David T. Bernhardt

Active healthy living: Prevention of childhood obesity through increased physical activity

The current epidemic of inactivity and the associated epidemic of obesity are being driven by multiple factors (societal, technologic, industrial, commercial, financial) and must be addressed likewise on several fronts. Foremost among these are the expansion of school physical education, dissuading children from pursuing sedentary activities, providing suitable role models for physical activity, and making activity-promoting changes in the environment. This statement outlines ways that pediatric health care providers and public health officials can encourage, monitor, and advocate for increased physical activity for children and teenagers.

Dynamic sonography with valgus stress to assess elbow ulnar collateral ligament injury in baseball pitchers

Abstract. Sonography is a valuable method for imaging superficial tendons and ligaments. The ability to obtain comparison images easily with dynamic stress allows assessment of ligament and tendon integrity. We studied the medial elbow joints of two baseball pitchers using MR imaging and dynamic sonography. Both sonography and MR imaging identified the ulnar collateral ligament tears. Dynamic sonography uniquely demonstrated the medial joint instability.

Creatine supplementation in high school football players.

ObjectiveTo describe creatine supplementation patterns and behaviors associated with creatine supplementation in high school football players. DesignA cross-sectional, multisite, anonymous, descriptive survey was conducted between October 1999 and February 2000. Setting37 public high schools in Wisconsin. SubjectsA total of 1,349 high school football players, grades 9–12. Main Outcome MeasuresSelf-reported prevalence of creatine use, as well as perceived benefits and risks. In addition, sources of information and influence regarding creatine supplementation were assessed. Results30% of the respondents reported using creatine. Creatine use was lowest in the 9th grade (10.4%) and highest in the 12th grade (50.5%). 41% of the players at small schools stated they used creatine compared with 29% of the players in large schools. Enhanced recovery following a workout was the most likely perceived benefit of creatine supplementation, while dehydration was cited most often as a risk of creatine use. Users were encouraged to take creatine most often by their friends while their parents discouraged creatine use. ConclusionsCreatine use is widespread in high school football players. High school football players who use creatine may not be aware of the risks and benefits associated with creatine supplementation. Sports medicine professionals who work with this population need to educate athletes, coaches, and parents about the use of creatine as a performance-enhancing supplement.

AMSSM Position Statement on Cardiovascular Preparticipation Screening in Athletes: current evidence, knowledge gaps, recommendations and future directions

Cardiovascular screening in young athletes is widely recommended and routinely performed prior to participation in competitive sports. While there is general agreement that early detection of cardiac conditions at risk for sudden cardiac arrest and death (SCA/D) is an important objective, the optimal strategy for cardiovascular screening in athletes remains an issue of considerable debate. At the centre of the controversy is the addition of a resting ECG to the standard preparticipation evaluation using history and physical examination. The American Medical Society for Sports Medicine (AMSSM) formed a task force to address the current evidence and knowledge gaps regarding preparticipation cardiovascular screening in athletes from the perspective of a primary care sports medicine physician. The absence of definitive outcome-based evidence at this time precludes AMSSM from endorsing any single or universal cardiovascular screening strategy for all athletes, including legislative mandates. This statement presents a new paradigm to assist the individual physician in assessing the most appropriate cardiovascular screening strategy unique to their athlete population, community needs and resources. The decision to implement a cardiovascular screening programme, with or without the addition of ECG, necessitates careful consideration of the risk of SCA/D in the targeted population and the availability of cardiology resources and infrastructure. Importantly, it is the individual physicians assessment in the context of an emerging evidence base that the chosen model for early detection of cardiac disorders in the specific population provides greater benefit than harm. AMSSM is committed to advancing evidenced-based research and educational initiatives that will validate and promote the most efficacious strategies to foster safe sport participation and reduce SCA/D in athletes.

Selected Issues for the Master Athlete and the Team Physician: A Consensus Statement

SUMMARY This document provides an overview of selected medical issues that are important to team physicians who are responsible for the care and treatment of athletes. It is not intended as a standard of care and should not be interpreted as such. This document is only a guide and, as such, is of a general nature, consistent with the reasonable, objective practice of the health care profession. Adequate insurance should be in place to help protect the physician, the athlete, and the sponsoring organization. This statement was developed by a collaboration of six major professional associations concerned about clinical sports medicine issues; they have committed to forming an ongoing project-based alliance to bring together sports medicine organizations to best serve active people and athletes. The organizations are the American Academy of Family Physicians, American Academy of Orthopaedic Surgeons, American College of Sports Medicine, American Medical Society for Sports Medicine, American Orthopaedic Society for Sports Medicine, and American Osteopathic Academy of Sports Medicine.

Syncope in athletes.

SummarySyncope is a brief sudden loss of consciousness and muscle tone secondary to cerebral ischaemia, inadequate oxygen or glucose delivery to the brain. The causes of syncope may be benign and require very little in the way of evaluation or treatment. However, syncope may be the harbinger of sudden death, and extensive evaluation, monitoring and detailed recommendations regarding advisability of participating in sports should be reviewed with the patient.The history is the most important clue when attempting to identify which patient with syncope is at risk for sudden death. A careful cardiac and neurological examination should be performed in any patient presenting with syncope. Selective use of laboratory testing and cardiac monitoring may assist the practitioner in making the diagnosis.Most often patients with syncope will have a benign cause such as vaso-vagal events, hyperventilation or orthostatic hypotension. Patients with a cardiac condition causing their syncope are at increased risk for sudden death. The ominous, cardiac-related causes of syncope in the younger population include hypertrophic cardiomyopathy, aberrant coronary arteries and aortic dissection secondary to Marfan’s syndrome. In the older athletic population, coronary atherosclerosis may present with syncope. Dysrhythmias may be the cause of syncope in both populations.

AMSSM Position Statement on Cardiovascular Preparticipation Screening in Athletes: Current Evidence, Knowledge Gaps, Recommendations, and Future Directions.

ABSTRACTCardiovascular (CV) screening in young athletes is widely recommended and routinely performed before participation in competitive sports. While there is general agreement that early detection of cardiac conditions at risk for sudden cardiac arrest and death (SCA/D) is an important objective, the optimal strategy for CV screening in athletes remains an issue of considerable debate. At the center of the controversy is the addition of a resting electrocardiogram (ECG) to the standard preparticipation evaluation using history and physical examination. The American Medical Society for Sports Medicine (AMSSM) formed a task force to address the current evidence and knowledge gaps regarding preparticipation CV screening in athletes from the perspective of a primary care sports medicine physician. The absence of definitive outcomes-based evidence at this time precludes AMSSM from endorsing any single or universal CV screening strategy for all athletes including legislative mandates. This statement presents a new paradigm to assist the individual physician in assessing the most appropriate CV screening strategy unique to their athlete population, community needs, and resources. The decision to implement a CV screening program, with or without the addition of ECG, necessitates careful consideration of the risk of SCA/D in the targeted population and the availability of cardiology resources and infrastructure. Importantly, it is the individual physicians assessment in the context of an emerging evidence base that the chosen model for early detection of cardiac disorders in the specific population provides greater benefit than harm. American Medical Society for Sports Medicine is committed to advancing evidenced-based research and educational initiatives that will validate and promote the most efficacious strategies to foster safe sport participation and reduce SCA/D in athletes.

Is There an Association Between Superolateral Hoffa Fat Pad Edema on MRI and Clinical Evidence of Fat Pad Impingement

OBJECTIVE Patients with symptomatic Hoffa fat pad impingement often exhibit fat pad edema on MRI. We studied two patient groups to determine the association between MRI fat pad edema and clinical symptoms of Hoffa fat pad impingement. MATERIALS AND METHODS We studied 34 consecutive patients with an MRI diagnosis of fat pad edema and no injury in the prior year (group 1) and 47 consecutive patients with a knee MRI examination and no injury in the prior year (group 2). Two sports medicine physicians reviewed the clinical records to confirm or exclude symptomatic fat pad impingement. Two musculoskeletal radiologists independently scored 12 Hoffa fat pad locations for the presence of edema, noting the epicenter. RESULTS Seventeen of the 34 patients in group 1 had clinical symptoms of fat pad impingement, with all 34 having fat pad edema. There was no association between clinical fat pad impingement and fat pad edema in any specific location (p > 0.183), but patients with fat pad impingement had a greater number of regions of edema (p = 0.005, 0.026 for two observers). In group 2, all four patients with clinical fat pad impingement had MRI fat pad edema, but 38 of the 43 patients without clinical impingement had MRI fat edema; 11 of the 38 had edema centered in the superolateral fat pad. CONCLUSION Edema is present on MRI in the superolateral region of Hoffa fat pad in patients with clinical fat pad impingement. However, such edema can also be present in patients without symptoms of fat pad impingement.

Screening for insulin resistance and cardiovascular risk in collegiate football linemen.

Objective:To investigate the relationship between fitness, obesity, and the risk factors of type 2 diabetes and cardiovascular disease in obese-classified [by body mass index (BMI) > 30 kg/m2] collegiate football linemen and male students of similar age and BMI. Design:Cross-sectional observational study. Setting:Institutional university based. Participants:Two groups of volunteer students. Thirty collegiate football linemen and 10 sedentary age-matched and size-matched peers. Independent Variable:Status as lineman or sedentary student. Main Outcome Measures:Height, weight, blood pressure, and body fat percent (BF%) were measured for each subject. Fasting blood draw was used to determine glucose, insulin, cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), and triglycerides. Results:The athlete group had lower mean (SD) BF% [21.8 (3.89) vs control 27.1 (7.07); P = 0.01], despite no significant difference in age, weight, height, or BMI. The athlete group had lower systolic blood pressure [135.6 (13.29) mm Hg vs 148.1 (13.77); P = 0.015] and at-risk LDL (10% vs 40%; P = 0.05). The groups did not differ significantly in other measures. Body fat percent (before and after adjusting for BMI) was significantly correlated with every risk factor except glucose, whereas BMI was only significantly correlated with blood pressure and insulin. Conclusions:Collegiate football linemen with elevated BMI have select risk factors, particularly blood pressure and LDL cholesterol that improved over sedentary peers. However, concerning risk factor profiles of linemen warrant standard age-appropriate and size-appropriate screening for cardiovascular and metabolic disease. Body fat percent more strongly correlated with risk factors than with BMI and may be the stronger tool for estimating risk in this population.

Hip injuries in young athletes.

The hip is an area of the body commonly injured in athletes and one that requires special consideration in the pediatric and adolescent athlete. This article reviews diagnoses specific to the young athlete and discusses more recent advances in imaging of the hip and arthroscopic treatment of the hip in the young athlete.