Swimmer’s injuries and treatment

Orthostatic intolerance

A July 2022 paper (2) looked at orthostatic intolerance (lightheadedness, fainting or feeling faint, increased heart beat when arising to a standing position) as a potential contributor to prolonged fatigue and inconsistent performance in elite swimmers.

In this paper, the authors described five elite swimmers with prolonged fatigue and athletic underperformance. Based on (previous) work in myalgic encephalomyelitis /chronic fatigue syndrome, we focused on orthostatic intolerance as a possible contributor to symptoms.

  • Participants were referred for evaluation of fatigue and underperformance to the Chronic Fatigue Clinic at the Johns Hopkins Children’s Center. All patients were evaluated for overtraining syndrome, as well as for features commonly seen in myalgic encephalomyelitis/chronic fatigue syndrome. The latter included joint hypermobility, orthostatic intolerance, and non-IgE mediated milk protein intolerance. Orthostatic intolerance was tested by performing a ten-minute passive standing test or a head-up tilt table test.

Orthostatic testing provoked fatigue and other symptoms in all five swimmers, two of whom met heart rate criteria for postural tachycardia syndrome. Treatment was individualized, primarily consisting of an increased intake of sodium chloride and fluids to address orthostasis. All patients experienced a relatively prompt improvement in fatigue and other orthostatic symptoms and were able to either return to their expected level of performance or improve their practice consistency.

The author’s concluded: “We suggest that passive standing tests or formal tilt table tests be incorporated into the clinical evaluation of athletes with fatigue and underperformance as well as into scientific studies of this topic. Recognition and treatment of orthostatic intolerance provides a new avenue for improving outcomes in underperforming athletes.”

A 2022 update to the pulication STATPERALS writes about Surfer’s Ear: “Surfer’s ear, or exostoses of the external auditory canal, is a slowly progressive disease from benign bone growth as a result of chronic cold water exposure. It is a condition most commonly associated with surfing but can be seen in anyone repeatedly exposed to cold water such as swimmers, divers, kayakers, and participants of other maritime activities. Although usually asymptomatic and benign, external auditory exostoses (EAE) can cause conductive hearing loss, recurrent otitis externa, otalgia, otorrhea, cerumen impaction, and water trapping.”

2 Petracek LS, Eastin EF, Rowe IR, Rowe PC. Orthostatic Intolerance as a Potential Contributor to Prolonged Fatigue and Inconsistent Performance in Elite Swimmers.
3 Landefeld K, Bart RM, Lau H, Cooper JS. Surfer’s Ear. InStatPearls [Internet] 2022 May 8. StatPearls Publishing.


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