Healthy Sports: 2009 year in review

Looking back over 2009, there have been several “Healthy Sports” stories that have sparked comments and controversies worth mentioning:

• In April an article dealt with the topic of safety in baseball. One point addressed “avoiding injury from a hard-hit ball coming off a metal bat.” This comment sparked a swift response from the “Don’t Take My Bat Away Coalition” (DTMBA), a special interest group funded by metal bat manufacturers. Armed with engineering data, their executive director made the argument that a ball comes off the bat no faster with a metal versus a wooden bat. When confronted on the “Healthy Rounds” radio show with the option of using a metal or wooden bat to hit a life-saving home run, he would choose the metal bat.

• The Healthy Sports column that discussed sports options for autistic children received outstanding comments by many groups of dedicated parents and educators. I was pleasantly surprised to find there are more options for these children than I had mentioned, including a soccer program in Hawaii just for children with autism.

• A column about sports anxiety quoted many local professional and amateur sports personalities regarding how they deal with this problem. Comments showed that this is a very common obstacle not only for athletes but also for other performers including public speakers.

• The column that has garnered the most interest this year reviewed information surrounding “Chronic Traumatic Encephalopathy” (CTE). Previously referred to as “Dementia Pugilistica,” it was believed to only pertain to repeated blows to the head from boxing. New data shows that this entity has resulted in premature dementia in football players. This has prompted congressional hearings and anticipated rule changes in football. There is much more to come on this subject.

Let’s all hope for a safe and healthy 2010.

Weight loss surgery should not be taken lightly

Bariatric surgery, also known as weight loss surgery, is increasing in popularity among Americans. Before going to the operating room, there are certain necessary steps to be taken — including a trip to a local gym.

The two most common forms of bariatric surgery are gastric bypass and laparoscopic banding.
The gastric bypass involves altering the digestive tract so that fewer calories are absorbed and the patient feels full more quickly.

Gastric banding is a less permanent approach where a band is placed around the stomach. The band can be tightened by injecting saline at different times.

Surgical candidates must have a body mass index (BMI) of 40 or more. This is the equivalent of a 5-foot, 10-inch person weighing 285 pounds. If the person has an obesity-related illness (diabetes, hypertension, high cholesterol), a BMI of 35 is acceptable.

“All potential patients must undergo extensive pre-surgical evaluations including psychological, dietary and exercise counseling,” said Dr. Carlos Barba, a bariatric surgeon and director of the bariatric surgery program at the Hospital of Central Connecticut. Dr. Barba believes that surgery is only part of the program and the most common cause of failure is a lack of commitment.

Exercise is crucial to any weight loss program. The type of exercise is variable. Consultation with a personal trainer is advisable. Morbidly obese patients may begin with an aquatic program where they are buoyant and progress to walking and weight lifting. Many arthritic patients use a low impact routine that may include recumbent cycling.

Bariatric surgery has helped many people eliminate risk factors for heart attack, stroke and cancer but weight loss surgery is not a “quick fix,” it is an invitation to a life-long commitment to fitness.

Body sends signals of serious injuries

The physical demands placed on professional football players are astounding. The amount of physical contact and the impact of this contact continue to intensify.

The length of disabled lists at Week 14 has also grown. The highest profile disabled players appear to be quarterbacks and running backs: Tom Brady, Kurt Warner, Brian Westbrook and Ben Roethlisberger.

Unfortunately, there are also a growing number of unqualified critics casting doubt on the validity of these injuries. Sadly, among these critics are outspoken teammates.

The human body has a remarkable ability to let a person know when it’s injured. Symptoms such as pain, diminished performance and cognitive changes are a clear indication that rest is needed. Although this sounds simplistic, the amazing part is how often athletes ignore these symptoms and go on to more severe or chronic injuries.

Many young, inexperienced athletes may disregard these indications. That is why coaches, parents and athletic trainers must monitor their activities. Adult athletes have no excuse for not being “in touch with their bodies.”

The NFL has recently assigned impartial neurologic consultants to every team. Their job is to specifically determine when an athlete should not play after a concussion. The difficulty is that there are no clear physical signs of concussion like a sprain or wound and the MRI is usually normal. The physician must rely on the information provided by the athlete.

One role of a sports medicine physician is to “run interference” for injured athletes. At times, athletes will come forward and explain symptoms that indicate a need for rest. It is the responsibility of that physician to place that player on the disabled list and deflect any criticism aimed at the athlete.

Successful athletes at any level know how to read their injury signals.

Ankle sprains can be serious injuries

Ankle sprains are among the most common injuries that will sideline an athlete at any level of competition.

A new term appearing on injury reports is the “high ankle sprain.” The high ankle sprain refers to severe trauma to the ankle joint often requiring aggressive therapy.

The ankle joint consists of three bones: the tibia, the fibula and the talus, along with a series of ligaments connecting these bones. The most common ankle sprain occurs when the foot and ankle rotate inward. This results in stretching and tearing of ligaments followed by swelling.

Treatment with Rest, Ice, Compression, Elevation (RICE) is usually sufficient for a full recovery.

The high ankle sprain, also called a syndesmotic ankle sprain, involves the ligaments that stabilize the tibia and fibula. The mechanism of injury consists of outward twisting of the foot and ankle. It is most commonly seen in football, basketball and soccer. It may result from rapid changes in direction or direct impact. Initial treatment is similar to any ankle sprain but this may not be sufficient.

“If a high ankle sprain does not become stable, it will develop into a chronic problem,” said Dr. Michael Joyce, an orthopedic sports medicine specialist and UConn team physician. A plain X-ray of the ankle is not sufficient and accurate diagnosis requires a weight-bearing X-ray or MRI to see if the bones spread apart, according to Dr. Joyce.

Surgical intervention includes a variety of procedures with the goal of permanently stabilizing the joint while allowing for full return to sports.

High ankle sprains are serious athletic injuries and require careful evaluation and treatment. Coaches have enough familiarity with high ankle sprains to know that they mean an extended recovery.

Violent collisions can cause cervical spine injuries

New York Giants linebacker Antonio Pierce suffered a neck injury during a game on Oct. 25. He was reported to have symptoms of neck pain and a burning sensation radiating to his arm. After his symptoms subsided over the next few days, he returned to his normal activity. When neck pain returned weeks later, an MRI revealed a bulging disc in the cervical spine, placing him on the disabled list.

Pierce’s situation is not that uncommon, especially for a linebacker. The cervical spine consists of a series of seven bony vertebrae designed to protect the fragile spinal cord and nerve roots. This area of the nervous system is responsible for sensation and movement of the upper extremities.

Sandwiched between each of the vertebrae is a cartilaginous disc. The center of the disc consists of soft, moist material to cushion any impact.

In a situation where there is repeated trauma to the head and neck causing compression, the discs become brittle and susceptible to fracture and eventual herniation (bulging). A disc that is out of place can irritate the nerve roots and/or the spinal cord.

Football players who use their heads when blocking and stretch their necks to one side tackling are particularly susceptible to these injuries. An MRI scan of a linebacker’s cervical spine typically shows bony arthritic changes and compressed discs consistent with that seen in an elderly person.

Treatment for these injuries can be conservative with physical therapy, anti-inflammatory medications and rest. Surgical intervention may include simply removing the herniated portion of disc alone or in combination with fusing the vertebrae for stability.

Cervical spine injuries can be avoided by strengthening supporting neck muscles, wearing a protective collar and most importantly, utilizing proper blocking and tackling techniques.