Pushing intense exercise too far can lead to exertional rhabdomyolysis

Military training is regarded as the optimum test of physical fitness.  New workout programs like Cross-Fit, boot camp, P90X and Insanity strive to emulate that training.  Unfortunately, this intense physical drilling has lead to a variety of injuries that can be avoided with proper precautions.

One prominent and life threatening injury is exertional rhabdomyolysis (ER).  ER is the result of dramatic muscle breakdown allowing release of enzymes into the blood stream.  Once these enzymes reach toxic levels, they lead to renal failure and potential death.

Non-physical causes of ER include drugs, illness and physical compression.  Most cases are the result of a combination of physical and non-physical causes.

In a recent lecture at the University of Connecticut, Dr. Francis O’Connor, a military physician and researcher who has been studying ER for many years, reviewed many of his findings of military recruits and their relevance for all athletes.

Most serious cases of ER are experienced in military recruits during basic training.  This finding relates to the inability of athletes to acclimate to a new level of performance.  Gradually increasing exercise tolerance is crucial.

Intense drilling and the use of exercise and dehydration as punishment is another common factor in patients who experience ER.  Coaches and personal trainers must rethink these time-honored practices of pushing athletes beyond their limits to produce physical “toughness.” 

Underlying illness, most notably influenza, is a common predisposing factor to ER.  The typical aches and pains experienced with the flu is actually a form of muscle inflammation and breakdown.  Attempts to use exercise to alleviate this discomfort only escalate the damage.

Supplements designed to improve athletic performance often contain stimulants like DMAA that increase body temperature and blood pressure.  These supplements also diminish an athlete’s ability to recognize physical limits and allow them to push beyond muscle tolerance.

Intense exercise can improve overall fitness but caution will avoid potential tragedy.

As athletes get larger, focus on spinal injuries grows

Kinetic energy is best defined as “the energy possessed by a body because of its motion.”  This physical principle provides a basis for the excitement and attraction of high-velocity collision sports.  Unfortunately, it may also be the basis for their downfall.

It is no secret that athletes have become larger, stronger and faster over the past decade.  Attending a high school or youth sporting event will provide sufficient proof.

The human body is an efficient and durable machine but the question of whether it can withstand the kinetic forces it is currently subjected to in sports is now in question.  This issue has particular importance regarding the bony vertebrae that protect the spinal cord.

Last week alone, two high-profile football players sustained significant spinal injuries.  Devon Walker, a defensive back for Tulane University, suffered an awkward head-to-head collision while tackling an opponent. This resulted in a fracture of the spinal vertebrae just below the skull in an area known as the cervical spine.

Roger Saffold, a tackle for the St. Louis Rams, was also involved in a head-to-head collision and had to be taken from the field on a stretcher.  Although no fracture was reported in Saffold’s injury, there is concern regarding the potential for further injury.

The spinal cord provides the main link for the nervous system between the brain and the peripheral nerves. Those nerves provide sensation and movement.  Head-to-head impacts result in the entire kinetic force of the collision to be directed on the spine.

Similar to other forms of injury, an inflammatory response is triggered and produces swelling and subsequent damage to the nerve fibers.  Unfortunately, this damage is often permanent and results in paralysis of all extremities (quadriplegia) or just the lower extremities (paraplegia).  Aggressive treatment and surgery can often limit damage.

As kinetic forces increase, so does the apparent danger of participation in football and similar sports.  A solution to this dilemma is a necessity.

Cardio Tennis serves up a workout with a twist

Tennis is an exciting sport that incorporates fitness, strategy and technical skill.  The game has now entered a new phase in the form of “Cardio Tennis.”

The modern game of tennis developed in the late 19th century.  Since then, the rules have changed very little. The original lawn surface has added options of clay and a variety of artificial surfaces.

The tennis racquet has undergone dramatic change from its origins.  Originally made from wood with thick strings, the incorporation of space age materials and dramatic changes in the shape and surface area of the racquet over the past 40 years has resulted in an implement that bears little resemblance to its predecessors.

Tennis is a sport that requires episodic bursts of activity that can require extreme fitness as demonstrated by long, intense professional-level volleys or a slow-paced doubles match.

Cardio Tennis is a training program that incorporates tennis skills with a high-energy aerobic work out.  Like other forms of aerobic exercise, the goal is to raise the athlete’s heart rate to a safe level and maintain that level of exertion.

In Cardio Tennis, the emphasis is on the fitness component and ability to burn calories rather than the ability to play tennis.  Constant movement during the hour-long class is combined with returning forehand and backhand volleys.  The groups consist of up to eight participants of varying ages and skills.

“Cardio Tennis is perfect for people looking for an unintimidating, cardiac workout that is designed for all fitness levels,” said Bobby Schlink, a USPTA certified tennis professional who teaches Cardio Tennis at the Lyme Shores Tennis Center.

Multiple studies have confirmed that aerobic exercise performed for sixty minutes three times per week can increase longevity.  Cardio Tennis is one way to achieve that health goal.

 

Healthy ideas for a vacation at sea

Over 10 million people will select a cruise as a preferred means of vacation travel.  Most cruise lines provide all-inclusive packages with meals, entertainment and lodging.  Maintaining a healthy weight and following a prescribed diet can be a difficult task.

There is no magic formula for maintaining a healthy weight.  The human body is an efficient machine, calories are taken in to provide energy and calories are expended with effort.  Often, a cruise provides many opportunities to take in more food with fewer opportunities to work out.

Fortunately, many cruises now present healthy options for fitness and dining.  Some healthy cruising tips include:

•  Fitness center.  Locate the fitness center and become familiar with the equipment available.  Modern cruise ships have an extensive assortment of workout gear.  Treadmills, ellipticals and stationary bicycles are among the most popular. A television set mounted to the apparatus also makes the time go by faster.

•  Fitness classes.  A cruise is a good occasion to try something new.  Personal trainers direct spinning, yoga, Zumba and TRX sessions.  A personal trainer on board may be able to put together an effective exercise program for year-round use.

•  Jogging track.  Ships now map out an area designated for guests who wish to jog or walk.  This area is typically located on the upper deck allowing for great views and a chance to enjoy some time outdoors.

•  Stairs.  Passengers who wish keep off some pounds should pass the elevators and opt for the stairs whenever possible. 

•  Pool. The swimming pools on board are typically very busy during the day but early morning is a perfect time to swim laps or perform a water aerobics program.

The most effective way to enjoy a cruise without gaining weight is to find a like-minded partner to support you at the gym and at the buffet.

Local approach to the concussion crisis

The sport of football is facing a growing problem regarding the health and safety of its athletes.  Approximately 3.8 million athletes in the United States will suffer a concussion this year.  Many of these may be the result of high velocity collision sports like football and hockey.  Since last season, four NFL players have committed suicide and autopsies revealed chronic brain damage associated with multiple brain injuries.

Concussion is best defined as “a syndrome of immediate and transient alteration of neurologic function as a result of a biomechanical force.”  The biomechanical force is generally a blow to the head.  Athletes have become bigger, stronger and faster over the past twenty years and protective equipment has not been able to keep up.

Many experts in the field of sports medicine have focused their efforts on reducing brain damage from repeated concussion.  Recommendations include modification of rules, teaching proper playing skills, providing appropriate, well-fit equipment and assuring the presence of trained medical personnel at sporting events.

Education is crucial to the success of any far-reaching public health effort.  Locally, Backus Hospital has partnered with the NFL Players’ Association and St. Louis Rams Super Bowl champion Ernie Conwell to produce an eight-minute video educating coaches, parents and athletes on the signs and symptoms of concussion.

Six local high schools have already agreed to show the video to every athlete involved in a high-velocity collision sport.  The goal of this program, titled, Concussion: Recognition, Rest, Recovery, is to increase early awareness and reporting of concussions.

The video is available online at www.backushospital.org.  Copies of the CD can be obtained free by sending an e-mail to aalessi@wwbh.org. 

Concussion is a serious consequence for all athletes regardless of gender and level of competition.  The widespread dissemination of accurate information can be lifesaving.

Olympic passion spreads from Europe to eastern Connecticut

A young woman is living in Manhattan in 2007, applying her Ivy League education in the financial field.  It is an ideal life by many standards.  Then, while visiting her sister in Vermont, they go for a bike ride in the hills.  Upon her return to Manhattan, she purchases her own bicycle and begins a daily regimen of riding each morning at 4 a.m. in Central Park.

After several months, she enters an amateur race with her sister.  She not only wins this race but also catches up to the professionals who had started five minutes earlier.

This event sparked a passion in Evelyn Stevens that led her to leave her comfortable life in 2009 to begin a journey that has culminated in her first Olympic cycling competition.

Many Olympic athletes are seasoned veterans in their sports by the time they are teenagers.  Stevens story goes against this trend.  Starting at age 26 may give her a physiological and psychological advantage.

Over the course of the next two weeks, Backus Hospital is sponsoring an Olympic participation program.  The program is designed to encourage participants’ involvement in a variety of sports.

Information regarding this innovative program, along with training tips, can be obtained by going to backushospital.org/medalist

Another Olympic story of interest involves physicians and medical personnel chosen to treat American athletes.  There are 80 medical professionals available to treat 525 athletes.

Among these practitioners are physicians, chiropractors, nurses, athletic trainers and massage therapists.  This team must be ready to treat a wide variety of medical conditions including complex orthopedic problems and general medical issues like influenza.

The Olympic games continue to evolve as a spectacular sports event that provides entertainment value for everyone.

Training the brain for high-speed decision-making

Repetition is a time-honored method for sharpening technical skills needed in an emergency.  Physicians, pilots, soldiers and police have utilized sophisticated simulators to create scenarios requiring rapid and precise decisions for many years.  There may now be a way for athletes to train their brains in a similar way.

The nervous system can be described as an electrical grid with wires (neurons) that interact to form intricate networks.  These networks carry sensory and motor signals that result in conscious actions. Neural plasticity refers to the ability of the brain to create new pathways that replace injured areas of the nervous system.

Recent studies have looked at a generation of subjects who have been playing video games.  The results show that people who play action games are able to make decisions 25% faster than people who don’t, without sacrificing accuracy.

Experienced video game players can process information and act on the information four times faster than non-gamers.

Axon Sports is known for designing and implementing computerized cognitive testing used in the assessment of concussion.  Their latest venture involves training the brain to make rapid and accurate decisions in a variety of athletic situations.

Computerized sports training is specific to an athlete’s sport and position played.  Quarterbacks are presented with different defenses and batters visualize various pitches.  One goal is to present many game situations without subjecting the player to injury.

The “athletic brain” is trained for high-speed decision-making, visualization, emotional regulation, focus, reaction and spatial reasoning.

“The athletic brain is a vehicle for athletes to make optimal decisions in game-time situations,” said Jason Sada, President of Axon Sports.

Soon these computerized training programs will be accessible to the general public and many young athletes.

In addition to aerobic and resistive training it appears that cognitive training is becoming an essential component to a balanced fitness regimen.

The benefits of Bikram Yoga

Most athletes hope to sweat profusely and lose weight when working out.  Bikram Yoga may be a quick way to accomplish both of those goals while improving overall health.

I was recently invited to participate in a standard 90-minute Bikram session.  I agreed with cautious curiosity.

Yoga is an ancient Indian practice that combines mental, physical and spiritual disciplines.  It consists of poses or postures designed to increase strength and flexibility.  Another crucial element to Yoga is controlled breathing to relax the body and mind.

Bikram is a form of “hot Yoga” where postures are performed in a room heated to 105 degrees Fahrenheit with 40% humidity.  Developed in the 1960s, Bikram Yoga consists of 26 postures and two breathing exercises. 

Many Yoga postures can be prescribed for specific medical problems similar to physical therapy.  The 26 Bikram postures were chosen to provide the best overall mental and physical experience.

The heat component increases circulation to muscles and allows muscle fibers to become more supple.  This reduces the likelihood of tearing and soreness after maintaining difficult postures.

“The most important feature of Bikram Yoga is the fact that anybody can do it,” said Richard Mercer, director and owner of Bikram Yoga Simsbury.  Mercer, a former Division I football player, advises new participants to set small goals of being able to stay in the room for the allotted period and participate in the poses within individual limits.

Bikram is an outstanding workout that uses a variety of muscle groups.  One of the biggest obstacles to a new workout is the degree of post-exercise soreness.  Bikram produces minimal discomfort and presents a good fitness option for both beginners and trained athletes.

Wellness programs provide professional support

A recent article in The Bulletin told the story of a 6-year-old boy who, along with his mother and others, was rescued at sea by the U.S. Coast Guard. The group was escaping oppressive conditions in Haiti 18 years ago.  The young man decided that he would eventually serve in the Coast Guard like his rescuers.  Last week, he graduated from the Coast Guard Academy as an officer.

This story exemplifies the fact that children are impressionable and often emulate both the positive and negative behaviors of adults.  Health and fitness habits are no exception.

More than 60 million Americans are considered obese or overweight.  This epidemic has carried over to the pediatric population and the connection is more than coincidence.  The solution may be establishing healthier role models.

The transition to a healthy lifestyle often requires professional support. Wellness programs provide a variety of options for comprehensive diet, exercise and stress management.

Wellness councilors serve as coaches through what is hopefully a dramatic change for the individual and their entire family.  Although the approach is multidisciplinary, exercise is a crucial element.

Regular fitness activities can reduce stress by providing an outlet.  Both aerobic and resistive exercise can improve sleep habits and reduce food cravings.  Many people have used regular exercise as a substitute for smoking.

“Wellness programs are designed to re-energize a person’s life by attaining health goals and managing risk factors for chronic disease,” said Sheri McNally, a local wellness counselor who provides programs for employers.  McNally utilizes Skype, email and telephone conversations in addition to personal attention to support participants.

Many people are concerned with the financial legacy they will leave their heirs.  A legacy of good health by setting an example may have the greatest value of all.

The curious case of turf toe

Toe injuries are not often associated with the need to remove an athlete from a contest. Turf toe is a painful foot injury that has pushed athletes to the sideline for extended recovery periods.

The human foot is divided into three basic sections: the hindfoot (heel), the midfoot (arch), and the forefoot (toes).  Turf toe affects the forefoot.

Turf toe involves the first metatarsalphalangeal joint.  This joint is the connection between the great toe and the bone that anchors it to the foot.  Like other sprains, it consists of damage to the connective tissues that stabilize the moving parts.

The mechanism of injury consists of the sudden, extreme dorsiflexion (upward bending) of the great toe.  The force results in stretching and tearing ligaments beyond their normal range of motion.  Cartilage can also be injured in more severe trauma.

Inflammation follows with swelling and pain.  Initial treatment includes rest, ice, compression and elevation.

This type of injury usually involves an activity on a firm surface.  Turf toe is most common in football.  The recent popularity of artificial turf over natural turf is part of the reason for the rise in cases.  A force applied to the calf muscle while the knee is flexed is another cause of turf toe.

“The injury is primarily mechanical in nature and so is the treatment.  Putting the foot in a more rigid shoe or an orthotic device will avoid further injury,” said Dr. Joseph DiFrancesca, a Norwich podiatrist who treats many athletes with turf toe.  He also believes that careful selection of athletic shoes with a rigid shank will reduce injury rates.

The healing process for turf toe can take several weeks.  Unfortunately, an early return to activity without sufficient healing can lead to a chronic debilitating injury