muscle damage level is dependent upon the data obtained through the assessment of enzyme and blood values at serum blood level that reaches the extracellular level. The peak period of creatine kinase (CK) increased after exercise varies according to the type, volume and duration of exercise. A number of studies reveal that CK values reach the peak point after 1-5days after the exercise [6-11]have identified that CK values increase after long-term exercise and reach the peak point 24-48 hours later in their study. In a similar study by[1]. the same results have been identified[12]in their study with high density cycle ergometre have seen that serum CK values increase ten times soon after exercise and come close to the values before exercise 24hours later.
Various results have been achieved in different researches. Indicating that CK values reach the peak point 2-4 days after exercise, Smith and Miles(2000) stated that CK values reach the peak point 3-4days after leg resistant exercise [13]in their study on football players conducted measurements 18-20, 42-44hours later and pointed out that serum CK values reach the peak point in 22-24 hours[14]conducted 10-minute high density basketball stimulation exercise and measured CK values soon after exercise, 5-10-15minutes after exercise, 24-48-72-96hours after exercise. They concluded that CK values increased soon after exercise but came to normal level at the end of the 4th day. In similar studies,[6-10]the increase in total CK values implies occurrence of muscle damage.In view of these results, it appears that basketball contests affect CK blood parameters of the player, which shows skeletal muscle damage in players occurs during contest.
In reference to the measurements after contest, a significant statistical difference in CK values wasn’t observed between the control group and the group subjected to 10-minute recovery protocol (P>0,05).According to the data acquired, total CK values vary from subject to subject. As stated in literature, there is a judgement that CK values aren’t affected by recovery protocols.
These results support the similar studies in the same fields. In many studies, [9,15] LDH, AST, CK are intracellular cytoplasmic enzymes that turn to functionally related extracellular after cell death. Therefore, their existence as extracellular are always associated with cell death and tissue destruction. Thereby, it is used as diagnosis indicator of tissue destruction in infection or brain damage following cerebrovascular diseases in myocardium infarction and chronic liver failure in medicine [12]implemented exercise protocol with 20 different eccentric contractions onto non-dominant hand flexor muscles; carried out measurements before exercise, soon after exercise and 24-48-72-96hours later exercise; and concluded that LDH values increased soon after the exercise, reached the peak point in 24-48 hours and turned to pre-exercise values in 96hours . In another study by [16]. Plyometric exercise protocol with high density eccentric contractions was applied and the values were measured soon after exercise and 24-48-72hours later. It was found that LDH values starting to increase soon after exercise rose by about 100% 72hours later and the difference between the values measured 24 hours and 48-72hours later were stated to be statistically significant.[14]in their study that examined weight and muscle pain relations through 10-minute high density basketball technical exercises have put forward that LDH release that increase soon after exercise come to pre-exercise level 4 days later. Literature also presents similar results of LDH values in exercise-induced muscle damage studies,[13]Cool-down consists of movements whose intensity gradually decreases so that blood circulation and various body functions can turn back to the condition before exercise.
Cool-down exercises can be done in two ways; active or passive recreations. Passive recreation includes resting, sitting, lying or sleeping[3,17] have demonstrated that in comparison with passive recreation, 4-minute recovery protocol between repeated Wingate tests (28% of MAX VO2) enhance total work and the decline in capillary blood lactate of trained hockey players is more than that in sedentary [17,18]stated that of the recovery periods they have applied to different kinds, the most effective method is recovery protocol period.
These results support the similar studies in the field. According to [19]studies that are consistent with our findings, it has been indicated that soon after muscle damage myoglobin (MYB) Concentration reaches the peak point before CK values. That the pre-contest MYB values are lower than half-time and post-contest values implies that muscle damage has notably increased. However, it is informed that MYB values of football players come to resting values 24-48-72hours after contest [12] in the exercise protocol with high density eccentric contractions carried out at cycle ergometer, have come to the conclusion that 53 ± 22,1myoglobin values come to 554,5 ± 25,4 soon after exercise. Showing parallelism with our study, 49, 7 ± 12, 4 MYB values measured 24 hours after exercise turn to their preexercise level [20]carried out one-hour weight training exercise protocol including 50 subjects. The values were measured soon after exercise, during the following 7 days, 10th and 12th days. Similar results to those of our study were obtained. In literature, MYB measurements support our study as well.
The exercise protocols carried out in these studies are many repeated studies including high density muscle contractions. The results of our study could be assessed as an explanatory factor for the measurement values not being as high as those in similar studies, [21-23] have found the difference of fall rate of muscle damage indicators between the group applied stretching is than the other group recovery protocols. Besides, recovery times in various lengths were reported in the studies analyzing energy outcomes, lactic acid values and active and passive recovery processes. Within these studies, it is revealed that the groups put to active recovery experience a more rapid recovery process compared to the other groups [24].According to these results, basketball contests affect MYB blood parameters of the player. MYB values at blood serum level measure before and after contest refer to a considerable difference between the groups (p<0, 05) the literature studies on the adaptation process of the trained players to the training support our findings. Increasing MYB values in blood during exercise correspondent with the relation of recovery process with loading intensity, muscle contractions, the energy consumed, oxygen carriage required at cellular level and oxygen gap were found to be significantly different from the values of the subjects put to 10-minute recovery protocol after exercise. No important difference was recorded between the groups in terms of the values measured 24-48-72 hours after exercise during the recovery period, which means that the results are similar in both of the groups (p>0,05). In literature these studies there is evidence that MYB values start to rise soon after exercise and reach the peak level in the first 1-3hours. Moreover, MYB values at blood serum level measured 24hours after exercise came close to pre-exercise level in bothof the groups. In the group applied 10-minute recovery protocol, recovery values were found statistically significant (p<0, 05) [25,26] concluded that passive recreation results in slowly progressing recovery values and recovery protocol results in more rapid recovery curve.
Our study puts forward that MYB values that increase at the beginning of exercise come to pre-exercise level 24 hours after exercise. Although MYB values of Group A were found to be higher than those of Group B, in respect to recovery speed, it can be seen that a more rapid recovery takes place in the group applied recovery protocol.

Conclusion

Consequently, recent studies demonstrate that exercise causes muscle damage at micro level and the type and size of exercise is determinant in the amount of damage. Muscle damage is closely associated with race, gender, age and training condition. It has been revealed that the degree of damage varies from person to person, sometimes high sometimes low amount of damage, depend upon training level of the players and sporting experiences. It has also been indicated that muscle damage responses of players at blood serum level are at lower value and damage responses come to normal level within shorter time.
In respect to the present study, it can be said that there are muscle damage responses in the skeletal muscles of the basketball players at the end of the 4-day basketball tournament and these responses come to normal levels 24-48-72hours later. Besides, it has been revealed that muscle damage responses applied 10-minute recovery protocol after contest reach normal values more rapidly in comparison with the other group. As a result of this study it has been observed that the difference of LDH blood parameter is significant. In accordance with these results, basketball contests are influential on the LDH blood parameters of the player. LDH measurements indicate that the difference in recovery time is assessed as significant between the group applied 10-minute recovery protocol after contest and the one applied passive recreation.
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A Preliminary Study to Investigate the Prevalence of Pain in Competitive Showjumping Equestrian Athletes- Juniper Publishers

Juniper Publishers- Journal of Physical Fitness, Medicine & Treatment in Sports

Introduction

Due to the unpredictable nature of a 500kg animal capable of travelling at speeds of 65-75kmh-1 [1] horse riding has a high injury risk; arguably making it one of the most dangerous sporting activities to participate in [2,3]. The hospitalisation rate for equestrian activity is 49 hospital visits for every 1000hours of riding compared to rugby that has a hospital rate of 93 per 1000hours [4]. Most injuries occur as a result of falling off the horse whilst riding [1,5] and the more severe injuries often occur during a fall whilst jumping fences [6,7]. There have been sixty reported deaths occurring during jumping competitions between 1993 and 2017 which has encouraged the governing bodies of equestrian sports to work to improve safety standards [8,9].
Ball et al. [10] identified that over half of riders that had been hospitalized due to an acute riding injury, experienced chronic physical difficulties following their accident including chronic pain, weakness, decreased balance, headaches, limited use of limbs, decreased memory and mood changes. Whilst acute injuries resulting from horse riding have been documented, evidence is mainly anecdotal suggesting that musculoskeletal injuries arising from overuse could result in riders experiencing chronic pain. Horse riders are at a greater risk of experiencing chronic pain particularly back pain that the non-equestrian population [11,12]. This may be due to the repetitive nature of riding and/or as a longer-term consequence of an acute riding injury.
Research has examined the chronic pain experience by equestrian athletes competing in Dressage [12] and Elite Eventing [13] but to date there have been no published studies investigating pain experienced by equestrian athletes competing in showjumping. The demands placed on the rider do differ between disciplines both in terms of physiological demands and biomechanical skill [14]. The aim of the study was to investigate the prevalence of competitive showjumping athletes who experience pain, the location of their pain, factors affecting their pain and whether they perceive this pain to effect on their riding performance.

Materials and Methods

A six part 34 question on-line survey (Survey monkey) was made available to equestrian athletes who competed in showjumping, and who were aged eighteen years and over following full institutional ethical approval. The on-line survey was accessible for a 1 month period and no incentive was offered to participants. An online survey was chosen as they reduce time, cost and potential error arising from the transcription of paper questionnaires, in addition to allowing participants to respond at their convenience [15]. Volunteer participants were recruited from personal contacts via email and number of specialist equestrian social media sites (such as the Horse & Hound forum) was identified and a link to the survey was posted on these sites. A snowball sampling technique was employed where those receiving an email regarding the survey were asked to send on the email to other female horse riders that they knew. Due to the anonymity of the survey, completion of the form was considered as consent to take part in the study (as explained to them in the participant information sheet preceding the survey).

Measure

A survey was constructed using the principles put forward by Diem [16]. The survey containing twenty questions was developed containing a mixture of closed - response (e.g. Yes/ no and Likert scale) and open-response items designed to take no longer than 10 minutes to complete. Section 1 asked respondents to state their eventing competition level. Section 2 asked questions related to previous injury and self reported level of pain (adapted from validated questions taken from shortform McGill Pain Questionnaire [17], location and cause of this pain. Section 3 was specific to the perceived impact this pain had on their performance. Section 4 asked what factors contributed to increased levels of pain when riding (e.g. saddle, movement of the horse, cold weather, yard work). Information related to the participants management strategies for dealing with this pain (e.g. over the counter pain medication, prescription pain medication, manual therapy such as physical therapy, chiropractic treatment and other strategies) was also gathered. The final section (5) was modified for equestrian athletes from the Oswestry pain questionnaire [18] to assess the impact their pain has on their general life and wellbeing. Validity evidence for the instrument was provided by reviewing the questionnaire for: (1) clarity of wording, (2) use of standard English and spelling (3) reliance of items, (4) absence of biased words and phrases, (5) formatting of items, and (6) clarity of instructions [19]. Two faculty senior academics experienced in survey design, were asked to use these guidelines to review the instrument. Based on the reviewers’ comments the instrument was revised and as a pilot study the questionnaire was distributed to 10 riders before further revisions were made prior to final administration.

Data Analysis

In total there were 110 survey responses; however of these only 91 identified that showjumping was their main riding discipline. Eleven participants did not complete the survey fully. As such, the data for the remaining 80 participants met the inclusion criteria for data analysis and the remaining 30 responses were discounted. Data from the Survey monkey  package were downloaded into a Microsoft Excel (2010) spreadsheet. Descriptive statistics were used to report frequencies and percentages within data. The Chi-squared test and odds ratios were utilized to assess prevalence of pain experienced by showjumping riders. An alpha value was set at p< 0.05 (confidence interval 95%) throughout unless otherwise stated. Data were analysed using SPSS for Windows version 24.

Results

Participants

The 80 showjumping participants had a median age of 23 years (Interquartile range from 20 to 31 years). The majority of participants (89 %) were female and only 11 % were male. The majority of participants (70 %) self- described as amateur competitive riders, with 12.5 % described as recreational riders and 17.5 % self-described as professional riders. Figure 1 describes the pain reported by the participants, with a participant being 1.42 times more likely to experience pain than to be pain free.

Participants Self-Reporting Pain

participant was twice as likely (2.0 times) to be experiencing chronic pain (67%) as acute pain (33%). If they solely competed in showjumping this odds ratio increased to 2.2 times more likely to be experiencing chronic pain than acute pain. Participants who competed in other disciplines as well as showjumping were 1.5 times more likely to be experiencing chronic pain compared to acute pain.
Of the participants reporting pain, 85% reported experiencing neck and back pain. The majority of these experienced lower back pain. 66% of participants reported experiencing pain in other regions of the body, with the knee being the most common. Table 1 displays the location and level of pain experienced by participants. The majority of pain was described as being mild, however participants experiencing hip and upper back pain had median levels of moderate pain. Some participants did report severe pain.
The median durations of pain experienced all exceeded two years, with participants reporting neck, elbow, head and wrist pain reporting median durations of four to five years. Only 15% of those reporting pain had had a medical diagnosis. Only 15% of those reporting pain said that it has prevented them from riding, for durations ranging from the occasional day periodically to a whole year. 85% of participants reported that their experience of pain did not stop them riding.
30% of participants with pain did not report any method of management or treatment. The majority, 70% reported that they did try to manage or treat their pain. The most common method participants reported using to manage or treat their pain was over the counter medication. 67% of those using a management or treatment method used over the counter medication with only 9% using prescription medication. 47% reported using a manipulative therapy to manage or treat the pain, most commonly physiotherapy. 25% utilised an exercise programme to manage or treat the pain.
There was no association between age and report of pain (X2 1 = -0.165, p = 0.114). A highly significant association was found between years of riding and pain (X2 1 = -294, p = 0.004). 85% percent of riders perceived their pain to impact on their riding performance. Most commonly they believed that it affected their postural asymmetry (45%), followed by reducing their range of motion (36%), causing fatigue (24%), affecting mood by increasing anxiety and irritability (21%), and reducing concentration (19%). Only 14% of participants directly reported it affecting the horse by causing asymmetry.

Discussion

This is a preliminary and exploratory study, using a purposeful sample. The study identified that 61% of competitive showjumpers competing at the novice to sub-elite level were experiencing pain. This was lower than was seen in elite dressage riders [12] and elite event riders [13]. Chronic injury is a common cause of early retirement from sport [20,21], however there is little evidence to suggest this is a problem within the sport of showjumping. As with other equestrian sports, showjumping is considered an early start, late maturation sport [22], where the mean age of British Olympic showjumping riders in the twenty-first century is forty four years old [23]. It appears that many showjumping riders, such as Olympic Gold Medallist Nick Skelton, who won the gold medal at Rio at the age of sixty despite being in chronic pain after several serious injuries including a broken neck, continue to ride and compete. Lewis & Kennerley [12] and Lewis & Baldwin [13] found a significant relationship between elite equestrian athletes’ pain and their perception that this pain effected their riding performance. Douglas et al. [14], suggested that riders often do not consider themselves as the athlete within the unique dyad relationship that they have with their horse and if the horse is not injured then pain they experience is not a reason for rest, rehabilitation or even retirement from the sport.
In this current study eighty-five percent of riders believed that the pain affected negatively on their riding performance by effecting their posture, increasing fatigue, reducing their range of movement and effecting their concentration. Posture is a key element in any equestrian discipline where the rider aims to maintain a straight line running through the ear-shoulderhip- heel whilst moving in rhythm and harmony with the horse’s movement [24-27]. To maintain this position requires stabilization and isometric contraction of the core muscles [28] are needed to enable the trunk to return to equilibrium after perturbation. In order to control the horse the rider must be able to apply individual hand and leg ‘aids’ or signals by disassociation movements of the arms and legs. Injury or damage to the ‘core’ muscle groups can result in chronic lower back pain. 86% of riders in this study reported lower back pain suggesting that the cyclic nature of riding may damage these soft tissue structures [11] and that pain in these structures may have and impact of postural control whist riding. The activity of jumping requires the rider to alter or adjust their position by adopting a forward seat in order to cope with the increased mechanical forces involved. During jumping, the rider closes the hip and thigh angle and moves the trunk into a more forward position. In order to maintain their balance through the jumping phase the rider’s weight is absorbed by the legs, as opposed to pelvis and legs as seen in the regular riding position [14,29,30]. This adjustment in position requires a great deal of control of the body segments as the rider has to deal with acceleration forces from the horse particularly on landing [30]. Any restriction in the rider’s range of movement as a result of pain will effect their position over the fence and will impact on the performance of the horse. Riders also stated that the pain effected their levels of fatigue. Nadler [31]; Kankaanpaa et al., [32] and McGill [33] identified poor endurance in hip extensor muscles (Gluteus maximus) and hip abductors (Gluteus medius), key muscles used to maintain an effective riding position, in individuals that had chronic LBP, suggesting a link between fatigue in these muscle groups and pain.
Participants also noted that the pain affected their concentration. In showjumping riders are required to ride from memory a set pattern of fences of up to 15 obstacles, some with multiple jumping elements, usually with several changes of direction. Failure to jump the fences in the correct order results in an elimination [34]. Equestrian athletes must also process many variables from the horse and environment including speed, stride length, straightness, quality of the gait, ground conditions, type of fence, height of fence etc. in order to position the horse in the optimal take off zone to jump the fence cleanly. Failure to process this information and to make correct decision could result in the horse knocking the fence down (4 faults) or refusing to jump the fence (4 faults) Therefore, any disturbance to the rider’s concentration caused by pain may effect performance and safety of horse or rider.
The majority of showjumpers in the study employed pain management strategies. The most common strategy was the use of over-the-counter (OTC) non-steroid anti-inflammatory drugs (NSAIDs) such as aspirin, paracetamol and ibuprofen. Only 9% of showjumping riders used prescription, which is consent with results found in dressage and event riders [12,13]. NSAIDs are widely used in other [35-37], in part due to the ease, cost and accessibility of these drugs. Berglund and Sundgot-Borgen [38], exterminated that sporting athletes use NSAIDs six to ten times more often than the general population, this puts sports people at the potential risk of over mediating or over reliance on pain medication to continue training or competing. The use of self-medicating NSAIDs puts the rider showjumping rider at risk of non-compliance with the World Anti-Doping Agency (WADA) regulations and also the potential risk of side effects of these drugs. Frequent use of NSAID can cause damage to the cardiovascular system, gastro intestines (GI), kidneys and liver [35-37,39]. Following one month regular use of NSAIDs users have a higher relative risk of bleeding in the upper GI tract, other side effects include dyspepsia, nausea, ulcers [40-96].

Conclusion

This study using a small sample of equestrian athletes established that there is a high incidence of showjumpers who compete with pain, particularly back and neck pain. This is of some concern giving how long a showjumper can participate in the sport, which can span several decades. Participants reported that this pain effected their posture whilst riding, reduced their range of motion, caused fatigue, effecting mood by increasing anxiety and irritability, and reducing their concentration, all of which is likely to impact on both performance and safety. Despite pain experienced and effect on performance a large number of equestrian athletes continued to compete. Athletes self-medicating using NSAIDs could be putting themselves at an increased risk of long-term health issues. This research reports athlete’s perceptions and self-reported pain and management options, which may affect the data. Further research is needed to establish the causes of pain and appropriate management strategies.

Acknowledgement

The authors would like to acknowledge those who kindly took the time to participate in the study.

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