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.

The best of 2010 makes for good advice for 2011

This is the time of year when looking back helps give direction for the future. After reviewing the “Healthy Sports” columns for 2010, it is clear that several themes developed:

• Many people faced with chronic illnesses like Multiple Sclerosis, Fibromyalgia and Parkinson’s Disease fare better when they are involved in a fitness program. Yoga, dance and a combination of aerobic and resistance exercises can slow disease progression and improve symptoms. Remaining active is crucial when putting together an effective treatment plan.

• The long-standing effects of repeated brain trauma continue to be a focus of concern and research. This year, a connection between repeated head trauma and Amyotrophic Lateral Sclerosis (ALS) was proposed. While this theory garnered a great deal of notoriety, much more research is needed before any conclusions can be made. It is encouraging to see many athletes who have been involved in violent collision sports now donating their brains for postmortem analysis.

• An area of national concern is safety in youth sports. This pertains to all sports where the participants are younger than 14. The lack of medically trained personnel in attendance, the violent nature of the individual sport and the fact that children are more susceptible to catastrophic injury are all factors that have heightened awareness. Thanks to this increased level of interest, USA Hockey is considering raising the age where checking is allowed to 14. A symposium sponsored by the National Football League and the American College of Sports Medicine will convene next month to address urgent safety modifications in youth sports.

The most rewarding trend is knowing that “Healthy Sports” readers continue to be active and safe in whatever sport they choose.

Sports can taken on new meaning during season of giving

Recently, You Tube and various news services brought us one of the most heartwarming stories in sports. It is especially appropriate during this season of giving.

Cross country runners compete on courses consisting of different types of terrain including steep inclines and dramatic descents. In this year’s California state high school championships, a young competitor named Holland Reynolds was in third place after two miles of a three-mile race when she hit what runners call “the wall.”

The wall is best described as the point in physical competition when large skeletal muscles become depleted of essential nutrients. This is manifested by extreme exhaustion and muscle cramping.

Although Holland is a well-trained athlete, she had been recovering from a flu-like illness the day of the race but felt well enough to compete in the crucial event. Unfortunately, with only several yards remaining in the race, exhaustion led to paralysis and left her crawling to the finish line.

Her effort resulted in victory for her team, but her motivation for continuing was much deeper than winning a trophy. Her coach, Jim Tracy, has been fighting his own battle with exhaustion since being diagnosed with Amyotrophic Lateral Sclerosis (Lou Gehrig’s disease).

ALS is a degenerative neurological disorder that affects motor nerves that are responsible for triggering muscle movement. It results in progressive paralysis and eventual death. Coach Tracy’s persistence in continuing to work with his team despite adversity is what served as inspiration for Reynolds.

Many sports stories emphasize winning at all costs. Athletics is truly an adventure that lets everyone involved find out more about themselves. This series of events exemplifies what is best about sports and competition.

Give the gift of fitness this holiday season

The Christmas marketing assault continues as many consumers prepare to purchase gifts for family members and friends. The wide variety of offerings for athletes deserves some scrutiny.

Recently, there has been a surge in high-tech computerized items as well as expensive pieces of equipment. Novel fitness presents can add interest to a workout and many of the best items are not costly.

Some items worth considering:

• Suspension Trainers. Body weight suspension trainers provide a simple approach to resistance training. Athletes use their body weight to provide resistance in a variety of positions. The apparatus is a series of straps that are braced on a beam or pole. The exercises allow multiple muscle groups to be exercised during the movement. Many of the maneuvers are variations on push ups, sit ups and pull ups with an aerial component.

• Kettlebells. A kettlebell is best described as a cannonball with a handle. Its use provides an excellent workout that includes cardiovascular, resistance and flexibility elements. They come in different weights and are excellent for exercising both limb and core muscles. The dynamic component allows imitation of actual movements in a particular sport. Starting with low weight is crucial to avoiding injury.

• Safety Items. Many runners continue their workouts in “rain, sleet, snow and gloom of night.” If a member of this hardcore group is on your list, consider lights or clothing that add visibility, devices that bring warmth to cold extremities and anything that provides gripping power to sneakers on slippery surfaces.

• Lessons. A gift certificate for a class or lesson in an area of interest for the recipient can provide a special experience. Sometimes this can serve to begin a new challenge.

Fitness-related gifts can be an inexpensive investment in good health.

Longer seasons means longer disabled lists

As athletic seasons lengthen, so does the list of injured and disabled players. This trend is most prominent in collision sports like football, hockey and lacrosse.

Many teams are now competing for championships, bowl positions and other awards. Athletes are being seriously recruited for scholarships or professional contracts. It is not by coincidence that the most intense competition happens when individuals and teams are most challenged by fatigue and injury.

During this part of the season, a good working relationship between the medical staff and coaching staff is essential. Athletic trainers and team physicians must weigh the risks to athletes when granting permission to play after an injury.

In the past, these decisions were straightforward and based on the type of injury and what were very limited resources for rehabilitation. In sports medicine today, many new surgical and medical modalities allow for athletes to return sooner without significant risk.

The most noteworthy advancements have been in the area of orthopedic surgery. Athletes now return as soon as the week after injury when previously, similar fractured bones eliminated them for the season.

Their recovery is due to the insertion of hardware in the form of plates and screws that align the fracture. This stabilizes the site and allows a speedy recovery.

The resourcefulness of athletic trainers is an important component. One example is a quarterback who is able to return thanks to the creative design of an immobilizing boot fashioned around a football shoe. Another example is a defensive player who is able to start at his position only days after having hardware applied for a hand fracture using a specially designed glove/cast.

As football season comes to a close, good coaches know that some of their most valuable assets work in the training room and have the initials “ATC” after their names.

Hockey coaches must know signs of concussions

The topic of sports concussion has recently become very popular in the media. While most attention has been directed toward football, some of the most severe concussions are associated with ice hockey.

Concussion is one element in the spectrum of neurological injuries classified as traumatic brain injury. It consists of an alteration of neurological function as a result of the brain being impacted by an outside force. Young developing brains are more susceptible to permanent damage.

As athletes have grown in size, strength and speed, “violent collision sports” have become more aggressive.

Concussions in ice hockey are particularly severe because they often involve high-velocity impact. A typical scenario occurs when a player is skating on the open ice and is unexpectedly struck by another player moving at full speed. Recent studies also show that the element of surprise plays a role in the degree of injury.

In recognizing the gravity of the current situation, the NHL has passed Rule 48 forbidding “lateral or blindside hits to the head.” Connecticut has passed a new law requiring all scholastic sports coaches to complete a course on the recognition and treatment of concussion.

Unfortunately, none of the current regulations extend to youth sports where the youngest and most vulnerable athletes play. USA Hockey, the principal governing body for youth hockey, has no requirement for coaches to obtain any instruction about concussion.

Once again, the responsibility for safety in youth sports falls on the shoulders of parents. Both parents and athletes should become well-versed in the signs and symptoms of concussion. Although not required, parents should insist that their child’s coaches attend a course on concussion.

Participation in youth hockey is an expensive investment of time, effort and money. Before investing further, parents must be sure their children are safe.

Elliptical trainers can help keep the pounds off during holiday season

Over the course of the past 20 years, the elliptical trainer has become one of the most popular pieces of exercise equipment. Now that the holidays and the potential for overeating are rapidly approaching, investigating future fitness options should begin early.

The elliptical trainer was designed to simulate the movements of walking, running and climbing without the lower extremities impacting the ground. In doing so, repetitive trauma to the lower extremities is vastly reduced.

Among the most limiting factors in the careers of runners is a lower extremity injury. Chronic inflammation of the knees, hips and ankles eventually leads to arthritis.

Sometimes referred to as a cross trainer, the elliptical trainer incorporates the use of multiple large muscle groups in the lower extremities. The cardiovascular or aerobic portion of the workout allows for sustained elevation of the athlete’s heart rate.

Most elliptical trainers now have the option of adding a component where the arms can push and pull levers that alternate with the lower extremities. This adds an upper extremity component to a workout. The ability to increase the resistance of the mechanism adds the ability to build muscle.

Many experienced athletes find the workouts to be best at burning calories.

“If there was one piece of equipment to buy for a combined cardiac and strength workout, the elliptical is the best choice,” said Jeff Ehlers, manager of the Total Fitness store in Newington. Elliptical trainers have become the most popular fitness items sold.

The newest iteration of the elliptical — the suspension trainer — has no wheels or tracks. Although not inexpensive, elliptical trainers, like many other types of athletic equipment, are a worthwhile investment as long as they are regularly used.

Physical activity helps those with Parkinson’s disease

Parkinson's disease is a progressive neurodegenerative disorder affecting motor function. Recent information indicates that physical activity may slow the progression and improve the quality of life for those affected.

Movement disorders are a broad category of illnesses that include Parkinson's disease and related disorders. They are generally the result of a neurochemical imbalance. In the case of Parkinson's, it is due to a lack of dopamine in the area of the brain controlling the fluidity of movements.

Typical symptoms include a tremor along with very slow, stiff movements. Treatment involves supplementing the dopamine in the brain while increasing the sensitivity of dopamine receptors.

Standard physical therapy regimens consist of range of motion exercises to avoid tightening of joints. More recent programs emphasize balance and stretching by utilizing yoga and tai chi.

Dance has now become an accepted complementary modality in the treatment of Parkinson's disease. Dance programs are generally held in group sessions for patients and caregivers. A study performed at Washington University compared patients enrolled in Argentine tango classes to those receiving non-dance therapies. The tango group fared better regarding slowed progression and improved function. The Argentine tango was especially appropriate for this study since it requires dynamic balance, frequent turns, variable speeds and walking backward.

Locally, a weekly dance class for patients with Parkinson's disease and their caregivers has been ongoing at Connecticut College. These classes, led by instructor Rachel Balaban, are designed to improve the strength, stamina and balance of participants. "The dance program addresses the physical and emotional needs of patients by providing an outlet for both patients and caregivers," said Balaban.

While dance therapy may be an unconventional treatment for Parkinson's, it has certainly proven to be effective.

Football safety debate could benefit from local examples

The topic of safety in football has recently risen to become a priority at all levels. There is a high level of concern that changing the rules, equipment or strategy will detract from the entertainment value of one of America's most popular sports.

Specifically, this initiative is the result of the rising number of concussions and spinal injuries, as well as the potential long-term effects of cumulative trauma.

Football is among what are best described as violent collision sports. Others include hockey and rugby. Concussion is a group of symptoms that results from a blow to the brain. It may be from a direct blow or a sudden jerking of the head causing the brain to strike the inner skull.

Proposed changes in football include changing the rules to penalize players for what is felt to be excessive violence as well as using their helmets as weapons. Another proposed change is modifying the execution of plays to minimize vulnerability to injury. Some absurd proposals include eliminating the use of helmets entirely.

One change that would make a difference is creating a "culture of safety" in football.

Arguably, from the standpoint of neurological injury, the most violent sports are combat sports like boxing, mixed martial arts and kick boxing. In boxing, the only way points are scored is by inflicting neurological injury on the opponent.

In Connecticut, the Mohegan Tribe Department of Athletic Regulation, the Mashantucket Pequot Athletic Commission and the Connecticut State Boxing Commission have developed this approach over recent years. Interestingly, the changes put in place have not taken away from the "entertainment factor" in any of these events.

Maybe there is something to be learned.

A culture of safety means that the safety of athletes is the highest priority. Safety takes precedence over money and winning. It is also not limited by time and is an ongoing process.

Boxing has shortened the number of rounds involved in a bout. A typical championship match used to be 15 rounds and is now 12.

Locally, many bouts are four or six rounds and there are more bouts on a card for the night. MMA uses three, five-minute rounds. This provides an opportunity for more athletes and removes them from exposure to injury.

The NFL is currently considering lengthening the season to 18 games from the current 16- game schedule. This will increase the exposure of professional football players to neurological injury.

Combat sports utilize independent physicians to evaluate participants. These physicians are not employed by the venue, promoter or fighter. Professional football relies on a system where physicians are direct employees of the team.

Rules have evolved in combat sports to allow for safety. Football is trying to implement similar rules. These are in place to make the contest safe and officials will gradually become more comfortable with enforcement, while athletes will become more comfortable with following the rules. In boxing, the loss of points or disqualification have been effective penalties. Hefty fines as proposed by the NFL have little impact.

Creating a culture of safety is not an overnight process but a gradual evolution. Football does not need to "reinvent the wheel" to promote safety at all levels.