Sports Physician

Efferent restorative therapy in sports medicine.

Sooner or later a sports physician (the medical supervisor of an athlete) is confronted with the problem of stagnation of the physiological resources of his charge. Sometimes this phenomenon occurs at the peak of the achievement of maximum results. The outcome is the sad fact that at competitive events (championships, the Olympics, etc.) the athlete falls short of his stable and steady functional state.

...the coaches, the medical staff, the sponsors and so on are declared to be the culprits. etc.

"Oxidative stress" (OS) in an athlete - the reaction of the body to threshold loads - is up to now defined differently by researchers: by some - as compensatory; by others - as decompensation;

The biochemical and physiological processes occurring in the body of an athlete during the period of active training (training camps) are characterized by:

• Growth of the concentration of peroxide compounds (including free radicals).
• The functions of the biomembrane are impaired.
• The intracellular mechanisms of energy production suffer because of the overload and inadequate work of the mitochondria of muscle (and often also parenchymal) cells, where, due to the intensification of the Krebs cycle (KC) - a series of reactions occurring in the mitochondria, in the course of which the catabolism of acetyl groups is carried out; upon the oxidation of the latter the free energy of the fuel resources of the tissues is supplied. The KC is the common final pathway of the oxidation of carbohydrates, lipids and proteins. In the course of metabolism glucose, fatty acids and amino acids are converted either into acetyl-CoA or into intermediate compounds of the KC. Acetyl groups are part of acetyl-CoA (CH3-CO-S-CoA, active acetate), the thioester of coenzyme A.
• The transmembrane transport of small molecules by means of Na+, K+, Ca++ channels is disrupted – as a consequence disturbances of the processes of membrane polarization and of the contractile function of the myocyte follow.
• The receptor proteins on the plasma membrane of the muscle cell that are in contact with the muscle ending are blocked.
• Blood rheology deteriorates.
• Hypoxia of the tissues of the body increases.

The consequence of these processes is a disturbance of humoral and cellular immunity, destabilization of the functioning of the parenchymal organs and the myocardium, chronization of microtraumas (especially at the sites of attachment of tendons)

In combating these manifestations physicians quite justifiably use, for the prevention of oxidative stress (OS), multivitamin preparations combined with mineral supplements - to replenish their deficiency; preparations that improve the mitochondrial energy supply of the cell (creatine phosphates, "Neoton", etc.), dietary supplements, diet therapy, etc. For the purpose of correcting hypoxic states antihypoxants are used.

It should be noted that the active use of "energy" preparations at the peak of OS does not give the desired effect because of the blockade of the myocyte receptors and the overload of the mitochondrial system.

It is possible to break this vicious circle by means of a sharp reduction of physical loads and a long period of rest, which is impossible during the period of competitions. Or by means of the removal of peroxide compounds from the body, the unblocking of receptors, the improvement of the rheological properties of the blood. All the effects listed above are achieved with the use of the method of extracorporeal blood purification. Among the methods applied in efferent therapy, the most accessible, effective, safe and atraumatic is the method of MEMBRANE PLASMAPHERESIS. In its turn, among the devices used for performing this procedure, the most reliable and safe is the single-needle device for performing membrane plasmapheresis "HEMOPHENIX" with disposable track-etched plasma filters "ROSA".

The efficacy of the methods of efferent therapy, in particular of MEMBRANE PLASMAPHERESIS, can be as follows:

At the level of the organism:

• Increase of compensatory and adaptive reactions.
• Normalization of the hormonal status and of the hypothalamic-pituitary-adrenal systems.
• Immunomodulatory effect

At the organ level:

• Improvement of the microcirculation of vitally important organs.
• Normalization of systemic hemodynamics.

At the cellular level:

• Normalization of oxygen metabolism.
• Normalization of the metabolic orientation.
• Normalization of immunoregulatory disturbances.

At the level of the biomembranes:

• Antihypoxic effect.
• Protection against the end products of lipid peroxidation and against intoxication products.

All the mechanisms listed above provide:

• Deblocking of receptors and an increase of the functional activity of hematopoietic, phagocytic and immunocompetent cells;
• Immunocorrection;
• Improvement of blood microcirculation;
• Anti-inflammatory effect;
• Removal of the products of the breakdown of tissues and cells (in hemolysis, myoglobinemia), of microbes and of toxic substances, including those bound to proteins.

Overall result: an increase of the potential capabilities of the body, stable functioning of the organs and systems during maximum loads.

Features of the membrane plasmapheresis method on the "Hemophenix" device

1. A single-needle type of connection to the patient, which is especially valuable with "bad" veins and a deficit of venous access.

2. Operation in automatic mode (microprocessor system of control and monitoring): the device practically itself selects the perfusion parameters most optimal for the specific conditions - these are the duration both of the withdrawal and of the return of blood.

3. Absence of traumatization of the formed elements of the blood (unlike the gravitational method of plasmapheresis).

4. The small filling volume of the extracorporeal circuit (80 ml) makes it possible to perform Plasmapheresis in children starting from the age of 6 months, in the absence of absolute contraindications - hemophilia, thrombocytopenia. Frequently the performance of plasmapheresis has saved the life of a child with the timely and qualified use of this treatment method.

The practical application of membrane plasmapheresis (MP) in the practice of a sports physician looks as follows.

1. Diagnostics of oxidative stress in an athlete by means of clinical observation and examination.

2. Absence or reduction of the effect of therapy with energy-stimulating preparations.

3. Pain syndrome from sustained injuries (especially with elements of compression – "crush syndrome")

Even a single performance of a plasmapheresis session with removal of up to 0,3 - 0,5 CPV makes it possible to reduce the intensity of oxidative stress (OS), while a 3-fold performance, in the absence of concomitant pathology, is guaranteed to remove all the manifestations of OS, which is confirmed by objective clinical and clinical.

The general condition of the athlete improves, the pain syndrome decreases, up to its complete disappearance. The efficiency of the use of creatine phosphates (for example, "Neoton") increases, while its negative side effects are levelled out.

The procedure is performed in the morning and lasts on average 1,5 hours. Taking into account that all the formed (cellular) elements of the red and white blood are returned to the bloodstream in full volume, "washed" and atraumatically, and that the volume of the removed plasma was replaced in an isovolumic mode with plasma-substituting solutions - the athlete proceeds to training already one day later.

Before competitions the procedure is performed 3-4 days before the start.

A session of membrane plasmapheresis is absolutely painless, it is performed in the sterile and comfortable conditions of the treatment room. It is tolerated very well by patients - during the procedure one can watch TV or simply doze. Duration – 1,5 hours.