Time To Rethink How Practice is Conducted?

Practice gives greater exposure to concussive and sub-concussive forces than the games themselves. As reported in the New York Times, recent studies conducted on three NCAA Division I teams, a football team will encounter more than 2500 significant blows to the head that are in excess of 50g’s of force and approximately 200 head blows that are above 200g’s. These are just the blows that are of significance and are considered great enough for the athlete to sustain a concussion. The sub concussive forces that occur every time there is contact with another athlete or the ground are too great in number to count. The deaths of Chris Henry (Cleveland Bengals) and Owen Thomas (University of Pennsylvania) have shown the importance of limiting the exposure to sub concussive forces to the brain, not just those significant enough to create injury.

There have been some important research findings in the past few months that, if taken seriously, will lead to safer sport. Until recently, purposeful heading of the ball in soccer was considered a non-issue in regards to brain trauma. According to the American Academy of Pediatrics (AAP), the rate of concussions among soccer athletes in both recreation and elite leagues is similar to football and hockey. With the recent evidence of Tau protein formation resulting from multiple sub concussive hits to the head, the AAP has recently (released September 2010) altered their position that the “contribution of purposeful "heading" of the soccer ball to both acute and potential long-term concussive effects, such as cognitive dysfunction, seems less controversial today than previously.” (Clinical Report Injuries in Youth Soccer) The AAP is waiting for more definitive evidence to actually site the relationship between purposeful heading and long term brain damage. But the sport of soccer (or any of the contact and contact/collision sports) should not wait for long term studies to come to fruition before action is taken. Currently Chronic Traumatic Encephalopathy (CTE) can not be definitively diagnosed except through an autopsy of the brain.

Heat Illness is Preventable

Heat illness is preventable [period]. This also means that the associated complications that arise from a heat illness situation are also preventable. There is more to take into consideration than just temperature and hydration. With the proliferation of medications, dietary supplements and energy drinks, it is important to understand the effects and side effects of what the athlete is ingesting. Common side effects with many supplements and energy drinks include diuretic effects and increased core body temperature. This means that more emphasis needs to be placed on hydration and physically cooling the body. Heat illness and dehydration can also play a significant role in a condition known as exertional rhabdomylosis, a rare but serious condition resulting in increased levels of CK (creatine kinase) that may cause muscle and kidney damage. (Exertional rhabdomylosis is a major concern with athletes who carry the sickle cell trait.)

Knowledge of heat illness prevention and recognition is important knowledge for all levels of sport coaching. A football coach the state of Kentucky was arrested (also acquitted) for negligent homicide in the heat illness death of one of his athletes. Two Middletown, CT football coaches were charged with reckless endangerment (charges were also dropped) after an athlete collapsed from dehydration. While these cases resulted in the respective charges being dropped, this emphasizes the need to prevent preventable conditions such as heat illness.

Lou Gehrig's Disease May Be Connected to Concussions

There is no more important time than now to stress the importance of using a neurocognitive concussion test, like the ImPACT test, on all contact and contact/collision athletes. This means starting at the youth/club level and continuing through the elite and professional levels. There has been an effort to educate the sport culture about the danger of increased intracranial pressure caused by of Second Impact Syndrome (SIS). Now as this education effort is taking place, we find that SIS is not the only danger if an athlete is allowed to return-to-play before a head injury has been resolved. Chronic traumatic encephalopathy (CTE) has been identified by the Tau protein in the brains of former professional football athletes. This is a condition where repetitive concussive and sub-concussive forces to the head have resulted in depression and dementia-like symptoms. Dr. Ann McKee (Boston University Center for the Study of Traumatic Encephalopathy) was instrumental in discovering the Tau protein which is evident in CTE. She and the Boston University Center for the Study of Traumatic Encephalopathy are also instrumental in the very recent discovery (to be published next week in the Journal of Neuropathology & Experimental Neurology) which possibly has a significant connection between head injury and ALS (Lou Gehrig’s disease. In this study, another protein has been identified (TDP-43) creating a connection between ALS and head injuries. With evidence mounting concerning the effects of repetitive traumatic forces to the brain, if sport is to survive the athlete must be protected. Developing a concussion protocol and requiring neurocognitive testing must not be a thought for a sport league or athletic program. It must be a reality. What a coincidence that a concussion may have had a role in Lou Gehrig’s roll in securing a spot on the NY Yankees as well as in the disease that ultimately took his life.

See New York Times article:
Study Says Brain Trauma Can Mimic A.L.S.

Heat Stroke - Return to play?

The temperature in Phoenix got up to 113 degrees today and a question was bought up as to when it is safe to exercise again after heat stroke. Great question! Researching the answer, I found an article in the New York Times (After Heat Stroke,When is it Safe to Exercise?) asking this same question. For years, it has been thought at heat stroke is caused by damage to the hypothalamus in the brain. There are many textbooks that are still professing this (which is a solid reason to question the use of textbooks). But this does not account for the damage to the cerebrum and cerebellum (along with the absence of damage to the hypothalamus) that has been identified in MRI scans of the brain in people who have been diagnosed with heat stroke.

Heat is the most severe physiological stress placed on the body during exercise. The entire paradigm of athletic performance and athletic injury prevention centers on warming the body in preparation for exercise. This means that athletes are intentionally placing their body into hyperthermia each time they exercise. Heat stroke occurs when the body loses its ability to cool itself when placed into hyperthermia. There is not a single cause of heat stroke likewise there can obviously not be a single determination of when it is safe to resume exercise after heat stroke. Heat stroke does not just affect the brain it also affects the other life sustaining vital organs.

What is known is that it is not necessary how hot the body gets during heat stroke, but how long it stays over heated. During this period of hyperthermia, blood is directed towards the skin in an attempt to cool. This deprives the internal organs of oxygenated blood which may or may not result in permanent damage. In many ways, this may be considered a metabolic cascading injury similar to cerebral concussions. Various medical organizations including the American College of Sports Medicine and the National Athletic Trainers’ Association have position statements concerning heat stroke, but there still is not a definitive answer to when an athlete can “return to play”.

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.