Football is not more important than life.

When football becomes more important than life it is time to reconsider priorities. Nothing is more important than the child (and the parents) who places their trust in a coach. There are a lot of people who are only looking at the current situation at Penn State as only a misstep in a historic legacy and looking at this as a degradation of Penn State. It must be made clear that this is NOT about Penn State University or the superior quality of education that this institution provides. This is about the fact that in some institutions, football (Penn State is only one) has a level of monetary power that places the sport at a level where otherwise intelligent minds (and eyes) are blinded. If a teacher was to hear about a sexual abuse incident like what happened at Penn State, they would be expected (and required) to report it to the legal system. Even though the current child sexual abuse cases(s) were reported, these cases were also delayed, covered up, dismissed by the college administration, college police and city police. Football is not this important! Even though the revenue that the sport provides is an incredible amount of money, it should not cloud the priorities of the institution or of life. Just ask the young men (boys) who are the unfortunate victims if this is not true. Does this sexual abuse tragedy in any way place any untoward light on the quality of Penn State? No it does not. It does place untoward light on the level of emphasis that is placed on the multimillion dollar sport of football though. The institution of the sport should never take precedence over the child who is participating in it.

Two-a-Day Practices: Worth the cost?

The time has come to seriously consider whether two-a-day practices are worth the damage that they cause the athlete. The single most severe physiological stress that is placed on the athlete’s body is the stress caused by heat. One need’s to think (and decide) if simply adhering to past tradition of two-a-day practices being a rite of passage is necessary with the knowledge base that is available in athletic performance and injury prevention.

It is August and it is hot outside. Not just here in Arizona where we can expect the temperature to be in excess of 110 degrees (with a low temperature often around 90 degrees at night), but throughout the country. Already this fall there have been four high school football athletes and one coach die tragically due to the extreme physiological stress of the heat. The four football athletes all suffered from exertional heat stroke (a heat related illness which results in the core body temperature increasing to the point of internal organ damage), while the football coach suffered from an underlying heart condition that was exacerbated by the heat. While it has not been reported or indicated, these tragedies bring out the need to educate athletes of all ages on the effects that ergogenic supplements and energy drinks have on the human body. Many of these energy drinks have high levels of caffeine, along with taurine and gaurana, with the end result being an athlete whose central nervous system is greatly stimulated and one who dehydrates faster. With two-a-day practices where athletes are hitting in both practices, it is important to consider the role that fatigue plays. Fatigue will not only be caused by prolonged exercise, but it will also be greatened by dehydration. (Not allowing enough time for the body to rehydrate, along with ingesting ergogenic drinks that speed the urinary process facilitate this dehydration.) As the body fatigues, the amount of force necessary to create injury is lessened.

Considering the research publicized concerning concussive and non-concussive forces applied to the head during football and soccer, excessive hitting and practice can easily become a liability for the athletic program. The National Football League has practice limits. The NCAA has rules against consecutive two-a-day practices as well as the adoption of testing for sickle cell trait which may lead to sickling of the hemoglobin and excertional rhabdomolysis. Beyond this there is little or no consistency in regards to practice safety. Dr. Robert Cantu (Boston University), pioneer in the study and treatment of sport related traumatic head injuries, stated in an August 21, 2011 Washington Post article: “It’s inconceivable to me that you can take young scholar athletes at an age that is more vulnerable and have them play more dangerously than at the highest professional level.” Well said.

Disposable Athletes

There are a few ways to look at the concept of the “disposable athlete”. Much of how we view this has to do with the level that the athlete is participating. The culture of club sports has given us year around practices and games with little rest for the athlete. When the cost of competing on some of the elite clubs approaches $10,000/year (with registration, tournament fees, uniform, travel, etc), the focus begins to shift to the financial investment leaving the young athlete in a position where they have to play injured in an effort to recoup the investment.

How many high school coaches/parents/athletes follow the motto of “no pain, no gain”? Many sports either purposely or mistakenly (they still do it, though) operate under a paradigm of toughness (physical and mental). This is an important aspect of sport which leads to many of the benefits that are derived from participation. But, when mistakes are made (exercise induced injuries are a result of mistakes) and the line is crossed resulting in athletes participating injured, the disposability of the athlete is exposed. There is always a new supply of athletes waiting for their turn to play.

Sometimes athletes become disposable out of a lack of knowledge. This lack of knowledge often comes from research that brings out new knowledge, or it may be a result of refusal to keep abreast of the current base of knowledge. There are many athletes who simply disappear from view due to the accumulation of multiple injuries such as head injuries. Until recently (the past few years), repetitive injuries to the brain were not considered significant by many due to the fact that diagnostic modalities could not detect an injury to the brain unless there was physical damage. The evidence is there now to definitively contradict that earlier thought, causing wonder to how much damage has been caused to how many athletes?

While sometimes it may be a lack of knowledge or limited financial backing, it may also be a result of greed (personal or corporate) that creates the disposable athlete. The higher levels of sport have large amounts of money involved from gate receipts, television rights, salaries, product endorsement, etc. The University of Connecticut is reported to have lost more then 1.5 million dollars in playing in their first ever BCS bowl game. It is unknown whether a loss such as this will have any affect on the health of the athlete or the athletic program. The National Football League and the National Football League Players Association are at odds, and facing a possible lockout, with one of the points being health benefits and over the number of games in the regular season (the increase of the number of regular season games to 18). The owners want to increase their profits, the athletes want to negotiate higher salaries and through this there will be a direct correlation between the number of games and the physical health to the body and brain. Even at the professional level, the athlete has become disposable. Amazing that at the beginning levels of sport and the elite levels of sport, money is often a factor in creating a disposable athlete.

Exertional Rhabdomyolysis: It is not about excessive exercise, but about productive exercise.

Within the past 6 months, there have been two high profile occurrences of Exertional Rhabdomyolysis. While most cases of Exertional Rhabdomyolysis are rare and isolated cases, this past August (2010) 24 Oregon high school football athletes were treated or hospitalized by this affliction. On Monday, 1/24/11, 12 University of Iowa football athletes were hospitalized with Exertional Rhabdomyolysis. This is a disturbing trend. This condition is considered rare and in the past has afflicted few athletes. The fact that it is now affecting large numbers of athletes simultaneously gives cause for concern. Anecdotally there may be a number of causes (supplement use, energy drinks, lack of physical conditioning to name a few), but there is one common denominator; excessive unaccustomed exercise accompanied with dehydration. This brings the question, where is the coach. It is not how hard the exercise/practice session is that is important, but how productive this session is. The University of Iowa issued a statement stating: “Our No. 1 concern is the safety of our student-athletes”. The head coach is ultimately in control and in charge of his/her athletes (especially when it comes to their practice/exercise regimen). For this many athletes to succumb to Exertional Rhabdomyolysis (whether it is in Oregon or Iowa), it is important to note that it is most likely a coaching mistake that resulted in this medical emergency.
Simply put, Exertional Rhabdomyolysis is a condition where unaccustomed excessive exercise results in the breakdown of muscle fibers leading to the release of excessive amounts myoglobin, potassium and creatine kinase into the blood stream. This may then result in renal failure and in extreme cases death. This condition is considered to be compounded in the athlete who carries the sickle cell trait.

C+ means more work is needed

On January 12, 2010, the National Athletic Trainers’ Association (NATA), along with 29 other healthcare and sports organizations met and held a summit to address the youth sports safety crisis that is currently affecting youth sport. But… with heightened attention paid to the effects of concussions on athletes… with the new bills passed in many states regarding the treatment of concussion and Traumatic Brain Injury (TBI) in youth athletes… with rule changes and increased disciplinary action for rule violators… with the amount of media exposure paid to the need for preventing preventable sport injuries… we still are not where we should be. The National Athletic Trainers’ Association still knows more can and should be done. Thus on 12/7/2010, the National Athletic Trainers’ Association and the Youth Sports Safety Alliance have given all of these efforts a “C+” for 2010 noting that 48 youth athletes have died in the past year. This injury epidemic can not be stopped by organizations like the National Athletic Trainers’ Association and STOP Sports Injuries alone. It is going to take a complete paradigm shift (a change in the culture of youth sports, if you will) in how youth sports are governed, played and taught. The Sports Legacy Institute has brought research into practice resulting in rule changes in collision sports, increased awareness and a change in the NFL culture and attitude regarding TBI. The culture is changing in college and professional sport, but not at the youth level yet. In a December 8, 2010 New York Times article (Parents Embrace Documentary on Pressures of School), a child psychologist is quoted saying: “When success is defined by high grades, test scores, trophies we know that we end up with unprepared, disengaged, exhausted and ultimately unhealthy kids”. Since sport related injuries are caused by a mistake (intrinsic or extrinsic), having a disengaged, exhausted and unhealthy kid participating in youth sports is just the type of mistake that will give us an injured athlete (contributing to this epidemic).

Timing is everything

Timing is everything. A simple hit to the chest at the right time can be deadly. This is illustrated in the CNN.com article from 12/8/10 where a 16 year old catcher was hit in the chest and collapsed. This is a classic example of commotio cordis. Commotio cordis is a condition where sudden cardiac death occurs when there is a forceful blow to the chest over the left ventricle 10-30 m sec before the peak of the T-wave of the heart contraction cycle. While this is a very rare problem, it is estimated that there is a 90% mortality rate and illustrates the need for an AED to be accessible where ever athletic practices are held.