Gregory L. Landry

Overuse injuries and burnout in youth sports: a position statement from the American Medical Society for Sports Medicine.

• Youth sport participation offers many benefits including the development of self-esteem, peer socialization, and general fitness. • However, an emphasis on competitive success, often driven by goals of elite-level travel team selection, collegiate scholarships, Olympic and National team membership, and even professional contracts, has seemingly become widespread. • This has resulted in increased pressure to begin highintensity training at young ages. • Such an excessive focus on early intensive training and competition at young ages rather than skill development can lead to overuse injury and burnout.

Substance use and other health risk behaviors in collegiate athletes.

OBJECTIVESnTo (a) determine the prevalence of alcohol and other drug use, and health risk behaviors among a general university population; and (b) compare health risk-taking behaviors between genders, and varsity athletes and their non-athlete peers.nnnDESIGNnDescriptive survey of multiple health risk behaviors, including physical, mental health, alcohol and other drug, and sexual risk taking.nnnSETTINGnTwo large midwestern universities.nnnPARTICIPANTSnA convenience sample of 86% of 1,210 eligible students (271 athletes and 775 nonathlete peers) completed a self-administered, anonymous questionnaire during team meetings or class sessions.nnnINTERVENTIONnNone.nnnMAIN OUTCOME MEASURESnDifferences between gender and athlete status were assessed using Cochran-Mantel-Haenszel statistics for the following variables, determined by questionnaire responses: physical risk, mental health, alcohol and other drug use, and sexual behaviors.nnnRESULTSnCommon risk behaviors in the entire collegiate sample included riding in a car with a driver who was under the influence of alcohol, driving and swimming under the influence of alcohol, binge drinking, and low rate of condom use for all types of sexual intercourse. Risk-taking behaviors varied by gender, with men showing more risk behaviors than women, except for suicide and sexual behaviors. Male athletes had a higher prevalence of risk behaviors than their male nonathlete counterparts, in contrast to female athletes, who had fewer risk behaviors than their female nonathlete counterparts.nnnCONCLUSIONnIn contrast to previous studies, results of the present study show, when results are stratified by gender, that not all athletes engage more frequently than nonathletes in high risk behaviors. Results suggest that educational and early intervention strategies to decrease risk may need to be tailored according to gender and athletic status.

Mononucleosis and athletic participation: an evidence-based subject review.

Infectious mononucleosis (IM) is a common medical condition that afflicts thousands of young athletes each year. Despite the self-limited nature of this disorder, the variability of the clinical presentation and the rare risk of splenic rupture routinely present sports medicine clinicians with difficult return-to-play decisions. Currently there are no evidence-based guidelines regarding the management of the athlete with IM. This review discusses the available research data pertaining to the management of IM in young athletes and develops questions for future clinical research.

Wisconsin minimum weight program reduces weight-cutting practices of high school wrestlers.

OBJECTIVEnWinconsin high school wrestlers were surveyed 1 year before (90W) and 2 years after (93W) a new program was implemented to restrict weight loss for competition. The Wisconsin wrestling minimal weight program (WMWP) included a minimal weight limit determined from percent body fat and a nutrition education program.nnnDESIGNnA retrospective survey of wrestlers was conducted, with schools stratified to reflect school size and quality of the wrestling program.nnnPARTICIPANTSnRespondents surveyed in 1990 included 713 wrestlers from 45 schools; 368 wrestlers from 29 of the same schools responded to an identical survey in 1993.nnnMAIN OUTCOME MEASURESnMeasures of weight-cutting practices, weight-loss methods, bulimic behaviors, and nutritional knowledge.nnnRESULTSnThe most weight lost (MWL), the weight lost to certify (WLC), the weekly weight cycled (WWC), the longest fast (LF), and the frequency of cutting weight (FCW) all decreased significantly (chi 2, p < 0.05) among 93W wrestlers compared with 90W wrestlers. The results for the 90W group are as follows: MWL, 3.2 kg +/- 2.6; WLC, 2.8 kg +/- 2.8; WWC, 1.9 kg +/- 1.5; LF, 20.5 hours +/- 17.2; FCW, 6.2 +/- 6.4. The results for the 93W group are as follows: MWL, 2.6 kg +/- 2.6; WLC, 2.4 kg +/- 2.9; WWC, 1.6 kg +/- 1.4; LF, 16.5 hours +/- 15.6; FCW, 4.7 +/- 6.7. Weight-loss methods, including restricting food or fluids and use of rubber suits, declined significantly (chi 2, p < 0.05). Wrestlers exhibiting more than one of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R)-related bulimic behaviors decreased by 11% (chi 2, p < 0.05), but those exhibiting all five (1.6%) remained the same.nnnCONCLUSIONSnThe results suggest that the WMWP appeared to reduce unhealthy weight-loss behaviors among high school wrestlers. Other states should be encouraged to institute similar programs as recommended by the American Medical Association and the American College of Sports Medicine.

Central nervous system trauma management of concussions in athletes.

The care of athletes with concussions is challenging because each patient has different symptoms. An athlete should never be returned to play until completely asymptomatic. Classification systems for concussions are not based on scientific evidence and represent some practitioners best guess at what is safe for young athletes. Many experienced team physicians believe they can allow an athlete to play safely if there are no symptoms at rest and no symptoms with increasing intensity of exercise. Abbreviated neuropsychological testing and balance tests show promise for use in the field to increase the sensitivity of our neurological evaluation on injured athletes. Any neuropsychological or balance evaluation is more helpful if baseline data is collected on athletes before they are injured.

Health Risk Taking and Human Immunodeficiency Virus Risk in Collegiate Female Athletes.

Risky health behaviors of female intercollegiate varsity athletes and their nonathlete peers were compared. Five hundred seventy-one female university students (109 athletes and 462 nonathlete peers) at two midwestern universities completed a self-administered, anonymous questionnaire during team meetings or class sessions. Each athlete was matched with two nonathlete controls of similar age, ethnicity, and class year to test for dichotomous outcome variables. A human immunodeficiency virus (HIV) risk scale was developed to identify factors associated with increased HIV risk for all of the female participants. Measures of alcohol and other drug use were associated with HIV risk. The athletes were found to engage in significantly fewer risk-taking behaviors than the nonathletes and to be at less risk for HIV. High levels of risk behaviors generally indicated the need for increased efforts to change risky behaviors in all college women.

Herpes and tinea in wrestling: managing outbreaks, knowing when to disqualify.

The two most troublesome skin infections in wrestlers are herpes gladiatorum and tinea gladiatorum. Determining whether athletes should or should not be disqualified from practice or competition because of these infections requires some expertise. Recommendations are presented to assist the practitioner in the care of these conditions in wrestlers and other athletes who have frequent skin-to-skin contact.

Chest pain in active Young People. Is it cardiac

In brief Chest pain in children and adolescents is usually benign and noncardiac, unlike that in adults. Some of the more common causes are activity related, such as chest wall trauma and exercise-induced asthma. A careful history and physical examination will often provide a diagnosis, though about one third of causes are idiopathic. Most patients will not require extensive testing or referral. Education and reassurance are essential for relieving patient and parent anxiety.

Drug screening in the athletic setting

Considerable energy and money are being spent on drug screening nationally, both in the workplace and the athletic arena. Many legal questions remain unanswered because there are so many different kinds of drug screening programs, and many of the issues have not been tested in court. Unfortunately, there is not a gold standard for screening for AOD in student-athletes or in any other setting. The efficacy and detrimental effects of drug screening on student athletes has not been examined in any scientific fashion, and further longitudinal studies are needed to determine efficacy.

Athletes Test Positive for Morphine.

Three collegiate athletes tested positive for morphine after a championship competition; however, all three denied narcotic use. The medical team was stumped until the coach suggested a food source. Reviewing the literature and recreating the scenario helped identify the cause.