Category Archives: Sports Medicine

Title IX Hits 40

Image courtesy of Sarah Jones via Wikimedia Commons (CC)

What does Title IX mean to you? Athletics is typically high up on the list for many people. Title IX has played an important role in getting girls and young women onto the field. On the 40th anniversary of the landmark gender equity in education legislation, U.S. Secretary of Education Arne Duncan noted in a speech, “when Title IX was enacted in 1972, less than 30,000 female students participated in sports and recreational programs at NCAA member institutions nationwide. Today, that number has increased nearly six-fold. And at the high school level, the number of girls participating in athletics has increased ten-fold since 1972, to three million girls today.”

In an era of nationwide public health concerns over childhood obesity, getting girls and young women involved in sports becomes even more important. However, Title IX’s expansion of school-based athletics programs has more far-reaching benefits as well. As Secretary Duncan pointed out, female athletes “are more likely to graduate from college than female students who don’t play sports.” Female athletes are also less likely to use drugs and become pregnant as teenagers.

Sports are only part of the Title IX picture though. In fact, neither the word “sports” nor “athletics” are used in the text of the legislation. The law has changed the academic landscape for female students.

U.S. Navy photo by Greg Vojtko (Public Domain)

Here’s a few things that you might not know:

  • 57% of students in postsecondary education in 2009-2010 were women; women also accounted for 62.6% of students receiving a master’s degree.
  • Since 1976, girls enrolled in gifted and talented education programs have outnumbered boys enrolled. In 2009, 8.1% of girls participated in gifted and talented education programs, compared to 7.4% of boys.
  • A greater percentage of the girls in 7th or 8th grade (20%) are taking Algebra I, compared with boys (18%).
  • Girls are evenly represented in biology and outnumber boys in chemistry, but are underrepresented in physics.

Welcome to middle age, Title IX. Let’s see what else you can do to get girls on the field and in the classroom.

Kerri Wachter

Data from the “Gender Equity in Education A Data Snapshot” by the U.S. Department of Education’s Civil Rights Data Collection.

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Will the UK Win Gold in Public Health Preparedness?

In all likelihood, there will be no large-scale public health crises during the London 2012 Olympics. But Dr. Brian McCloskey has to prepare, just in case. That’s his job as the London director of the UK’s Health Protection Agency (HPA), the UK-government-funded yet independent public body charged since 2004 with protecting the health of the country’s population from all threats, including those from infectious disease, chemicals, violence, and anything else that may arise. The HPA also collaborates with the World Health Organization on “emergency preparedness for Mass Gatherings and High Consequence, High Visibility events,” Dr. McCloskey explained at the 22nd European Congress of Clinical Microbiology and Infectious Diseases (ECCMID), sponsored by the European Society of Clinical Microbiology and Infectious Diseases.

Dr. Brian McCloskey/Photo by Miriam E. Tucker

“Mass gatherings” are nothing new for London, which has routinely hosted large music and sporting events against a backdrop of ongoing terrorist threats. However, the Olympics represents one of the largest public health challenges yet, in terms of sheer scale and international media scrutiny, noted Dr. McCloskey, who has been with HPA since its inception and was director of public health with the U.K.’s National Health Service for 14 years prior to that.

The Olympics officially begins July 27 and ends 12 Aug. 12, followed by the Paralympics 29 Aug. 29 to Sept 9. In addition, London will also host the Olympic torch relay, Queen Elizabeth’s Diamond Jubilee beginning in May, Wimbledon in June, possibly the largest-ever gay pride festival in late June-early July, and the Notting Hill Carnival in August. “In other words, there will be one long party in London from May through September,” he commented.

In all, the Olympics will comprise 26 sports in 34 venues, with 10,500 athletes, 17,000 people living in the Olympic Village, 21,000 media and broadcasters, and approximately 180,000 spectators per day in the Olympic Park. The challenge, he said, is to plan to respond to anything that can happen without disrupting life for Londoners.

Dr. McCloskey and his colleagues have been studying experiences at previous Olympics, as well as published literature on mass gatherings such as the yearly Islamic pilgrimage, or “Hajj,” to Mecca. Indeed, “mass gatherings” is an emerging area of medicine that was explored in depth earlier this year in a series of six articles in The Lancet. There is also a WHO advisory group on mass gatherings, and even a specialty curriculum being developed, he said in an interview.

Judging by previous experience, “The most likely thing to happen is nothing at all. Most Olympic Games go off without any problems, with only minor impact on the public health service and on public health. But, we do need to think about all the things that could happen.”

Mass gatherings have been associated with both food/waterborne and airborne/respiratory infectious diseases. Yet, less than 1% of healthcare visits in Sydney during the 2000 Olympics were for infectious diseases. In the 2006 winter Olympics in Torino, Italy, surveillance for acute gastroenteritis, flulike illness, measles, and other health-related events turned up nothing unusual as compared with non-Olympics time periods.

London Underground Billboard/Photo by Miriam E. Tucker

During the 2012 Olympics, the HPA will deliver a “Situation Report” each morning to Olympics organizers, describing the state of public health in England and highlighting any potential issues. Managing rumors will also be important, he noted.

Laboratory surveillance, clinical case reporting, and syndromic surveillance—based on patient complaints—will all be enhanced during the Games, with the help of primary care providers and hospitals around the U.K. Any triggers will be followed up, with a much lower threshold and greater speed than usual. In fact, most of these surveillance systems have been in place for at least a year now. “So we’re feeling very comfortable,” Dr. McCloskey said.

And these measures will last beyond the Games. “We will have at least two new surveillance systems in the U.K. as a legacy afterwards…What you get is improved public health systems but also better recognition of the importance of public health and better working relationships…Every country I’ve talked to who’s hosted the Games says we can expect that legacy. Provided nothing goes wrong. But of course, it’s not going to go wrong, it’s all in place, so come and enjoy it.”

–Miriam E. Tucker (@MiriamETucker on Twitter)

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NBA Legend Bill Walton Grateful, ‘Feelin’ Fine’

Five years ago NBA Hall of Famer Bill Walton returned home to San Diego from a road trip when “my spine collapsed,” he told attendees at the annual meeting of the American Academy of Dermatology.

Bill Walton holds court in San Diego. Doug Brunk/IMNG Medical Media

Years of debilitating back problems had finally caught up with him. He had spent more than 4 decades on the road as a basketball player then as a television broadcaster, navigating his 6-foot, 11-inch frame through “horrendous hotels I couldn’t stand up in, sitting in chairs built for children” and being cramped in the cabins during “mind-numbing airplane flights, [logging] 800,000-plus miles a year.”

He spent 2 years mainly lying in a horizontal position on the floor, he said, “in excruciating, unrelenting pain. If I had had a gun, I would have used it. I was standing on a bridge knowing full well that it was better to jump than to go back to what was left.”

But then he was saved, he said, “by doctors like you, by innovating companies like the ones changing the world of dermatology.” More than 3 year ago Mr. Walton underwent an 8-hour experimental surgery on his spine – his 36th orthopedic operation.

“They straightened everything up, bolted it back together,” he said, noting that the foundations of the procedure involved placement of two titanium rods and an Erector-Set-like cage. This was followed by a week in a medically induced coma, 73 postoperative days on morphine, “and the long hard climb back to trying to figure out how to play the game of life and how to get on that mountain one more time.”

During his recovery, Mr. Walton, now 59, said that he was reminded of how lucky he’d been in life, of the support of his parents, friends, and “heroes and role models who stood for principle, who lived their lives with passion and purpose. And they believed in more than material accumulation.”

To borrow a phrase from the Grateful Dead gem “Touch of Grey,” well-known Deadhead Mr. Walton appears to be “feelin’ fine” these days. His views on sports are as colorful as ever. He described basketball as “the perfect game of all, unlike football, which is basically a halfway house between the Army and prison. And baseball, which is a bunch of guys out of shape scratching themselves, standing around, taking steroids, and waiting for the game of life to come to them.”

Welcome back, Bill.

— Doug Brunk

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When Bats Attack: New Design Should Improve Safety

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Collegiate ballplayers like this athlete from the U.S. Air Force Academy started using the redesigned bats in 2011. Image courtesy Wikimedia Commons/Danny Meyer, USAF/Public Domain

Doctors  know about concussions from football, lacrosse, hockey, and similar contact sports, but what about baseball? Apparently, aluminum baseball bats have been implicated in severe injuries and even deaths in school-aged children.

How? It comes down to physics. According to researchers at Washington University in St. Louis, the aluminum bats currently in use can cause the baseball to rebound so quickly, and with so much force, that even an attentive pitcher can’t always get out of the way in time.  In a tragic example, they cited the 2010 death of a 13-year-old pitcher in Vermont — killed by a line drive off an aluminum bat — and noted there have been other reports of similar fatalities.

To cut down on the risk of serious injuries and deaths from hard-hit line drives, the National Collegiate Athletic Association last season started mandating the use of a new style of aluminum bat. The new bat is engineered to put less energy behind the ball once it’s hit, so it is less likely to cause serious harm.

Here’s one of the researchers explaining of the features of the new bat:

This year, the new bats will be used by high school players as well. The National Federation of State High School Associations will enforce the use of the new bats, so ideally the hazards of school baseball will be limited to bug bites and sore jaws from hours of gum-chewing in the outfield.

–Heidi Splete (@hsplete on Twitter)

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Do Trauma Patients Need An Aspirin?

Acute traumatic injury has been shown to produce a prothrombotic state that predisposes trauma patients to an increased risk of venous thromboembolic events. But are these patients also at increased risk for stroke?

Researchers at the University of Louisville report that trauma patients were 1.6 times more likely to develop a cerebrovascular accident (CVA) after admission than medical and surgical controls matched for known CVA risk factors such as age, hypertension, diabetes, atrial fibrillation, and tobacco use.

On logistic regression, trauma was the only significant risk factor for CVA between the two groups, Dr. Jason W. Smith reported at the recent meeting of the Eastern Association for the Surgery of Trauma.

By Patrice Wendling/Elsevier Global Medical News

Dr. Smith called for more studies concerning the etiology and management of post-traumatic hypercoagulability and suggested that “CVA prophylaxis may be warranted in select trauma patients.”

The analysis identified 64 strokes after admission among 7,633 trauma admissions from 2008-2010, for an overall CVA rate of 0.8%. Out of this group, 23 strokes were found to be related to TBI and blunt cervical vascular injury, leaving 41 patients with non-injury related CVA in the analysis. The medical/surgical controls included 14,121 patients obtained from the university’s hospital database over the same time period.

When compared with a second control group of 120 trauma patients matched for Injury Severity Score and mechanism of action, the 41 trauma-related CVA patients presented with significantly more stroke risk factors, including older age, pre-existing hypertension, diabetes, and tobacco use.

Their chance of placement in an extended care facility also skyrocketed from 28% to 81%, while mortality rates more than tripled from 7% in controls to 22% in the trauma-related CVA patients, Dr. Smith and his co-authors reported.

The one bright spot was that on follow-up in the medical/surgical analysis, trauma patients had higher six-month post-CVA functional assessment compared with the controls.

–Patrice Wendling

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Top 20 Fitness Trends for 2012 Released

According to results from a new survey from the American College of Sports Medicine, the top three fitness trends for 2012 are educated, certified, and experienced fitness professionals; strength training; and fitness programs for older adults.

The findings, part of the college’s sixth consecutive “Worldwide Survey of Fitness Trends,” appear in the November/December 2011 issue of ACSM’s Health and Fitness Journal. Results were based on a survey of more than 2,600 fitness professionals. You can access the article for free here.

Outcome measurements and clinical integration/medical fitness both dropped out of the top 20 trends this year, but physician referrals ranks No. 20. “This is a trend toward an emergent emphasis being placed on partnerships with the medical community, resulting in seamless referrals to a health and fitness facility and health fitness professionals,” according to the article, which was assembled by Walter R. Thompson, Ph.D., a regents professor of exercise science in the department of kinesiology and health at Georgia State University.

The top 20 fitness trends for 2012 are:

1. Educated and experienced fitness professionals

2. Strength training

3. Fitness programs for older adults

4. Exercise and weight loss

5. Children and obesity

6. Personal training

7. Core training

8. Group personal training

9. Zumba and other dance workouts

10. Functional fitness

11. Yoga

12. Comprehensive health promotion programming at the worksite

13. Boot camp (a fitness activity structured after military-style training)

14. Outdoor activities

15. Reaching new markets. An estimated 80% of Americans don’t have a regular exercise program.

16. Spinning (indoor cycling)

17. Sport-specific training

18. Worker incentive program

19. Wellness coaching

20. Physician referrals

— By Doug Brunk

Image courtesy Flickr/ Sebastian Fritzon/Creative Commons License

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Concussion Training, Research on the Rise

As awareness and understanding of traumatic brain injury has grown among the military and deployed soldiers, closer to home, it’s athletes of all levels who are feeling the hit. From Little League to the NFL, concussions are on the rise. At a hearing held by the Senate Committee on Commerce, Science, and Transportation, witnesses testified that the community isn’t always aware of the severity of the illness.

(c)nycshooter/iStockphoto.com

Alexis Ball, a former soccer player at the University of New Mexico, testified that she sustained 10 concussions over 8 years of playing competitive soccer. Despite repeated concussions, Ms. Ball said she continued to play because she and her family did not understand the severity of her injuries.

Because of sequelae from her repeated injuries, Ms. Ball was medically disqualified from playing collegiate sports in 2009. Today, she has permanent impairments to her vision and balance.

While pro football and hockey players are often saddled with multiple concussions , sometimes ending their career, concussion is most commonly seen among young athletes. According to data on concussion-related emergency room visits, researchers have found that about 40% of the time, the patient is between the ages of 8 to 13.

While concussions are a common occurrence on the field, most doctors lack the proper training in the treatment and diagnosis of the condition, according to Dr. Jeffrey Kutcher, chair of the sports neurology section of the American Academy of Neurology, who also testified before the Senate committee.

Dr. Kutcher said that most physicians don’t understand that concussions must be handled differently for every patient, as opposed to a “cookbook” approach.

While little is known about the complexity of the condition, researchers are working to change that. At the annual meeting of the American College of Emergency Physicians, a team doctor for the San Francisco 49ers discussed a new tool for gathering data on sports-related concussions. By using mouthguard-based accelerometers, physicians aim to learn about the type of hits that cause concussions, and hopefully find ways to protect players against future head injuries.

Physician groups are also working to improve their training on diagnosing and treating concussion. AAN’s Dr. Kutcher said his group is working to incorporate concussion training at the residency level for neurologists, as well as primary care and emergency physicians. The AAN is also developing sports neurology fellowships and developing CME on concussion. The group has also released a Sports Concussion Toolkit for providers, including basic sports concussion guidelines.

–Frances Correa (@FMCReporting)

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A New Weapon Against Concussion

Sports-related concussions are a growing concern in scholastic and professional athletics, as more studies have shown lasting effects from even a single blow to the head.  Concussions have also become a major concern for physicians, who are often pressured to clear athletes to return to play.

Courtesy Wikimedia Commons user Patrick J. Lynch/Creative Commons

Earlier today, I heard a little about what is increasingly being deployed as a new weapon in the quest to learn more about sports-related concussions: the accelerometer.  Dr. Dan Garza, an emergency and sports medicine physician at Stanford Hospital and Clinics, and medical director for the San Francisco 49ers, discussed Stanford’s use of accelerometers in the helmets of football players and of female lacrosse and field hockey players. (Virginia Tech announced a similar program back in 2007.)

The goal: to get real-time data on what kind of hits these players are taking. During practices and games, the players wear mouthpieces outfitted with accelerometers and gyrometers “that measure the linear and rotational force of head impacts,” according to the Stanford news story on the just-initiated program.

It’s also rimmed with microchips that transmit the accelerational force (known as G force) data to coaches on the sidelines. Dr. Garza said the mouthpieces are a bit eery with their red glow. “They look like Christmas trees out there,” he told his audience, attendees at the American College of Emergency Physicians Scientific Assembly in San Francisco.

Dr. Garza shared a game film from the Stanford Cardinals’ contest against Washington State on Oct. 15 in which wide receiver Chris Owusu received what looked to be a helmet-to-helmet hit (story here). He dropped to the ground and lay there for a bit. On the sidelines, Dr. Garza and his crew received the data from Mr. Owusu’s mouthpiece. They determined that the force of impact was equal to 184 Gs.

That type of accelerational force is considered deadly (for more on G forces, see here and here). For comparison purposes, astronauts only sustain up to 40 Gs at launch and an Indy race car driver might pull 3 Gs in a tight corner. Forces over 100 are usually only encountered in motor vehicle accidents.

Dr. Garza and his colleagues will use the data in a wider study. In the Stanford release, Dr. Garza said the study  “will build toward establishing clinically relevant head-impact correlations and thresholds to allow for a better understanding of the biomechanics of brain injuries.” It may also help with diagnosis and subsequent management of concussions.

Stanford’s football program is being especially closely watched these days, as its quarterback, Andrew Luck, is considered to be a potential number one pick in the NFL draft next year.

The NFL recently announced that it would restart a long, broad look at concussion among its players.  The league has also bankrolled a head-injury program overseen by the Boston University Center for the Study of Traumatic Encephalopathy.

As more attention has been focused on sports-related traumatic brain injury, Congress has gotten involved also. The Senate Commerce, Science and Transportation Committee is having a hearing this Wednesday on companies marketing supposed anti-concussion equipment.

—Alicia Ault (on Twitter @aliciaault)

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What Fuels the Athlete With Type 1 Diabetes?

A phenomenon that was virtually impossible just a couple of decades ago is now becoming increasingly commonplace: Athletes with type 1 diabetes are not only competing at elite levels in just about every sport, but in many cases are actually beating nondiabetic competitors. Gary Hall Jr. won three Olympic Gold medals in swimming after his diagnosis in 1999. Natalie Strand, an anesthesiologist, won the TV extreme-sport reality show Amazing Race with her partner last December. And bicycle racers Team Type 1 won the Race Across America in 2009 and 2010.

Of course, exercise is encouraged for people with both type 1 and type 2 diabetes as a way of improving glycemic control, cardiovascular health, and quality of life. But in competitive sports, milliseconds count and physical perturbations of any kind can mean the difference between winning and losing. With type 1 diabetes, aerobic exercise can result in hypoglycemia, while anaerobic exercise can cause glucose levels to rise. Many sports involve a combination of the two. The athlete with type 1 diabetes must perform frequent glucose checks and eat or take insulin as needed to maintain normal or near-normal glucose, while at the same time performing the athletic feat itself. It seems nearly impossible, yet they do it … with the help of both new technology and devoted health care professionals.

“I take each athlete, learn their sport and find solutions,” said Dr. Anne Peters, the endocrinologist who managed Gary Hall Jr.’s diabetes regimen during the Olympics and is now doing the same for professional racecar driver Charlie Kimball. “Each athlete is unique and requires individualized care.”

Javier Megias of Team Type 1 checks his blood sugar while warming up for a time trial at a race in Italy. Photo courtesy of Team Type 1

New research is aimed at understanding the physiology of these athletes better in order to improve that care. Team Type 1, sponsored by Sanofi, is funding a study in which data are being collected on about 10 bike racers with and 10 without type 1 diabetes. The athletes are being evaluated before, during, and after races using continuous glucose monitors and devices placed on the bicycles that measure variables such as power, heart rate, energy expenditure, speed, and altitude. Data on the athletes’ diet, insulin doses, and other variables are also being collected in a total of five major cycling events, each of which includes 4-8 individual races. “Bottom line, it’s a lot of data,” said Team Type 1 director of research Dr. Juan Frias.

Interestingly, blood glucose values of up to 200 mg/dL – far above “normal” – have been recorded in the nondiabetic riders during very intense portions of races. This “stress hormone” effect had been seen previously in the lab and in some hospitalized patients, but has not been well documented in field-based, real-world studies of healthy people. “Ultimately we hope that this feasibility study will provide data that will help us begin to better understand the optimal glucose concentrations needed to maximize athletic performance, Dr. Frias said.

Findings from the TT1 study will likely be announced at scientific conferences during 2012 and ultimately published, he told me.

Another research project, led by Nate Heintzman, Ph.D., of the University of California, San Diego, is studying athletes who are part of Insulindependence, an organization that promotes physical fitness and sport for people with type 1 diabetes. One of Insulindependence’s recreation-specific clubs, Triabetes, trains people with type diabetes to compete in triathalons. The UCSD-supported project, called the Diabetes Management Integrated Technology Research Initiative (DMITRI), is looking at many of the same variables as in the TT1 study, but is also collecting other data, including behavioral and cognitive information and biospecimens for DNA sequencing.

Insulindependence Captains starting their track workout at UCSD in June. Every person in this photo has type 1 diabetes. Courtesy of Nate Heintzman, Ph.D.

“The idea is to use emerging wireless and device technology as well as genetics and genomics to understand more about the personalized basis of blood glucose management. I think we’ll uncover trends to help tailor therapeutic regimens, and also develop technology on a personal level,” Dr. Heintzman said.

The DMITRI project began in June, and data will begin to emerge in the coming months. In the meantime, if you’re a health care provider or person with diabetes interested in learning more, Dr. Peters recommends Sheri Colberg-Ochs Ph.D.’s Diabetic Athlete’s Handbook. And if you’re seeking inspiration, you can follow Team Type 1 founder and CEO Phil Southerland’s efforts to enter the team in the 2012 Tour de France, professional cycling’s most elite event.

Bottom line, according to Dr. Peters, “The truly gifted athletes I have known seem to be born with an ability that compels them to compete, diabetes or not.”

-Miriam E. Tucker (@MiriamETucker on Twitter)

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Filed under Anesthesia and Analgesia, Cardiovascular Medicine, Endocrinology, Diabetes, and Metabolism, Family Medicine, IMNG, Internal Medicine, Pediatrics, Physical Medicine and Rehabilitation, Primary care, Sports Medicine, Uncategorized

CDC Cautions Athletes to Stay Cool

Is it fall yet? It has been a long, hot summer in much of the U.S.

courtesy of Wikimedia commons user Wikigab

Outdoor exercise is one of the benefits of summer, but this year’s extended, extreme heat prompted the CDC to issue an official advisory, warning the public to exercise caution when exercising outdoors, in order to avoid heat-related illness.

In the press release, Dr. Robin Ikeda, CDC’s deputy director for noncommunicable diseases, injury, and environmental health, said that “Coaches, parents, teachers, and athletes should educate themselves on how to recognize and prevent heat-related illnesses.”

Doctors who are doing preseason sports physicals before those August practices begin have a great opportunity to educate young patients (and their parents) and remind them how to help the kids take the heat while they get in shape for the fall sports season.

The CDC makes it easy. Refer kids and parents to the CDC Extreme Heat Media Toolkit for reminders about how to manage working out in the hot weather and how to identify signs of trouble.

–Heidi Splete (on twitter @hsplete

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