Rowing fitness provides high intensity workouts in a limited time

Fitness enthusiasts often face the challenge of balancing sufficient workout time with work and family obligations.  One potential option is rowing.  As one of the oldest competitive sports, rowing uses multiple large muscle groups to attain an excellent workout in a short period of time.

The Yale-Harvard rowing regatta was first held in 1852 and is the oldest intercollegiate sporting event in the United States.  On-water rowing consists of sweep rowing (both hands on one oar) and sculling (one oar in each hand).

In 1981, Concept 2 produced an indoor rowing machine that revolutionized training and helped many athletes gain the fitness benefits of rowing.

Workouts, both on and off water, consist of short intense sprints and longer, moderately paced sessions.  Due to the intense cyclic exercise of major muscle groups and the aerobic demands, rowing results in superior cardiovascular endurance.

Cardiac ultrasound studies of elite rowers demonstrate increased cardiac muscle mass.  These studies show the ability of a trained heart to pump more blood with less effort.

The rowing stroke starts with an explosive pushing-off motion by the legs, extending the back and pulling the oar through with the arms at the finish.

Rowing injuries most commonly affect the low back, upper and lower extremities.  The action of the low back moving from flexion to extension against resistance puts tremendous torque on the ligaments, muscles and discs.  This can result in sprain, strain and disc herniation.

Upper extremity injuries from rowing are a result of overuse.  Joints become inflamed causing bursitis and tendonitis.

The most common lower extremity joint injury affects the tendons holding the patella (knee cap) in place.  Rapid extension of the knee can cause the patella to divert from its usual track resulting in tendon pain.

Rowing is a sport worth exploring when looking for an intense workout in a limited period of time.

Mackey-White Committee delves deeper into head trauma

The potential for injury while participating in violent collision sports has become more apparent in recent years.  Athletes are now bigger, stronger and faster since the inception of sports like football and hockey.  The problem is clear but the solution is not.  The Mackey-White Traumatic Brain Injury (TBI) Committee is making an effort to solve this problem.

Named after NFL Hall of Fame players John Mackey and Reggie White, the committee was established in 2009 under the direction of the National Football League Player Association (NFLPA) Executive Director DeMaurice Smith.

"The Mackey-White Committee is the forum which helps guide the NFLPA on workplace safety and the health of our players,” said Thom Mayer, the NFLPA medical director.  “While it originally focused on concussions and traumatic brain injury, its scope now encompasses all aspects of player safety.  Its membership comprises a "Pro Bowl" team of physicians, scientists, and current and former players whose work has been extremely impressive," said Mayer.

Among the most productive features of the meeting is discussion with current and former athletes, some of whom suffer from the chronic effects of TBI.  One request is to protect athletes from themselves when they make bad decisions to keep playing after brain injuries.

Positioning neurologists and other sports concussion experts on each sideline during games is one recommendation that is still being considered by the National Football League.  At collegiate and youth levels of the sport, a recent study confirmed that the association of a licensed health care professional with a team improves the diagnosis and recovery from concussion.

Empowering on-field officials to report concussion and remove injured athletes from play has already been productive.  Instituting a “battle buddy” program that has helped military personnel is under consideration.

It has become clear that football must continue to evolve in order to continue its current level of popularity.

The long road ahead for Kevin Ware

Many Americans recently witnessed one of the most gruesome sports injuries during this year’s NCAA basketball championship.  Kevin Ware, a guard for the University of Louisville, shattered his right lower leg leaving the bone protruding through the skin.

The tibia and fibula are the bones that make up the lower leg.   The tibia is larger and is subject to the most pressure. These bones provide support for the muscles that allow ankle mobility.

Bones consist of two principal components. The outer, cortical layer consists of dense, compact bone.  The inner, trabecular portion of bone is less dense and consists of a porous structure that contains blood vessels and bone marrow. Bone is primarily made up of calcium phosphate.  The structure of bone allows excellent resistance to compressive forces with poor resistance to torsional pressure.

Despite intense physical training, fractures are not uncommon in athletes due to demands placed on the skeletal system and previous injuries that result in micro fractures.  Vitamin D deficiency is another potential risk factor in the general population as well as in athletes.

 

The injury suffered by Kevin Ware involved multiple forces.  Landing firmly on the foot produced a compressive, vertical force on the tibia.  Unfortunately, there was also an angular, horizontal force that produced torsional pressure.  This combination resulted in a severe, displaced fracture.

The injury was further complicated when the fractured bone tore through the skin.  A compound fracture like this now creates an opportunity for infection.

Treating a fracture like the one suffered by Kevin Ware consists of immediately protecting the open wound to avoid infection and immobilizing the limb so that the sharp bone edges do not tear into vital blood vessels and nerves.

Surgical repair includes connecting the fractured segments and allowing them to fuse.  Early, partial weight bearing will hasten the healing process and allow rehabilitation to begin.

After witnessing the injury suffered by Kevin Ware, it will be exciting to follow his recovery and return to playing basketball at a high level.

        

Guidelines for protecting the brain

Concussion is a group of symptoms that result from an injury to the brain.  The injury may occur after impact to the brain from an outside force or the brain striking the inner skull.  It affects between 1.6 and 3 million American athletes each year.

The American Academy of Neurology first published a series of guidelines for the evaluation and management of concussion in athletes in 1997.  Over the course of the past 15 years much has been learned on this vital topic.

Last week, this same group published the most comprehensive scientific review of concussion in sports that has ever been undertaken. This multi-disciplinary study looked at over 14,000 published studies from 1955 to 2012. The reviewers included neurologists, psychologists, physiatrists and athletic trainers.

The original guidelines were based on a grading system with the mildest being a grade 1 and most severe grade 3.  The current information shows that each patient who suffers a concussion has to be treated individually.

Some of the most important conclusions from the study include:

•  The presence of a licensed health care professional with experience diagnosing and treating concussion at an athletic event improved early recognition and recovery.

•  A concussed athlete was at greatest risk for a second concussion within 10 days of the first injury.

•  Body checking in youth hockey, hockey players wearing half visors, quarterbacks and any athlete playing on artificial turf is more susceptible to having a prolonged recovery period after concussion.

•  Male athletes playing football, Australian rugby and hockey were most susceptible, while soccer and basketball had the highest risk for females.

  

“The most effective treatment for concussion continues to be removal from the game as soon as a concussion is suspected,” said Dr. Jeffrey Kutcher, one of the principal authors of the study.

This review not only presents new information but confirms the slogan that “when in doubt, sit it out.” 

The power of teamwork

 

The concept of “team building” is often used in the business environment.  It best applies to bringing together a group of people with a singular purpose.  In sports that purpose is usually a championship but it is often the events that lead up to attaining that goal that are most significant.

This week the Healthy Sports spring training tour is in full swing and one story that seems to dominate the headlines is the New York Yankee injury roster.  Six of the top nine productive players are either injured or recovering from an injury.  Some sports pundits are already predicting a last-place finish.

The only place where these dire predications are not being heard is among the Yankees themselves.  Instead, they have chosen to remain positive and confident that they will win another championship.

That same positive team approach also has great value when facing a health-related problem.

Recently, TV viewers have been able to witness the recovery of anchorwoman Robin Roberts from a bone marrow transplant.  The transplant was necessary after her previously successful battle with breast cancer.  A team of doctors, nurses, family members and close friends was carefully assembled for the long ordeal.  Their principle job was to provide encouragement and remain positive throughout the ordeal. 

It is no coincidence that Roberts was previously an outstanding college basketball player and ESPN host who understood the importance of having the right team in place.  In fact, studies have shown that patients who have a support team are more successful in conquering an illness and those who face a terminal condition have a better quality of life in their final days.

Little league baseball season is about to begin and for many children this will be their first experience with the concept of a team.  It is the responsibility of the adults involved to make sure that their experience is one that will serve them for the rest of their lives.

Too early to link tau proteins to dementia

Many scientific studies present initial data that can provide a promising basis for future experiments.  Unfortunately, those studies are often misrepresented in the popular press and falsely raise the hopes of affected individuals.

In a study published this week in the American Journal of Geriatric Psychiatry researchers performed PET scans on the brains of five former NFL players.  The results indicated that the tau protein, believed to be responsible for chronic traumatic encephalopathy (CTE), could be identified in living subjects.  Tau could previously only be identified by staining brains recovered at autopsy.

CTE was actually first described in 1928 based on studies of deceased boxers.  It was called “Dementia Pugilistica” or “Boxer’s Dementia.”  Modern staining techniques have identified the deposition of the tau protein in certain areas of the brains of athletes who have suffered repetitive brain trauma.

The clinical presentation of CTE consists of cognitive decline, personality changes and movement disorders.  Although there is a clear correlation between tau protein and CTE, not everyone who has tau protein also has the syndrome of CTE.

The current report gives the impression that the scan performed as part of the research can now identify patients who will develop dementia.  This is not true and very misleading.

“Tau can be a marker of the presence of disease but may not be a biomarker of disease activity. Placing too much emphasis on a marker of disease as a true biomarker without years of clinical disease correlation may lead to treating a finding without clinical relevance,” said Dr. Kevin Crutchfield, a neurologist and Director of the Comprehensive Sports Concussion Program at Sinai Hospital of Baltimore.

Another criticism of the proposed correlation is the fact that this study involved only five athletes. 

While many researchers and clinicians are hopeful that we will someday be able identify and treat all forms of dementia before they cause significant impairment, this is many years away.

Adderall creeping further and further into athletics

Adderall is a stimulant medication prescribed by physicians to treat Attention Deficit Hyperactive Disorder (ADHD).  It has also become a popular “performance-enhancing drug” used by athletes.

ADHD is a behavioral disorder consisting of an inability to maintain attention along with features of hyperactivity and impulsivity.  It is typically seen in both boys and girls under the age of 7 but symptoms can persist into adulthood.  It affects approximately 8% of children.

Adults with ADHD typically have difficulty remembering information, completing tasks and concentrating.

There is no specific test for ADHD.  The diagnosis is primarily based on observing a child’s behavior or extensive neuropsychological testing in adults. 

The treatment principally consists of stimulant medications that can improve the ability to remain focused.  The dosage must be carefully adjusted based on symptoms and the response to therapy.

Adderall (dextroamphetamine-amphetamine) is the principal drug used to treat ADHD.  It is a potent stimulant that can cause increased blood pressure, rapid heart rate and seizures.  It has become an attractive performance-enhancing drug for athletes due to its ability to fight fatigue and improve concentration.

Non-prescription use of Adderall has increased recently among high school and college students to enhance academic performance.

The challenge for sports organizations like the NCAA, NFL and MLB is deciding which players have a legitimate reason for using Adderall.  Like other medications, an athlete can apply for a Therapeutic Use Exemption (TUE).

 “ADHD is overwhelmingly the most common diagnosis associated with TUEs in Major League Baseball,” said Dr. Jeffrey Anderson, Director of Sports Medicine at the University of Connecticut.  He also serves as the Independent Program Administrator for MLB’s Drug Prevention and Treatment Program.  He is responsible for overseeing the 119 TUEs issued by MLB this year of which 116 were for ADHD.

The use of medications to improve athletic performance is a growing problem.  The solution is not in more regulation but increased honesty among athletes.

Youth sports require balance between practice, free play

Over 35 million children in the United States participate in some form of organized sports.  Many parents believe that this is the beginning of a professional athletic career.  Unfortunately, without careful monitoring, it is often the end of a professional sports career.

Youth sports participation can provide a boost to a young athlete’s self-esteem, confidence and discipline.  The ability to work as a team is a skill that leads to lifelong success.

There is an ongoing argument as to whether successful athletes are born or made.  Many believe that continuous practice is crucial, while others believe that success is based on a perfect genetic make up.  Interestingly, both are required to some extent.

The issue of early sport specialization was a recent topic of discussion at the University of Connecticut in a lecture by Dr. John P. DiFiori a sports medicine physician from UCLA.  

Dr. DiFiori discussed the differences between  “deliberate practice” and “deliberate play.” There is a belief that 10,000 hours of practice are required to achieve a sufficient level of skill to be successful at an athletic task. This type of deliberate practice often leads to overuse injuries and limits an athlete’s options to be successful at other sports.

Deliberate play refers to a less organized approach where children are not closely supervised and allowed to be creative.  It is this latter style of play that helped develop many older athletes and is found today in many inner city playgrounds.

During the cold war era, East German Olympic athletes were recruited to sports academies where they trained from a young age.  Interestingly, these young athletes were not allowed to specialize in a particular sport until after the age of 14.  Until then, they played many different sports and were allowed to develop a variety of athletic skills.

The development of a successful, healthy athlete requires a careful balance between random and organized play.    

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.