Saturday, June 2, 2012

Biggest Health Hazards for Young Athletes

Concussions, spinal cord injuries, complications from asthma and diabetes, exertion heat stroke, and sudden cardiac arrest are among the biggest health hazards young athletes face right now, according to a National Athletic Trainers Association (NATA) report.  [1]

Concussion rates, especially, are on the rise -- and some experts say that may be a good thing in the long run. The increase in reported incidents has led to an increase in awareness among parents, athletic trainers, and coaches, Kevin Guskiewicz, the co-director of the Matthew Gfeller Sports-Related Traumatic Brain Injury Research Center at the University of North Carolina at Chapel Hill. And now "athletes are taking it more seriously."

The Detroit Lions are offering unwavering and strong support for a bill about concussions that is making its way before Michigan legislators.

The Lions have promoted the benefits of Senate Bill 1122, which would require youth sports organizations and schools to adopt concussion-awareness guidelines.

It’s already a requirement in 35 states.

Senate Majority Leader Randy Richardville calls it a common-sense approach and says the legislation will be on the floor this week. [2]

While the health hazards above can be the worst fear of many parents and coaches musculoskeletal (muscles, tendons, ligaments, and bones) injuries, while certainly not life threatening should be of concern because of the potential long-term quality of life implications.

Though not widely reported, knee injuries are "a very common injury, one that research shows can lead to the development of knee osteoarthritis, and can become debilitating in your middle-age years," Marjorie Albohm, the president of the National Athletic Trainers Association. "Injury to the cartilage, meniscus, or ACL predisposes you to early arthritis in your middle age."

Repetitive stress injuries are also on the rise. The days of lettering in several different varsity sports are gone; instead, students are encouraged to focus on a single sport starting at a very young age -- as early as kindergarten, in some places -- and stick with it throughout high school and college. Sometimes, they're urged to do so by coaches hoping to hone a particular skill. Other times, they're pushed by parents or driven to land a rare college scholarship. But the intense training in one sport over a long period of time can take a toll, even on young and seemingly fit bodies.

"Probably the thing that we're seeing the most right now is any type of overuse injury, from stress fractures to low-level muscle injuries," Charlie Thompson, chair of the NATA College/University Athletic Trainers' Committee and the head athletic trainer at Princeton University. "Off-season programs start too soon after the end of a long season, and we're not allowing recovery to happen."

"When they get to the high school level and then to the college level, we now see nine, 10, or 11 months of training without a break. It's too much," Thompson continued. "When they get to college, we see the end result: The number of athletes that are coming into college already having had surgery or who need surgery."

I wrote about the collegiate athlete injury rates last week and many of the injuries in the report were from over-use injury and occurred in sports with a large volume of repetitive motions.  As implied by Mr. Thompson the groundwork for a majority of those injuries was established well before setting foot on a college campus.

As young athletes were reminded this week, training in hot weather puts athletes of all ages at risk for heat stroke. Most people know the telltale signs -- dizziness, headaches, and shortness of breath -- but when you're dealing with a serious student athlete, those signs often get ignored.

"If you're doing intense workouts, you're going to get some of those signs and symptoms on a daily basis," Brendon McDermott, assistant professor and clinical coordinator for the Department of Health and Human Performance at the University of Tennessee at Chattanooga. "Athletes will continually push themselves. If it's something serious, their teammates or their coach are going to be the ones to recognize the symptoms."

It's situations like this when the benefits of having a full-time athletic trainer on staff are clear. While coaches are focused on winning games and developing an athlete's skill, and strength and conditioning coaches are focused on fitness and conditioning, athletic trainers are medical professionals who are certified to prevent, diagnose, and treat injuries and sport-related illnesses. Still, just 42 percent of high schools in the United States have access to an athletic trainer, according to data from NATA.

"Most of the scenarios that would be extreme happen during practice, not games," McDermott says. "I don't know of an exertion heatstroke that's occurred during a game."

"Our whole background is medicine," NATA's Robinson, who is also the head athletic trainer at Glenbrook South High School in Glenview, Illinois, said. "It's not realistic to expect a coach to have that type of background."

Parents have to do their part as well. "Parents should be taking a vested interest in their sons or daughters participation and asking questions like 'What is the emergency action plan?' 'Who has the first aid kit?' and 'Who's going to look after him when he's out there?'" Robinson added.

So what can leaders of young athletes do to prevent injuries?

"Sports participation is a double-edged sword," says James Gamble, a pediatric orthopedic surgeon at Lucile Packard Children's Hospital in Stanford, Calif. "Too little has given rise to the fact that one-third of children are obese. Too much has given rise to acute and overuse injuries."

According to the National Athletic Trainers' Association, more than 8,000 children are treated each day in emergency rooms across the U.S. for sports-related injuries. Dr. Gamble notes that based on his practice and published research, overuse injuries are becoming extremely common in adolescent athletes. "You get stress fractures and injuries to tendons where ligaments attach to bones. It's an insidious onset and gradually gets worse until the parent notices a child is limping at practice or a game, and eventually it gets so bad the child can't perform," he says.

Parents play a crucial role in teaching their young athletes how to prevent sports injuries. By following a few simple tips, mom and dad can help their children balance a love for participating in sports activities while also being safe. In addition to having a regular medical exam to make sure a child is healthy, parents should teach their kids to follow these practical guidelines:

Always warm up.
Kids have a tendency to jump right in at a practice, but parents -- and coaches -- should teach them about the importance of warming up before a sport. "You can't just go out and start the activity," says Dr. Gamble. Kids need a very aggressive warm up that also includes dynamic stretching.

Wear the right equipment for the sport.
If a child isn't wearing protective gear or the correct equipment, "he or she shouldn't be permitted to practice," Dr. Gamble. Make sure the equipment fits your child properly. Parents should also encourage kids to wear mouth guards and eye protection. Young athletes need proper foot gear, too. "When kids wear improper foot gear, that can really make them a set up for strains and fractures," warns Dr. Gamble.

Remember the 5 out of 7 rest rule.
The problem with year-round sports is that young athletes don't have adequate time to recover from physical activity. "Kids will practice during the week, and then they'll have tournaments on the weekend. And during the tournaments they may play two games for two or three days, and then they'll go back to practice and P.E. at school. It's an absolute increase in the number of sports and games played and then it's year round, so there's no chance for kids to recover and condition," says Dr. Gamble. He recommends that parents follow the 5 out 7 rest rule: "It's good to have two days for the child to recover, where they're not doing P.E. or a pick-up game. It's a real time to rest. The growing body needs rest."

Watch for overuse injuries.
 Is your child pitching more than he or she should? (And than catching right after pitching several innings?) Does your gymnast seem hesitant to put pressure on a foot or wrist but doesn't want to leave the floor? It could be that the child has an injury and doesn't want to admit it. "That's where parents come into play, to come up with the balance," says Dr. Gamble. "A child will go and go and go."

Ease into sports after an injury.
Kids think they're invincible, even after an injury. But the healing and rehab phases are critical, says Dr. Gamble. "What we see with recurrent injuries is that they'll rest for a bit then they go back to the same level of intensity [they were at before the injury]. They need to ease back into the sport." [3]

Recovery from injury is an active process.  While rest may be an option for the first day or two after suffering an injury the rehab process begins soon after.  Whether it’s hands on therapy, low-level stretching, icing or pool therapy the days of being told to sit and rest are long gone.  Whenever an injury occurs parents and coaches need to be informed by an athletic trainer, physical therapist or doctor on the appropriate protocol to shepherd a child through the recovery process.  And before returning to the field of play the athlete should be required to pass a movement assessment or screening to ensure the child is moving pain free and without compensations.  The movement compensations may have been acquired to avoid pain before the injured area reached a breaking point in the case of an injury that is the result of cumulative trauma and not a single occurrence.  In the case of an acute injury such as a collision that resulted in a torn ligament or broken bone the athlete may move in “guarded’ manner out of fear or lack of confidence in the mended body part.  A well-qualified athletic trainer or athletic development specialist would be able to devise an appropriate “test” that would allow them to see if the athlete was ready to return.

I want to finish up by saying that the best form of injury prevention for young athletes is sound long-term athletic development.  Starting at a young age and exposing a child to as many activities and sports as possible will allow them to build a robust foundation for future injury free athletic participation.  When children learn how to move well generally then they are equipped to compete specifically in the late teen years.  A child with a broad base of fundamental athletic movement is highly resistant to injury for a lifetime and better equipped to realize their potential on the field of play and in the game of life.

Can long-term athletic development even serve to prevent injuries such as concussions?  I believe that it can and here is why:

Additional News:

Calcium Supplements May Raise Heart Attack Risk

In a recent study researchers found a link, or association, between calcium supplements and heart attack, but the study cannot show cause and effect.  Not surprisingly the supplement industry was critical of the research saying the evidence “conflicts with the total body of evidence.”  Let’s suspend the possibility of a conflict of interest from the supplement industry in this instance.  Even if the evidence doesn’t support the claim of increased risk of heart attack taking any supplement in isolation is not optimal because it doesn’t come in it’s natural package that also includes other nutrient co-factors that makes calcium beneficial for your body.  In addition taking isolated supplements can lead to nutrient imbalances such as taking to much calcium can lead to lower levels of phosphorus, essential for…

Pick calcium-rich foods (grass fed dairy, green leafy vegetables) over a pill, suggests Ian R.Reid, MD, distinguished professor of medicine at the University of Auckland. He wrote an editorial to accompany the study.

Taking a calcium supplement once or twice a day, he writes, "is not natural, in that it does not reproduce the same metabolic effects as calcium in food."

"The most important message to women who have been self-prescribing calcium is that they should cease this practice, and look to a modified diet to obtain adequate calcium."

Calcium            Per calorie, kale has more calcium than milk.

Deficiency: Long-term inadequate intake can result in low bone mineral density, rickets, osteomalacia and osteoporosis.

Toxicity: Will cause nausea, vomiting, constipation, dry mouth, thirst, increased urination, kidney stones and soft tissue calcification.

Sources: Green leafy vegetables, legumes, molasses, sardines, okra, perch, trout, Chinese cabbage, rhubarb, and sesame seeds.


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