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.

Academic health (not just physical health) is important in concussion management

This is a great way to look at concussion management and how they affect the “student” athlete. (Big Ten medical staffs will examine concussion policies next week) Even though we are very careful to be correct in referring to athlete as a "student", are we also being careful in considering their “student status” when they are injured? The potential physical damage that comes from the mistreatment (misdiagnosis, inappropriate return-to-play, etc) can be very devastating. The academic side effects are also very important to consider. Injury to the brain can very easily alter an athlete’s academic career. College level academics are stressful and difficult enough for a healthy brain. There are papers to write, textbooks to read and exams to take. Injure the brain and these difficulties magnify. This means that academics must be considered in the treatment protocol. Realistically, only a small fraction of college athletes ever reach the professional and elite level. For this reason, academic health should have the same level of priority as physical health.

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.

Youth Sport Safety Alliance

Youth sport is in a crisis state due to the rising number of injuries that are sustained. This crisis has reached the point where it has become imperative that action must be taken in an effort to protect the athlete. In January, 2010, the “Alliance to Address Youth Sports Safety” summit was held to examine this crisis and to raise awareness of the health care concerns of the youth athlete. This summit was spearheaded by the National Athletic Trainers’ Association and supported by 29 health and sport organizations. With in excess of 7 million interscholastic high school athletes participating in sport, there are close to three fourths of a million sport-related injuries. In 2008 and 2009 there were 120 sport related deaths from conditions such as: brain injury, heat illness and sudden cardiac arrest. This is a true crisis state! From this summit the Youth Sport Alliance has issued a call to action. Information gleaned from the collective knowledge of the professionals in this alliance is valuable and needs to be processed out in an effort to raise awareness of the youth athlete injury crisis. Only by raising awareness, will the current sport paradigm be altered in a way to make the health of the athlete the center of importance.

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.

There is no such thing as a mild brain injury.

Time magazine has provided the influence of a major news magazine in educating athletes, potential athletes, parents and fans on inherent dangers of repetitive blows to the head in contact/collision sports like football. The feature "The Problem with Football: How to Make It Safer", provides a good solid scientific analysis of the cumulative effects of repetitive concussive forces that the brain goes through hit after hit, day after day on the football field and is presented in a literary manner that is easy for the nonscientist to comprehend. As more information is disseminated with regards to multiple concussive impacts and their relationship to chronic traumatic encephalopathy (also referred to as CTE), more coaches, parents and athletes will gain understanding and be able to make informed decisions when given the options presented to them by healthcare providers.

Within this article, there is a video well worth the 9 ½ minutes in length. This is Your Brain on Football.

While this article (along with the majority of current media attention) is centered on the sport of football, it is important to note that cerebral concussion injuries do occur in other sports. Coaches and parents need to assist in recognizing the signs and symptoms of a concussion since many athletes will not report the injury. There is no such thing as a mild brain injury.

Time to rethink football?

After watching the episode of Real Sports with Bryant Gumbel(on HBO) highlighting “Concussions in the NFL", I looked into the topic further and I think I like what I just read. There was an article, “Ten Point Plan to Save Football” (written by Chris Nowinski), which was referred to in this program. Searching for this article, I came across the Sports Legacy Institute. This is an organization founded by Chris Nowinski (Co-Director, Center for the Study of Traumatic Encephalopathy, Boston University School of Medicine) and Dr. Robert Cantu (Clinical Professor of Neurosurgery, Boston University School of Medicine). The Sports Legacy Institute was founded in 2007 when new medical research indicated that sport is in a national crisis concerning brain trauma. This article (Ten Point Plan to Save Football), is a good read and a beginning of further discussion and (more importantly) action. It is not just the exciting violent collision that creates dangerous consequences and a concussed athlete, but multiple lesser blows (or collisions) to the head that creates a cumulative effect that results in brain injury. After twenty-five years in the field of athletic training, I am a firm believer that there is no such thing as a “mild brain injury”. There are some points in this article which is (in my opinion) common sense and some of which will face steep opposition. American football is an “institution” in this country and has long been revered for its punishing violence and the sheer toughness of the athletes that play the game. Athletes are getting bigger, stronger and faster. Technology has produced better equipment and padding in an effort to protect the athletes. I think that it is important to note here that as athletes get bigger, stronger and faster; the forces in which they collide become greater. Also, as technology creates better protection, athletes become less inhibited when it comes to using their bodies as projectiles. As the mass gets larger and moves at a faster speed, the force of contact becomes more violent. Helmets and padding produce great protection for the exterior body surfaces, but do little for reducing the momentum of the brain inside of the cranium. This is the very reason that the entire paradigm of how the sport of football is taught and played must be rethought. The “Ten Point Plan to Save Football” article is a great place begin the shift in this paradigm.

Warrior Girls

“Warrior Girls” (Michael Sokolove) may be the best book that I have read when it comes to the injury epidemic facing female athletes. Sokolove has written several pieces for the New Your Times and has taken a layman’s view to an epidemic that those of us in the healthcare field have either innocently overlooked in the name of caring for injured athletes or have “stuck our heads into the sand” denying that this is even a problem. Young female athletes (in my humble opinion) are competing in an arena that demands perfection, year-around practice and massive amounts of money spent by parents. They are doing this without the resources that are traditionally reserved for their male counterparts (access to quality strength training). I am sure that this will cause some descent among some, but the evidence is there! As an athletic trainer for more years than I can count, I can anecdotally account for a lopsided number of ACL injuries among our female athletes compared to our male athletes. You may disagree with me, but read before you solidify your decisions. The one thing to remember is that exercise induced injuries are caused by a mistake. An epidemic has formed because a preventable mistake has not been corrected.

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.