Fitness gifts for the holiday season

Finding an appropriate gift for someone interested in fitness can be a complex and daunting task. The vast array of offerings may be confusing and an error will result in another dust collector. This week is a good time to make some recommendations and provide some caution.

Michael Sena’s Traveling Trainer. This product provides a perfect combination of fitness equipment, instruction and dietary tips in a convenient travel case. Sena, a nationally known personal trainer, provides instruction on the use of elastic stretch tubes of varying resistances. Although the premise is for this product to be used while traveling to places where a gym isn’t available, it is a great way to begin a home workout that requires minimal cost and space.

Fitness Monitors. These devices include pedometers, heart rate monitors and computerized bands that monitor all physical activity and diets. The range is vast and the usefulness varies. In general, the more comprehensive the apparatus the more technical ability is required. The objective here is to provide feedback regarding the intensity of an individual’s activity. That feedback will hopefully encourage more effort. Much of this can be accomplished by using a simple pedometer and bathroom scale.

P90X2. This is the latest iteration in a wildly successful video workout series. Each consists of intense exercises that last approximately 60 minutes and utilize a variety of muscle groups. They provide an excellent daily fitness experience and, based on many testimonials, accomplish the goal of getting subscribers in shape in 90 days. Although the series is expensive, it requires minimal equipment and space.

The current trend in fitness programs emphasizes equal parts aerobic and resistance exercises utilizing body weight for resistance. Stretching, balance and constant movement are essential elements.

A fitness program combined with dietary moderation will lead to a healthy new year.

Nonsteroidal Anti-Inflammatory Drugs

Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most prescribed medications worldwide. In sports medicine, they are often referred to as performance “enabling” drugs.

Common NSAIDs like Motrin, Naproxyn, Toradol, Voltaren and Celebrex can be administered orally, by injection or applied to the skin. As opposed to steroids, the NSAIDs have fewer side effects and do not build muscle like androgenic steroid drugs.

Inflammation is a normal response of the human body to injury. NSAIDs are effective in treating headache, injured nerves, arthritis and painful chronic conditions. In sports, NSAIDs are primarily used to treat acute muscle tears (strains), ligamentous injuries (sprains) and joint trauma (bursitis).

The classic inflammatory response causes signs of swelling, elevated temperature, redness and pain that are readily apparent to an observer. At a microscopic level, there is an intense cellular response where blood flow increases to the affected region allowing chemicals and white blood cells to leave the bloodstream and attack the injury.

While the inflammatory response is essential to good health, it can cause damage if it becomes chronic. NSAIDs are designed to reduce inflammation by blocking the cyclooxygenase enzymes (COX-1 and COX-2) and subsequently halting the production of prostaglandins, essential components of the inflammatory response.

Although NSAIDs have an analgesic effect, they reduce pain by altering the actual process causing the pain, as opposed to opiate drugs that merely block pain receptors.

It is not uncommon in sports to have more than one ongoing injury. NSAIDs do not target a specific injury and work at multiple areas simultaneously.

Although generally safe, potential side effects of NSAIDs include stomach ulcers, kidney damage and elevation of blood pressure.

In sports, where chronic musculoskeletal injuries are common NSAIDs have extended the careers of many athletes. After consultation with a physician, NSAIDs may be able to keep you in the game.

Sports injuries can't hide from imaging techniques

Sports injuries often require the use of x-rays and more sophisticated diagnostic imaging studies to determine the nature and severity of the injury. These studies and techniques have evolved significantly over recent years.

Among the most commonly used imaging studies are x-ray, computerized tomography (CT) and magnetic resonance imaging (MRI). X-rays were first used in the late 19th century, primarily to determine fractures and other boney injuries. CT scans came into use in the early 1970s and are designed to measure differences in density, especially in bones. MRIs create images based on changes in tissues such as tearing and swelling.

Dr. Nathaniel Dueker is a board certified musculoskeletal radiologist at The William W. Backus Hospital. He took time to review some of the most common sports injuries that require imaging:

Head injuries. Concussions are among the most common injuries seen in sports. While there is no image that can diagnose a concussion, a CT scan should reveal any evidence of acute hemorrhage or skull fracture. Persistent symptoms may warrant the eventual use of an MRI to look for chronic damage.

Shoulder injuries. These injuries typically involve tendons and ligaments. After a plain x-ray to rule out a fracture, an MRI is the best diagnostic tool. This study can demonstrate structural changes in the complex system that makes up the shoulder joint. An MRI of the shoulder can be performed with dye injected into the joint. This exam, called an MRI arthrogram, can be performed in different positions and may reveal subtle tears.

Knee injuries. Traumatic sports injuries to the knee typically result in ligament and cartilage tears. While x-rays will rule out bone injuries, MRI is an outstanding technique for viewing damage to these structures.

Appropriate diagnostic imaging studies can limit the need for surgery and get athletes back in the game sooner.

The heart is a muscle that needs training too

When athletes are described as “having a lot of heart” it often refers to their desire to compete even in the face of overwhelming adversity. In sports medicine, an “athlete’s heart” has an entirely different meaning.

The human heart is composed of four chambers: the right atrium, right ventricle, left atrium and left ventricle. The heart functions as a pump moving blood from the right side of the heart to the lungs where it becomes infused with oxygen. The left-sided chambers then jettison oxygenated blood throughout the circulatory system to other organs.

The left ventricle has the greatest demand and tends to become enlarged, creating a condition known as “left ventricular hypertrophy.”

If blood vessels become narrowed due to atherosclerosis, it requires more work for the heart to pump against resistance. The pumping mechanism must work harder and faster. That strain can lead to heart failure and death.

Like all muscles, the heart can be trained to increase in size and work more efficiently. A fitness regimen that will improve cardiac efficiency should consist of several forms of exercise:

• Aerobic activities such as running, rowing or cycling will maintain a high heart rate over an extended period of time.

• Resistance activities include weight lifting and other strength-oriented sports.

• Cross-training programs include a combination of aerobic and resistance activities. Boxers and other athletes who participate in sports where high levels of strength must be maintained over long periods of time rely heavily on these programs.

“The enlarged, more efficient athlete’s heart is a normal response to exercise training,” said Dr. Craig Denegar, a professor of kinesiology at the University of Connecticut. Screening athletes before athletic participation can be challenging since an enlarged left ventricle can also indicate significant cardiac disease.

A regular exercise program can produce a heart that pumps more blood with less effort.

The simple act of jumping rope

The decision to get into better physical condition can become a very expensive enterprise. When the effort involves children, the interest can be short-lived and lead to unused gym memberships.

Some activities involve little cash outlay and can be enjoyed by the entire family. Among these is jumping rope.

The history of jumping rope is believed to date back to Egypt in 1600 AD. Rope jumping not only served as child’s play but as training for warriors.

Dutch children in early America jumped with two ropes simultaneously and subsequently the term “Double Dutch” became common.

Jumping rope continues to provide an outstanding exercise for burning calories, building strength and improving coordination. Jumping rope for one hour can burn 1300 calories.

Modern rope jumping has become a group exercise activity performed as part of exercise classes. Although it is typically associated with children, it continues to be a preferred method of training for boxers and other combat athletes.

Athletes recovering from lower extremity injuries are often prescribed jumping rope as part of their recovery to rebuild strength and joint proprioception. Proprioception is the brain’s ability to detect the position of an extremity in space.

Childhood obesity is a major problem in the United States today. Physical education programs with shrinking budgets have found rope jumping to be an effective, inexpensive exercise.

Locally, a group of students from the Integrated Day Charter School who love to jump rope have put together a service-learning project titled, “Ambassadors for Heart.” Their goal is to perform at public events and raise awareness of the dangers of physical inactivity and obesity in children and adults.

The efforts of these young ambassadors are entirely supported by private donations. They deserve our support.

Jumping rope can be a first step toward better health.

Peyton Manning and cervical radiculopathy

Among recent recurring stories in sports is speculation regarding the successful return of Indianapolis Colts quarterback Peyton Manning. On Sept. 8, Manning underwent a third surgery to alleviate pressure on a nerve root in his neck.

The cervical spine consists of seven bones called vertebrae located below the skull. Discs made of cartilage separate each of the vertebrae to avoid the friction and wear of bone rubbing on bone. This entire system is held together by a series of ligaments.

The cervical spine is designed to protect the spinal cord and the nerve roots that emerge from the spinal cord to conduct motor and sensory impulses to and from the limbs and vital organs. Damage to these fragile nerves can result in paralysis or death.

Typical injuries to the cervical spine include:

• Fracture of the vertebral bones
• Tearing of the ligaments that attach the bony vertebrae
• Rupture of the intervertebral discs from their central location

In football and other violent collision sports, it is not uncommon to see worn and ruptured discs on imaging studies like MRI and CT scans. Unfortunately, these findings are sometimes seen in young healthy athletes.

The cervical nerve roots responsible for triggering the muscles of the arm are also the ones most commonly injured. Without adequate neural control, throwing is a difficult task, especially for an NFL quarterback.

Surgical intervention includes removing pieces of the offending discs. If the surgery or surgeries require removing a large volume of disc, bone chips are inserted between the vertebrae to prevent dislocation.

While fusing the spine creates a firm repair, it also limits the range of motion of the neck. It is this loss of motion, along with arm weakness, that will make Manning’s return a formidable challenge.

Peyton Manning’s recovery will require all the discipline and effort he has acquired over the years.

Amateur boxing has its place when done correctly

Amateur boxing has been described as being a part of the fabric of society. Boxing, for many young athletes, is their first exposure to organized sports.

Recently, the American Academy of Pediatrics and the Canadian Paediatric Society issued a policy statement on boxing participation by children and adolescents. The position states that they “…oppose boxing and, in particular, discourage participation by children and adolescents.”

The position statement goes on to encourage alternative sports such as “swimming, tennis, basketball and volleyball.” This position is based on limited data and doesn’t account for many intangible advantages or disadvantages.

Amateur boxing is highly regulated under the watchful eyes of experienced coaches. Physicians are present for events and pre-fight and post-fight physicals are required.

Head protection and heavily padded gloves protect against serious injury. Bouts are brief and sportsmanship is stressed. Style and finesse are the principal ways to score points and officials are quick to end a one-sided match.

The health advantages for amateur boxers are numerous. Each participant must train regularly to build strength and stamina. The structure of a boxing gym often substitutes for a stable home life.

Boxing provides a reason to avoid tobacco, alcohol and criminal mischief.

Jody Sheeley owned the Second Chance Gym in Norwich and has been involved in amateur boxing for many years. “Amateur boxing helps build self-confidence, especially for children who don’t do well in team sports,” said Sheeley. In his experience, he has never seen a youngster require emergency medical care as a result of an amateur boxing match.

Amateur boxing has provided a healthy outlet for many young people who do not have access to other competitive sports that require significant financial investment. It is a sport that deserves public support and not restriction.

Pat Summitt will battle Alzheimer's from the bench

Pat Summitt is the “winningest” coach in women’s basketball. At age 59, she has reached the pinnacle of her career, including induction into the Basketball Hall of Fame. Unfortunately, she now joins over 5 million other Americans in their battles with Alzheimer’s Disease (AD).

AD is a degenerative disease of the nervous system that prohibits its victims from learning new information and recalling recent events. The cause of AD is unknown but it can occur in families, as is the case with Coach Summitt.

Forgetfulness is a common part of normal aging. Difficulty finding the right word or recalling someone’s name is acceptable. When these difficulties progress to becoming lost in familiar surroundings and not recognizing close family members, AD must be considered.

Symptoms of AD also include difficulties with executive planning, loss of judgment and social withdrawal. The pressure and cognitive demands of successful coaching can be overwhelming. Pat Summitt’s attempt to continue coaching at the University of Tennessee at a high level is amazing.

There are several medications available for patients with mild to moderate symptoms of AD. Unfortunately, none of these medications alter the actual progression of AD.

Coach Summitt has not chosen to “ride off into the sunset.” Instead she is approaching this disease like any athletic challenge. She is preparing her assistant coaches to take on more responsibilities. She is also beginning a regimen of medication, cognitive exercises and mental preparation.

This approach is not surprising to those of us who work with athletes. When presented with an obstacle that is seemingly insurmountable, athletes dig in and prepare for battle.

Pat Summitt is a great coach and a leader for the rights of women in sports. Now she will put a famous face to a crippling terminal illness and hopefully stimulate interest toward a cure.

Preparation is key for triathletes

In the most recent New York City triathlon, two competitors died because of injuries incurred during the swimming event. While this should not discourage triathlon participation, it is a reason for caution.

Triathlon competitions are a combination of swimming, cycling and running in a single event. The most well-known event is held each year in Hawaii and consists of a 2.4-mile swim, 112-mile bike ride and a 26.2-mile run.

These events are more popular when distances are shortened. The New York event is made up of a 0.9-mile swim, 24.8-mile bike and 6.2-mile run. These shorter distances allow for broader participation, in regard to age and ability.

Recent studies show the death rate for triathletes is twice that of marathon participants. In a 2010 study published in the medical journal, JAMA, where 14 deaths from triathlons were analyzed, 13 of these occurred during the swim portion of the event while the other resulted from a bike accident.

Autopsies revealed the majority of those who died had cardiac abnormalities. Autopsy reports are unavailable for the two most recent triathlon deaths, although the cause of death is presumed cardiac in origin.

While the number of deaths in triathlon is relatively small (15 deaths per million participants), efforts should be taken to make these events safer. Physical examination of each athlete before an event is not practical, but all participants should be examined annually by their personal physician to determine if it is safe to participate in extreme events like triathlons.

The mass start of the swim event makes collisions inevitable and impedes the ability to reach an injured athlete. Staggered starts should be considered.

Triathlons are a great way to crosstrain and remain physically fit. Adequate preparation must include a thorough medical evaluation at any age.

Heat stroke is an avoidable tragedy

Seven young athletes have already died in the United States this month; most of these deaths were the result of exertional heat stroke (EHS). High school football camps will begin this week in the northeast and it is imperative that athletes, coaches and parents are aware of the early symptoms and treatment of EHS.

EHS, along with heat exhaustion and heat cramps, are part of a group of conditions known as heat-related illnesses. EHS is the most severe in what is a succession of events that can result in death without prompt intervention.

Most athletic activities in warm climates will easily get an athlete’s body temperature to 102 degrees Fahrenheit from the norm of 98.6. As the body approaches 105, sweating stops and the athlete will begin to experience headache, nausea, lightheadedness and confusion.

Treatment consists of rapidly lowering the body temperature. Certified athletic trainers are familiar with a protocol that requires the athlete to be immersed in an ice bath before transport to a hospital. The results are dramatic and lifesaving.

“We are now seeing more EHS since athletes spend most of the off season training in air-conditioned environments,” said Dr. Douglas Casa, a professor at the University of Connecticut and a recognized expert in heat-related illnesses. “This doesn’t allow their bodies to acclimatize to the warmer temperatures.” He also believes the increased size of athletes plays a significant role in EHS.

EHS can be prevented by following these simple steps:

• Gradually acclimatize to warmer temperatures before full workouts begin. The most vulnerable period is the first five days of practice
• Athletes should report early symptoms to a knowledgeable coach or an athletic trainer.
• An ice bath should be easily accessible for emergency use.

Early tips to ward off childhood obesity

Childhood obesity continues to be a growing worldwide problem. It results in the early onset of many chronic conditions not typically seen in children like type 2 diabetes, high blood pressure, elevated lipids and heart disease. It may also lead to significant depression and poor self-image.

Recent calls for obese children to be removed from their homes emphasize the parental responsibility of overseeing that children are physically fit. A program should begin at infancy and proceed through scholastic sports.

Infant programs typically involve both parents and children. Swim classes introduce infants to aquatic activities while making them safer around bodies of water. Parent-child groups that include a combination of walking and stretching have become popular from both fitness and social perspectives.

Youth sports are often a child's first introduction to team sports and the advantages and disadvantages that go along with these activities. In the past, youth sports were a playground and sandlot activity. Now they are subject to parental coaches, uniforms and draft systems to choose the most talented players.

Team competitive sports may not be the best choice for some children. Individual activities such as swimming, running, martial arts and cycling can be a better alternative. Multiple activities help develop a broader interest and utilize different muscle groups. Specializing in one sport at an early age may lead to disappointment. Many successful athletes played multiple sports and some were drafted professionally in more than one sport.

As academic and social pressures increase in high school and college, sports become an outlet for expression and relaxation. Unfortunately, it is at this stage when a sense of perspective should be reinforced. Injuries must be monitored and treated properly, but are often the end of promising careers.

Choosing and supporting a child's participation in sports is important for proper physical and mental development.

ACSM reveals exercise guidelines

Guidelines for what constitutes the most effective exercise regimen have been elusive. Recently, the American College of Sports Medicine (ACSM) created a committee of medical and fitness experts to review the scientific literature and make recommendations.

The ACSM committee sought to provide guidance regarding the quantity and quality of exercise needed to remain fit and reduce the risks of developing disorders associated with inactivity. These conditions include heart disease, obesity, high blood pressure, stroke and diabetes.

Regarding the quantity of exercise, the group concluded that adults should perform a minimum of 150 minutes of moderate-intensity exercise each week. This should be in addition to limiting the amount of sedentary activities such as watching TV, reading and playing computer games.

The quality of exercise was divided into four categories:

Cardiorespiratory Exercise: Also known as aerobic exercise, this category includes running, cycling, rowing, elliptical training and many other activities. The recommended 150 minutes can be divided over five days or three days. The frequency and intensity should be gradually increased.

Resistance Exercise: The goal should be to train each major muscle group two to three days per week. Between two and four sets of 8-12 repetitions work best. Free weights, bands or machines are all acceptable modalities but the amount of resistance should be low at first.

Flexibility Exercise: Stretching exercises are imperative before engaging in any fitness regimen. For many adults stretching should be performed upon awakening to avoid injured muscles through the course of a normal day. Each stretch should be held for 10-30 seconds and repeated two to four times.

Neuromotor Exercise: This group of exercise is aimed at improving coordination and balance. It is particularly important as athletes grow older and has been proven to avoid falls. Activities including yoga, tai chi and dance are part of this group.

While these guidelines set an ideal goal, any activity is a “step” in the right direction.

Baseball players are most susceptible to lower back injuries

A review of the current Major League Baseball disabled list reveals five players out of action due to injuries affecting the low back.

Low back injuries involve the elements that make up the lower spine in addition to the muscles that provide support and strength. Due to the amount of sports-related repetitious movement involving the low back, injuries are common and very disabling.

The lumbo-sacral spine consists of five bony, lumbar vertebrae and the sacrum. Each vertebra is separated by a cartilaginous disc to provide a cushion. The entire structure is held together by a series of ligaments.

This elaborate design protects the spinal nerves contained within the bony spinal canal. These nerves exit the canal via small holes called foramina and proceed to provide sensory and motor function to the lower extremities.

The low back musculature connects the lower ribs, spine, pelvis and sacrum. It is the muscular system that provides the strength and stamina necessary for repeated movement.

The most common sports-related injuries are caused by sudden impact that compresses the spine and twisting injuries due to torque placed on the muscles and ligaments.

Low back strain results from torn muscle fibers. These injuries are best managed conservatively with rest, anti-inflammatory medications and physical therapy. Baseball players and especially pitchers are prone to these injuries given the need to generate throwing power by twisting.

Injuries that involve the intervertebral discs can result in breakage of the disc and protrusion of the broken piece. If the herniated disc compresses the spinal nerve, the athlete may experience symptoms of weakness, sensory loss and severe pain.

Treatment may involve decompressive surgery and a long rehabilitation. A rigorous regimen of stretching and back strengthening exercises often referred to as a “back program,” is the best way to avoid time on the disabled list.

Warmer weather brings need for acclimatization

Acclimatization is the process by which an organism adjusts to a change in the environment. Now that warmer weather has arrived and many athletes have decided to get back into action, acclimatization is a crucial element to any regimen.

In sports, acclimatization is best applied to structural and metabolic functions. Structural aspects include muscles, tendons and bones and how they work together. Metabolic systems provide energy to support movement and activity.

In order to avoid potential structural injuries, athletes should stretch adequately before beginning a workout. Starting slowly with a shorter exercise interval and a moderate pace helps. A non-jarring workout such as swimming or cycling before hitting the road for a long run is advisable.

The most reliable indication of a structural problem is pain. Discomfort for 24 hours after a workout is not uncommon but after that, pain should subside. If muscle and joint pain persist or worsen, a medical evaluation is advised.

Metabolic injury can result from extreme physical stress, dehydration, oxygen deprivation or a combination of these factors.

Muscle breakdown from overexertion results in the release of enzymes from damaged muscles. This condition, known as rhabdomyolysis, can lead to renal failure.

Dehydration in the face of working out in hot weather can lead to heat stroke and cardiac failure.

Workouts at high altitude can lead to dizziness and headaches from changes in oxygen concentration.

“Injuries due to metabolic overload typically occur when an athlete is being pushed to work harder by a coach or personal trainer,” said Dr. Jeffrey Anderson, Director of Sports Medicine at the University of Connecticut. Coaches at all levels must be aware of human limitations, especially at the youth sports level, according to Anderson.

The human body has built-in warning signs of impending disaster, including lightheadedness, fatigue and pain. It’s only when these signs are ignored that tragedy occurs.

Regenerative medicine makes older athletes new again

Some athletes have successfully returned to their sports after reconstructive surgery and superseded their preoperative performances. The latest example is the return of pitcher Bartolo Colon who, after elbow surgery in 2010, has returned to his previous award-winning form.

Much of the credit for his return is being given to “regenerative medicine.” The field of regenerative medicine involves the use of stem cells to repair or replace damaged tissues. Regenerative medicine is based on recent breakthroughs in cell biology and presents seemingly endless possibilities toward the treatment of injuries and disease.

Stem cells are key elements in this exciting new field. Stem cells are found in organisms and have the ability to differentiate into various tissues. The most vivid example occurs in embryonic development but adult stem cells can be found in a variety of tissues.

Bone marrow is an abundant source of stem cells. Transplanting compatible stem cells between individuals has become fundamental in treating cancers that involve blood cells.

Orthopedic applications of regenerative medicine involve the repair and regeneration of tendons and ligaments. These procedures require a scaffold to build on, growth factors and stem cells. Finding the right combination of these essential items continues to be a formidable challenge.

“The science behind regenerative procedures is very solid but no one has been able to successfully apply these elements to the satisfaction of the FDA and insurance companies,” said Dr. Michael Joyce, an orthopedic surgeon specializing in sports-related injuries. Until then, he warns that athletes must be wary of ineffective, expensive substitutes.

Regenerative medicine will likely play a role in the treatment of athletic injuries in the future but at this time the only thing these procedures seem to regenerate is an athlete’s confidence.

Athletes can suffer strokes too

A stroke results from a lack of blood supply to an area of the brain and causes damage to cells. Common factors for stroke include diabetes, high blood pressure, obesity, high cholesterol and inactivity. Due to the scarcity of these risk factors in athletes, stroke is rarely seen in this group.

Although uncommon, an entirely different group of factors plays a role when an athlete suffers a stroke.

Head and neck trauma are often factors in stroke during athletic competitions. Direct head trauma can result in leakage from blood vessels, depriving large regions of the brain of necessary nutrients.

Violent forward and backward movement of the head can result in tearing the inner lining of vital arteries responsible for directing blood to the brain. This condition, known as arterial dissection, can form a clot within the affected blood vessel or become a source of small clots. These smaller clots often move toward the brain as emboli and block other arteries.

Treatment for arterial dissection involves the use of blood thinning medications and avoiding violent collision sports.

Another common risk factor for stroke in athletes is the existence of a patent foramen ovale (PFO). A PFO is a hole between the upper chambers of the heart, the right and left atria. The foramen ovale forms in the fourth week of embryonic development and should close in the first three months after birth. When it does not close, it is considered patent or open.

This abnormal channel allows direct passage of blood clots to the brain. These clots often originate in the legs and may result from immobilized lower extremities.

PFOs can be treated with equal success by surgical closure or blood thinning medications. Athletes appear to do better with surgical closure and usually make a full recovery to return to sports.

While considered rare, strokes do occur in athletes and treatment requires a different approach.

Athletes and energy drinks don't mix

Every athlete is looking for a competitive advantage. That advantage may be a better training technique, more advanced equipment or a different strategic approach.

Medicinal supplements have recently become a focus of attention and among the more popular are energy drinks. Most energy drinks are a combination of caffeine and sugar with assorted other herbal additions to boost the potency. The marketing and sale of energy drinks has become a multi-billion dollar enterprise that attempts to appeal to all segments of society regardless of gender, age or socioeconomic status.

Despite the marketing success of these products, no objective evidence has been produced regarding the ability of energy drinks to improve athletic performance. In fact, stories of physical detriment from the use of these supplements have begun to emerge.

One such incident impacted the life of Drake Williams, a high school senior basketball player, and was reported by Tanya Arja for Fox News Tampa. It was the first day of practice and the team was performing drills when he collapsed, a victim of sudden cardiac arrest. Fortunately, a defibrillator was immediately available and his heart was shocked back into normal rhythm.

While no direct correlation could be established, his doctors believe that the fact that he drank two energy drinks in the 24 hours prior to the incident played a role.

Energy drinks, like other nutritional supplements, are not regulated by the Food and Drug Administration. Soft drinks are considered food and limited to no more than 71 mg of caffeine per 12 ounces, while energy drinks can contain between 75 mg and 400 mg per serving.

Studies show that energy drinks are regularly consumed by 30 percent to 50 percent of children, adolescents and young adults. Some common effects of high doses of caffeine include irritability, restlessness, increased blood pressure and heart rate, headaches and tremors. Ironically, many of these effects may be detrimental to athletic performance rather than enhancing.

During any athletic endeavor, heart rate and blood pressure typically soar. The addition of highly caffeinated supplements such as energy drinks can create a deadly combination.

Baseball in Haiti

The smell of freshly cut grass, the sound of a ball hitting a bat and the feel of a freshly oiled mitt all signify the beginning of baseball season. It is a ritual that evokes pleasant memories for many Americans. During the past week, I have come to realize that Haiti is no exception.

Baseball has developed an international following beginning with exportation during World War II by American soldiers stationed abroad. Haiti has never been known as a center for the development of future baseball stars. In fact, there are no current professional baseball players from Haiti, yet a short trip over to the Dominican Republic reveals the largest number of foreign-born baseball players currently playing in the major leagues.

That may soon change. During my most recent trip to Haiti, I had a chance to work out with the “Tabarre Tigers,” a team of 20 boys from the streets of Port-au-Prince. They were first brought together by several Americans working as part of the Haitian relief effort through “Artists for Peace and Justice.”

The Tabarre Tigers play baseball in an actual cow pasture complete with cows and manure. Bases are sandbags previously used as flood barriers. Equipment includes well-used mitts, balls and metal bats. Athletic shoes consist of shower shoes, sandals and poorly fitting sneakers. A Haitian coach is present for safety and to provide basic instruction.

I soon came to find out that what these young athletes lacked in skill and equipment they made up for in spirit. The joy of playing the game was readily apparent. When it came time to play a practice game, sides were chosen playground style with the last chosen showing his frustration.

As the game went on, there was cheering, shouting and congratulations. Solid contact and successful throws were appreciated.

My afternoon with the Tabarre Tigers was strangely reminiscent of a time in sports many of us remember. No shouts of encouragement or disappointment from parents who are often too involved. No overly coached players. There is no “every player wins” philosophy in Haitian baseball or in Haitian life. It is highly motivating to learn that there are times when someone does lose.

This experience reminded me of the importance of youth sports in its simplest and purest form.

If you have new or slightly used baseball equipment and would like to donate it to this cause, you can drop off the equipment at the WXLM 980-AM studios, 7 Gov. Winthrop Blvd. in New London.

Baseball is back — and so are oblique muscle injuries

Baseball season has officially begun and, unfortunately, so has the ever-present disabled list (DL).

The DL is used to signify that a player is unable to compete and it allows the team to promote a substitute player from a lower level to the major league team. It also serves as a barometer for the success of strength and conditioning specialists as well as athletic trainers.

Among the injuries seen early in the season are those that affect the abdominal muscles. These are typically strains or tears in the muscle fibers. They can be very painful and debilitating for an athlete who competes in a throwing sport.

The oblique muscles consist of four paired muscles, the internal and external obliques. They are large, flat muscles that extend from the rib cage to the pelvis in a perpendicular orientation to each other. The principal role of these muscles is to provide stability to the trunk while protecting the abdominal contents.

Injury results from sudden tension on muscle fibers that are not supple. Oblique muscle injuries are most common in tennis, baseball and other sports where throwing and twisting are principal movements. Pitchers are especially impaired by these injuries.

Treatment of oblique muscle injuries consists of rest, alternating hot and cold applications and anti-inflammatory medications. The challenge is resting any muscle that provides support to the trunk. Whenever an athlete stands or turns, these muscles fire. Taping these muscles in an effort to restrict motion can result in diminished breathing.

The best way to prevent oblique muscle strain is through adequate stretching before any activity along with a core strengthening regimen.

Taking time to warm up before tossing a ball or swinging a racquet can keep all athletes off the disabled list.

Caution necessary with head injuries

The gravity of traumatic brain injury (TBI) in sports cannot be overemphasized. It is among the few ways an athlete can die during a contest.

The responsibility for determining when and if brain-injured athletes can return to full participation in their sports is often the most difficult decision a sports medicine specialist must make. A concussion is the mildest and most frequently encountered form of TBI.

Medical technology offers a vast array of imaging, as well as psychological and electrodiagnostic examinations, as part of the neurological evaluation. Despite the magnitude of the decision to return to play, there is no single test or formula to rely on for guidance.

Before 2008, a rating scale based on the presence or absence of loss of consciousness was used. Unfortunately, the scale was an unreliable indicator of when it was safe to return.

The most dependable approach to this dilemma involves two stages:

• The first is careful analysis of the clinical data, history of the incident and previous TBIs, physical examination and observation. An athlete must be symptom-free, including headaches, dizziness, confusion and visual changes.

Based on this information, it is determined whether an athlete can safely begin a rehabilitation program aimed toward full activity. This decision is best made by a physician experienced in treating athletes.

• The second stage in the recovery process includes returning to activity without symptoms. This procedure begins with a low-impact aerobic exercise for 20-30 minutes, then light resistance training and finally concludes with sport-specific activities performed under observation by a certified athletic trainer.

The rehabilitation process after TBI can take months and, sadly, many outstanding athletes never return to their sports.

Interestingly, it is often the great athletes who take the lessons learned from years of hard work and channel them into immense success in another field of endeavor.

Hip injuries can be avoided by stretching properly

Hip pain is often a difficult problem to diagnose and treat due to the challenge of finding the origin of the pain. In many instances, the source of hip pain involves injury to the iliopsoas muscle.

The iliopsoas muscle is formed by a combination of the psoas major, psoas minor and iliacus muscles. These muscles originate from the lumbar spine and pelvis and attach to the upper portion of the femur. Any injury in this area will result in poorly localized pain in the low back, hip and groin.

Typical injuries include iliopsoas strain, where there is tearing of muscle fibers, and iliopsoas tendonitis that is marked by inflammation of the iliopsoas tendon. These injuries are the result of sudden stretching of the muscle by flexing the hip or externally rotating the thigh. Repetitive hip flexion can also cause harm.

Symptoms of iliopsoas injury include pain and stiffness in the hip that can often radiate into the thigh. The pain can be very intense and often results in an athlete withdrawing from competition.

Iliopsoas injuries are most common in gymnasts, dancers, track and field athletes and soccer players. Venus Williams was recently forced to withdraw from the Australian Open due to what was reported as an injury to the iliopsoas. Any activity that requires repeated hip flexion can result in damage.

These injuries can be avoided through a stretching program performed regularly. Strengthening of core muscles including the hip and pelvis will not only improve overall athletic performance but avoid injury to the hip, pelvic and upper leg muscles.

Treatment includes rest, ice and anti-inflammatory medications. A stretching program should be instituted when pain subsides. Unfortunately, an iliopsoas injury often requires up to three weeks of rest.

Many musculoskeletal hip injuries can be avoided and successfully treated with a carefully executed stretching regimen.

NFL collective bargaining centers on safety

A collective bargaining agreement is the result of a negotiation between a group representing the interests of employees and an employer. Collective bargaining has now become an important term in professional sports. Unfortunately, when there is a breakdown in negotiations and a work stoppage results, it is the fans who suffer.

The current collective bargaining drama involves the NFL and the NFL Players Association. While financial issues are central to most employment agreements, this negotiation appears to have a focus on safety.

Dave Duerson was a 50-year-old, successful businessman and former Chicago Bears safety. In recent years, his life began to unravel with marital problems, business failures, uncharacteristic temper outbursts and an inability to remember simple information.

Duerson was diagnosed with Chronic Traumatic Encephalopathy (CTE) as a result of the multiple concussions he had suffered during his years of playing football. He was also an active NFL alumnus fighting for better health benefits for retired players and making the game safer for younger players.

Unable to face a future of dementia, on Feb. 17, Duerson committed suicide by shooting himself in the chest. He chose this manner to preserve his brain for future study. His desperate action has placed a new light on the current negotiations.

Neuropathologists around the world have recently begun to delve into the study of cumulative brain trauma and subsequent Alzheimer’s-like dementia. Some studies have shown changes in the brains of teenage athletes involved in violent collision sports like football and hockey.

“There is no reason, no medical justification, for any child younger than 18 to play football, period,” said Dr. Bennet Omalu, a neuropathologist in California. His opinion is based on studies emphasizing the importance of brain development in the first 18 years of life and the fact that when brain cells are destroyed there is no cellular recovery.

Young people everywhere often believe they are indestructible and are willing to take unacceptable risks for financial reward. The NFL is no exception. It will be interesting to see if the wisdom of elder veterans will direct these negotiations.

Sleep can improve athletic performance

The most potent way to heal injured tissues and rejuvenate multiple organ systems is not a new wonder drug or expensive supplement, it’s sleep. Sufficient amounts of sleep are crucial for outstanding human performance, especially in athletes.

Sleep actually consists of a series of stages that have different physiologic roles. The ability to cycle repeatedly through each stage with an adequate amount of time spent at each level is called “sleep efficiency” and serves as the goal when looking at the architecture of this process.

The two primary divisions of sleep are REM (rapid eye movement) and NREM (non-rapid eye movement). NREM is further divided into three other stages. Only 25% of total sleep time is spent in the REM stage.

During sleep, natural hormones are released in the body and enhance the physical recovery process. Among these are serotonin and growth hormone, the latter being a much publicized “performance enhancing drug” and subsequently a banned substance. Serotonin improves psychomotor performance. These factors alone can give an athlete a tremendous advantage in competition.

Adequate amounts of sleep are crucial to take full advantage of this hormonal production. Unfortunately, an athlete’s schedule that may include long trips, inconsistent sleeping conditions and erratic performance times are obstacles to sleep efficiency.

Dr. Setu Vora, a physician on the Backus Hospital Medical Staff specializing in the diagnosis and treatment of sleep disorders, advocates a simple approach when dealing with insufficient sleep in athletes.

“The best medication is no medication. The same discipline that athletes apply to their sports must also be applied to sleep. The bedroom should be used solely for sleep and an average of eight hours each night is the goal,” said Vora.

International athletes who must endure transatlantic travel should try to sleep on the flight. Earplugs and sleep masks can be helpful.

Adequate sleep, proper diet and a regular workout schedule is vital for athletes at any level.

Too much exercise can cause muscle breakdown

Last week, 13 University of Iowa football players were hospitalized for a condition known as rhabdomyolysis. This condition results from an extreme breakdown of muscle fibers and complications caused by the circulation of the breakdown products.

Rhabdomyolysis generally results from muscle injury. Trauma is typically the most common cause of rhabdomyolysis. Other causes include genetic conditions, dehydration, medications, supplements, seizures, heatstroke, vascular insufficiency, severe exertion or any combination of these.

There are two types of muscle, smooth or involuntary muscles and striated or voluntary muscles. Muscles consist of a complex system of filaments that contract and relax in response to impulses from the nervous system.

Striated muscles are the engines that drive the movement of joints. Like all engines they rely on a fuel source to continue working. If the demand placed on muscles exceeds the availability of nutrients, the fibers “lock up” and cramp. If the imbalance continues, muscle fibers begin to break down.

When muscles break down, proteins and enzymes are released into the bloodstream. Among these enzymes is creatine kinase (CK). The concentration of CK can be measured in a blood sample and indicates the degree of muscle breakdown. CK also appears in various forms that indicate what types of muscles have been injured.

In rhabdomyolysis, myoglobin is among the breakdown products. When high concentrations of this protein are emitted, urine develops a reddish discoloration. If high levels persist, kidney failure will result.

Treatment consists of intravenous infusion of fluids and renal dialysis if necessary.

In the case of the Iowa athletes, it is believed that extreme exertion as part of an offseason workout was the cause. One player reported having to perform 100 squat repetitions with 240 pound weights.

Physical exercise is a big step toward good health, but as 13 Iowa football players have discovered, moderation is essential.

Cold-weather sports can pose health risks

A recent trend in sports has been a return to outdoor winter events. Outdoor hockey games held in stadiums have drawn large crowds. The roof collapse of the Minnesota Vikings home field and relocation to a much colder venue added an additional element to the game.

This shift to more athletic events being held in inclement weather, especially sub-freezing temperatures, poses a danger for both athletes and patrons. During vigorous exercise, energy is expended both by the activity and the need to keep muscles warm.

The two most common forms of injury from exposure to cold include frostbite and hypothermia. Shivering is the first sign of impending cold injury. It consists of involuntary muscle contractions as a means for the body to generate heat. When shivering begins, an effort to get to a warmer environment should be the next step. Alcoholic beverages should be avoided.

Frostbite is the freezing of superficial tissues. It typically appears on fingers, toes and facial structures. Symptoms include pain, tingling, and pale skin that will often blister. The most effective treatment is gradual warming, being careful to avoid friction that can result in permanent tearing of damaged tissues.

Hypothermia is the most severe form of cold injury. It is the result of the core body temperature falling below 95 degrees Fahrenheit. The most severe impact involves neurologic and cardiac function. Patients become confused and sleepy with slurred speech. The clinical presentation resembles alcohol intoxication. Changes in cardiac rhythm can lead to sudden death.

The best treatment for cold injury is avoiding continued exposure. Appropriate attire should include thermal garments that retain heat. Dressing in layers is important. Special attention should be given to the extremities.

Exercising in cold weather does burn more calories and an outdoor workout should be modified accordingly.

Fencing exercises the body and mind

For many people, the start of a new year is an invitation to take on new challenges. This may include dieting, quitting smoking or beginning a fitness regimen. Those who have been involved in a workout program are often looking for some new element. Fencing is a worthwhile consideration.

The origins of fencing can be traced back to ancient Egypt and Rome, yet it remains both a physical and mental challenge even today. Participation is not dependent on age, size or gender.

Fencing builds stamina, strength and balance. Each match involves a series of advances and retreats combined with the skillful use of a weapon called a foil.

The sport appears to emphasize upper body strength but it is the lower body and core muscles that are crucial for success. Most athletic activities are based on forward rather than lateral movement. Fencing is among the activities that requires sideways movements that help train the neuromuscular system to avoid potential lateral falling injuries.

Common fencing injuries include wrist and ankle sprains, bruising and strained muscles. Physical preparation includes both strength and aerobic training. Meticulous stretching of upper and lower extremity muscles as well as core muscles is imperative to avoid injury.

Fencing is a sport in which lessons are necessary for full enjoyment and safety. Aaron Hughes, Head Fencing Coach at St. Bernard High School and Eastern Connecticut State University, offers weekly lessons and training sessions at Fitness World in Norwich.

“Participants are surprised at the amount of stamina and concentration required for fencing,” said Hughes.

One recent Sunday, local radio talk show host Lee Elci and I joined a class hosted by Hughes. We both enjoyed the class and competitive dueling afterward.

Fencing is a sport that exercises both the body and mind at any age.