TOPS to prevent SCD caused by HCM

What do SCD and HCM have in common other that just being letters of the alphabet. HCM (hypertrophic cardiomyopathy) is the leading cause of non-traumatic SCD (sudden cardiac death) in athletes. HCM is generally considered a genetic disease that involves abnormal hypertrophy of the left ventricle. What is often misunderstood is that this genetic disease may have an unknown origin. The HCMA is a non-profit organization dedicated to patients with HCM and is a good resource for information. There are 11 genes that are known to cause HCM. There are also more than 500 known mutations (defect in the DNA code) of these genes that are connected to HCM. This is why it is such a diverse disease. HCM may be a result of a de novo mutation. This means that the genetic mutation may occur spontaneously in an athlete with no family history of HCM. This video from Barnes Jewish Hospital in St. Louis, MO provides a good description of HCM.

In Arizona, Team of Physicians for Students (TOPS) is an organization that has a dedicated mission to help prevent sudden cardiac death from hypertrophic cardiomyopathy. TOPS provides a free pre-participation physical exam (for 8th grade through community college athletes) that includes an EKG for all participants with a follow-up echocardiogram if indicated. In 2009, there were 10 athletes that were not cleared for cardiac reasons. This means that there 10 potential cardiac emergencies that were identified before a catastrophic event occurred. Nationally, the Anthony Bates Foundation has a similar mission.

86 Percent Of Disadvantaged Preschoolers Lack Basic Motor Skills

Can we call it socioeconomic discrimination? There are many factors that lead to the creation of disadvantaged neighborhoods. Researchers at The Ohio State University suggest (86 Percent Of Disadvantaged Preschoolers Lack Basic Motor Skills) that children are not only “at risk” academically in underprivileged neighborhoods, but they may also be “at risk” physically. This study reports that 86% of the preschool participants scored below the 30th percentile labeling them developmentally delayed. The results were even more profound in object control skills (involving objects such as a ball or a bat). In object control skills females scored at the 11th percentile and males at the 22nd percentile. The preschool participants in this study are in a critical time in their physical maturation process. Any delay in development places these children at a disadvantage when competing with peers who are proficient in their locomotor skills. Exercise related injuries are caused by a training mistake. Not having the opportunity to learn the basic locomotor skills, is a mistake. A mistake that if not corrected will create injury. Organizations such as the Youth Sport Safety Alliance have been created to combat injuries in youth sports, but their effectiveness will be stymied by a class of youth athletes who have not been taught how to hop skip and jump correctly. Contrary to conventional belief (and ask any Physical Educator), locomotor skills are not naturally developed. They have to be taught and practiced. When it comes to youth and high school sport, success tends to be more prevalent in higher socioeconomic neighborhoods. In other words, “money talks”. We can call it socioeconomic discrimination if disadvantaged children are denied the opportunity to learn the basic locomotor skills involved in physical maturation.

The silent injury epidemic should no longer be silent.

As has been mentioned in this site before, youth sport injuries are at an epidemic level (Youth Sport Safety Alliance). This is a silent epidemic that hopefully is not remaining silent any longer. The physical, social and psychological benefits that come from youth exercise and sport are too numerous to list. Once the emphasis of sport left that of being a benefit to the athlete and became a benefit to over zealous coaches and parents, the injury epidemic (in my opinion) began. Orthopedic injuries that are incurred during the adolescent years may (and often will) have a direct impact on the growth and integrity of the joint affected. Youth sport should be providing benefits instead of providing detriments due to the unnecessary and preventable (chronic and/or acute) injuries. For this to happen, it may take a complete shift in the current youth sports paradigm. In the quest to become “great” in a particular sport, the youth athlete is being robbed of the opportunity of becoming a “great” athlete. Every young athlete has a desire to reach the top of their sport, pushing the athlete too hard and treating them like mini adults may very well deny the athlete of this desire. There is a reason that college and professional athletes (who are well conditioned and have reached physical maturity) have limits on practice times and are provided mandated recovery periods. This reason is so that the athlete may avoid preventable injuries and function at a competitive level. Youth athletes who are still maturing, should not have to wait until they are in college before their sport activities are adapted in an effort to aid in injury prevention and improved performance. If sport and practice adaptations (in an effort to prevent avoidable injuries) are not made at this level, the youth athlete may never have the opportunity to become a college level athlete. Coaches and parents need to do their part in stopping this epidemic by providing age appropriate and developmentally sound instruction along with allowing the child to develop a life-long love for sport is a place to start. Parents need to insist that the coach remains current with age-level coaching techniques and injury prevention. Coaches need to insist that the child be provided an environment that includes a combination of rest and play. Both should educate themselves on the exposure to injury in their particular sport as well as read “Warrior Girls” by Michael Sokolove and “Game On” by Tom Farrey. It is no secret that exercise related injuries are caused by a mistake. For an athlete to excel, these mistakes need to be identified and then eliminated. It is not in my opinion the purpose of youth sports to create the mistake.

Cramps in the legs and back may be more serious.

Cramps in the legs and low back during exercise may not be just a benign case of fatigue. These cramps may be a result of exertional rhabdomyolysis, a rare but potentially deadly complication when an athlete with sickle cell trait over exerts. Sickle cell trait is different from sickle cell disease in the fact that the athlete only carries one gene of sickle cell hemoglobin and instead of the two that result in disease. They also have one gene for normal hemoglobin. During intense exercise (especially without proper hydration) the sickle hemoglobin may change the shape of the red blood cell causing it to sickle and decreasing its ability to transport oxygen. Without oxygen during exercise exertional rhabdomyolysis may result. Since cardiac muscle has some skeletal muscle properties, this muscle breakdown will affect the heart as well as the skeletal muscles (mainly legs and back). According to the Columbia Tribune (Missouri), 7 of the 19 non-traumatic NCAA football deaths have been attributed to complications of the sickle cell trait. There has been enough concern, that the NCAA has recommended testing for the sickle cell trait in their pre-participation physicals. With dehydration being a complicating factor with the sickle cell trait, it may be a good idea for testing for this condition be apart of interscholastic sport as well as collegiate. National Athletic Trainers' Association (NATA) Consensus Statement.

The fine line between performance and dangerous

The February 10 edition of the New York Times has a feature titled “Tempting Fate”. Athletes will naturally try to perform at their best and attempt new skills. Somewhere there is a fine line between superior performance and reckless or dangerous performance. The elite athlete has found this line which has allowed them to achieve their level of greatness. Even so, it only takes a minute mistake that causes one to cross that fine line and there is exposure to injury. Kevin Pearce is an example of this. While practicing a new trick(double cork) on the Halfpipe, Shaun White made a slight mistake resulted in a fall that that is similar to Kevin Pearce's fall that caused a traumatic brain injury. This TBI may also injure any chances for Kevin to ever participate in this sport again. Athletes will always push themselves to achieve greatness in their sport. It is important that in their effort to improve and achieve greatness, these athletes are given an environment that is safe for them to perform. In our current social climate that demands excitement and entertainment in everything we do, sometimes the welfare of the athlete seems to become only a secondary concern. On Friday, 2/12/10, the opening day of the 2010 Winter Olympics, there has already been an accident that claimed the life of luge athlete from the Republic of Georgia. The sad comment here is that the athletes have previously complained that the course was too fast and dangerous.

Badwater Ultramarathon - the extreme

Just finished reading the article in the Arizona Republic about Perry Edinger running the Badwater Ultramarathon. Phoenix man completes Badwater Ultramarathon . What a great example of the demands placed on the body (physical and psychological)! 135 miles through Death Valley and up the the trailhead of Mt Whitney. To run 135 miles in less than 30 hours is incredible. To run 135 miles through Death Valley in July is unbelievable! Wow.

Welcome to the fall semester... I will be bouncing around between 3 different classes: HES 271, EXS 125 and HES 100 (all of these are related). Feel free to comment on anything posted. So that all cal feel comfortable, we need to keep this a professional blog and not a personal blog.