James L. Glazer

Attention deficit hyperactivity disorder and the athlete: an American Medical Society for Sports Medicine position statement.

Attention deficit hyperactivity disorder (ADHD) is an important issue for the physician taking care of athletes since ADHD is common in the athletic population, and comorbid issues affect athletes of all ages. The health care provider taking care of athletes should be familiar with making the diagnosis of ADHD, the management of ADHD, and how treatment medications impact exercise and performance. In this statement, the term “Team Physician” is used in reference to all healthcare providers that take care of athletes. These providers should understand the side effects of medications, regulatory issues regarding stimulant medications, and indications for additional testing. This position statement is not intended to be a comprehensive review of ADHD, but rather a directed review of the core issues related to the athlete with ADHD.

Eating disorders among male athletes.

Eating disorders may affect some athletes at rates much greater than the general population. Among male athletes, eating disorders are on the rise. Studies show that males participating in sports in which leanness confers a competitive advantage may be at greater risk of eating disorders. No studies have shown that it is possible to prevent eating disorders in at-risk populations. Once present, eating disorders can be challenging to treat. Psychotherapy and medications have been shown to be helpful. A team approach to the treatment of eating disorders should be used, including regular interaction with a dietician, a mental health professional, a team physician, and other professionals as needed. To maintain participation, athletes must partner with the health care team in their treatment, maintain a healthy weight, and be clear in the understanding that their health is a greater priority than their sport.

An Approach to the Diagnosis and Treatment of Plantar Fasciitis

Abstract Plantar fasciitis is a painful condition affecting many athletes. Anatomic and biomechanical factors combined with overuse can contribute to its genesis. Correction of gait disturbances, changes in footwear, use of tension night splints, and stretching of tight calf and plantar tissues have all be proven to relieve symptoms. Anti-inflammatory modalities, including medications, iontophoresis, and corticosteroid injection generally provide temporary improvement. Recent studies on the efficacy of extracorporeal shock wave therapy are conflicting. Injections with platelet-rich plasma or sclerotic agents are currently under investigation for use in this and other similar conditions. A small percentage of patients with refractory symptoms may benefit from surgical release of the plantar fascia. Diagnosis and correction of biomechanical factors leading to this condition should be a mainstay of treatment and may prevent recurrences.

Awareness of Altitude Sickness Among a Sample of Trekkers in Nepal

Abstract Objective.—To quantify awareness of altitude sickness in a sample of trekkers in Nepal and identify strategies for increasing knowledge in that population. Methods.—Sixty-five high-altitude trekkers were surveyed. Demographic data were gathered. Respondents were asked about their experience in high-altitude environments, and they answered clinical-vignette questions designed to test their abilities to recognize and identify treatments for common symptoms of altitude sickness. An altitude-awareness score was generated by tabulating correct answers to questions. Scores were correlated with demographic data. Results.—Respondents who scored highest (n = 8) had significantly more experience in high-altitude environments, averaging 5 to 10 years (P < .05), and achieved higher average altitudes on their treks of 5171 m (P < .05) than did low scorers. Respondents with low scores (n = 17) trekked to an average altitude of 4138 m. Seventy-three percent wanted to learn more about altitude sickness, 30% said they would prefer to learn from the Internet, and 27% said they would ask a doctor. Conclusion.—This study suggests that a large population of at-risk high-altitude travelers may be relatively naïve to the dangers of altitude sickness. Overall, respondents were interested in learning more about altitude sickness. Physicians and the Internet are the most attractive sources of information for this population.

Misrepresentation of Research Citations by Applicants to a Primary Care Sports Medicine Fellowship Program in the United States

Objective:To determine the prevalence of misrepresentation of publications and national presentations claimed in applications to the Maine Medical Center (MMC) Primary Care Sports Medicine Fellowship Program from 2001 through 2004. Design:A retrospective chart review study. Setting:The Maine Medical Center Primary Care Sports Medicine Fellowship Program. Methods:Presentations were confirmed in the program of the cited meeting or by contacting the sponsoring organization. Publications were verified by performing a MEDLINE search or by cross-referencing in Ulrichs International Periodicals Directory. If the title was listed, the citation was verified by contacting the publisher. Results:Fifty applicants reported research publications. Of those, 14 applications had publications that could not be verified. The overall misrepresentation rate was 11.3%; among applicants claiming publications it was 28%. There was no difference in misrepresentation rate between specialties. Eighteen applicants reported giving national presentations, and nine presentations could not be verified, corresponding to an overall misrepresentation rate of 5.6%. Of applicants claiming presentations, 38.9% had at least one misrepresentation. Conclusion:Applicants to the Maine Medical Center Sports Medicine Fellowship Program were found to have high rates of misrepresentation in their citations of both publications and presentations.

The ergogenics of fluid and electrolyte balance

Fluid and electrolyte balance within a fairly narrow range is a requirement for human life. Athletes, particularly endurance athletes, routinely stress their bodies to the point of altering fluid and electrolyte levels. In some cases, significant fluctuations can lead to deterioration in performance and even the athlete’s health. The body’s physiologic response to such fluctuations of fluid and electrolyte levels is complex and not completely understood. This article examines how the body copes with changes in fluid and electrolyte balance and how these changes may be minimized via replacement to sustain athletic performance.

Awareness of Altitude Sickness Among Visitors to a North American Ski Resort

Abstract Objective.—To quantify awareness of acute mountain sickness (AMS) in a sample of visitors to a North American ski resort and to identify strategies and interest for increasing knowledge of AMS in that population. Methods.—One hundred and thirty visitors to Big Sky Ski Resort, Montana, were surveyed. Demographic data were obtained. Respondents were asked about their current knowledge of AMS and then answered questions designed to quantify their depth of knowledge of the subject. Correct answers were correlated with demographic data. Respondents also answered questions indicating their interest in further education about altitude illness and their preferred modality for obtaining this information. Results.—In general, most respondents were young, 18 to 30 years (62.3%), and male (62.5%). Seventy-six percent had at least some college education and more than 5 years of skiing/snowboarding experience. Only 55% of respondents had some knowledge of AMS, but only 30% had knowledge of AMS symptoms using the Lake Louise Scoring System. About 30% knew the lowest altitude this illness can occur. There was a correlation between educational background and improved knowledge of altitude illness. Half of the respondents desired further information about AMS, and the Internet was the preferred source of information. Conclusions.—This study suggests that a large population of skiers in North America may be relatively naive to the dangers of AMS. The majority of the respondents were interested in learning more about altitude illness, and the Internet was the most attractive source of information.

The Ergogenics of Hypoxia Training in Athletes

Hypoxia elicits hematopoiesis, which ultimately improves oxygen transport to peripheral tissues. In part because of this, altitude training has been used in the conditioning of elite endurance athletes for decades, despite equivocal evidence that such training benefits subsequent sea level performance. Recently, traditional live high-train high athletic conditioning has been implicated in a number of deleterious effects on training intensity, cardiac output, muscle composition, and fluid and metabolite balance —effects that largely offset hematopoietic benefits during sea level performance. Modifled live high-train low conditioning regimens appear to capture the beneficial hematopoietic effects of hypoxic training while avoiding many of the deleterious effects of training at altitude. Because of the logistical and financial barriers to living high and training low, various methods to simulate hypoxia have been developed and studied. The data from these studies suggest a threshold requirement for hypoxic exposure to meaningfully augment hematopoiesis, and presumably improve athletic performance.

Lower extremity soft tissue conditions

Lower extremity soft tissue injuries and overuse conditions are frequently encountered among athletes. Muscles are frequently strained or contused, arteries and nerves can become entrapped, and tendons and bursae can become inflamed. Familiarity with the anatomy of the involved area is essential for making the correct diagnosis. The majority of these conditions can be accurately diagnosed based on a thorough history and physical examination alone, without the need for expensive imaging or invasive tests. Most of these conditions can be successfully managed conservatively, avoiding surgical intervention.

Plantar Fasciitis: Current Concepts to Expedite Healing

Plantar fasciitis is a degenerative condition affecting many active people. Anatomic and biomechanical factors can contribute to its genesis, as can overuse. Clinicians can recommend correcting gait disorders, modifying footwear, using tension night splints, and stretching tight calf and plantar tissues to bring about lasting relief. Anti-inflammatory modalities, such as medications, iontophoresis, and corticosteroid injection generally provide temporary improvement. Recent studies on the efficacy of extracorporeal shock wave therapy are conflicting. A small percentage of patients who have refractory symptoms may benefit from surgical division of the plantar fascia.