Suzanne Hecht

Bone Health in Endurance Athletes: Runners, Cyclists, and Swimmers

Weight-bearing exercise has been recognized widely to be beneficial for long-term bone health. However inherent differences in bone-loading characteristics and energy expenditure during participation in endurance sports place many endurance athletes at a relative disadvantage with regard to bone health compared with other athletes. Adolescents and adults who participate in endurance sports, such as running, and non-weight-bearing sports, such as biking and swimming, often have lower bone mineral density (BMD) than athletes participating in ball and power sports, and sometimes their BMD is lower than their inactive peers. Low BMD increases the risk of stress and fragility fractures, both while an athlete is actively competing and later in life. This article reviews the variable effects of distance running, cycling, swimming, and triathlons on bone health; the evaluation of stress and fragility fractures; and the diagnosis, management, and prevention of low BMD in endurance athletes.

Ultrasonographic Evaluation of Splenic Enlargement in Athletes with Acute Infectious Mononucleosis

Objective: To quantitatively assess the degree and rate of splenic enlargement and the time required for regression of splenic enlargement in collegiate athletes diagnosed with acute infectious mononucleosis (IM). Design: Prospective cohort study. Setting: Academic Medical Center(s) outpatient sports medicine clinic. Study participants: Volunteer Division I University athletes. Interventions: A limited abdominal ultrasound was performed on each participant by a licensed and experienced ultrasonographer. Splenic measurements were taken to assess maximum splenic length. Athletes who were subsequently diagnosed with infectious mononucleosis (clinical illness and a positive monospot) underwent serial splenic ultrasounds and physical exams (weekly) until resolution of clinical symptoms and splenic enlargement (as determined by ultrasound measurements). Main outcome measures: Per cent enlargement of spleen size (length) from baseline. Time (in days) from onset of clinical illness to maximum splenic length. Time (in days) required for resolution of splenic enlargement. Results: 20 subjects were diagnosed with acute IM during a 5 year time period. Maximum splenic length increased a mean of 33.6% (SD 19.9%) from baseline values. Peak splenic enlargement was reached a mean of 12.3 (SD 5.1) days from onset of clinical illness. A linear model demonstrated that spleen size decreases approximately 1% per day after reaching peak splenic enlargement. Conclusions: The majority of athletes with IM experience a moderate degree of splenomegaly. Peak splenic enlargement occurs within 2 weeks from the time of symptom onset in most cases, but may extend to 3.5 weeks. The rate of splenic enlargement appears to be predictable for an individual who develops IM. Ultrasonographic data further show that splenomegaly associated with acute IM infection resolves within 4–6 weeks of symptom onset in the majority of cases.

The Female Athlete Triad

The number of girls participating in sports has increased significantly since the introduction of Title XI in 1972. As a result, more girls have been able to experience the social, educational, and health-related benefits of sports participation. However, there are risks associated with sports participation, including the female athlete triad. The triad was originally recognized as the interrelationship of amenorrhea, osteoporosis, and disordered eating, but our understanding has evolved to recognize that each of the components of the triad exists on a spectrum from optimal health to disease. The triad occurs when energy intake does not adequately compensate for exercise-related energy expenditure, leading to adverse effects on reproductive, bone, and cardiovascular health. Athletes can present with a single component or any combination of the components. The triad can have a more significant effect on the health of adolescent athletes than on adults because adolescence is a critical time for bone mass accumulation. This report outlines the current state of knowledge on the epidemiology, diagnosis, and treatment of the triad conditions.

Concussion Assessment in Football and Soccer Players

AMSSM Research Abstracts (Clin J Sport Med 2004;14:310–311) Concussion Assessment in Football and Soccer Players Suzanne Hecht,* James C. Puffer,† Clifford Clinton,‡ Bassil Aish,§ Philip Cohen, Andrew Concoff,¶ Robert Hosey,# Alex Lai,* Joseph Luftman,** Henry Tsai* Daniel Vigil.** *UCLA Sports Medicine, Los Angeles, CA 90095, †American Board of Family Practice, Lexington, KY, ‡David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, §Huntington Beach, CA, Rutgers University Health Services, New Brunswick, NJ, ¶University of Texas—Houston, Houston, TX, #University of Kentucky, Lexington, KY, **Kaiser Permanente Sports Medicine, Los Angeles, CA. Purpose: This longitudinal study examined the reliability and clinical utility of the Standardized Assessment of Concussion (SAC) in football and soccer players over 4 years. Methods: The SAC is a brief sideline examination developed in accordance with the American Academy of Neurology and the Colorado Guidelines to evaluate neuropsychological changes following a concussion. Baseline SAC evaluations were administered to 691 athletes from 1997 to 2001 (198 NCAA Division 1 and 410 high school football players, and 83 NCAA Division 1 soccer players). The SAC was repeated on days 0, 1, 3, and 10 following concussion to the concussed player and a paired nonconcussed control player. Results: Reliability testing revealed intrarater and interrater reliability correlation coefficients equal to 0.74 and 0.60, respectively. Seventy-seven players suffered 87 concussions, with 99% of the concussions occurring in football players. The mean SAC score of concussed players was significantly decreased on day 0 compared to their mean baseline score (24.9 ± 3.9 vs. 27.0 ± 1.7; P < 0.0001) Nonconcussed control players’ mean SAC scores on day 0 significantly increased compared to their mean baseline SAC scores (26.9 ± 2.3 vs. 27.8 ± 1.8; P = 0.001). The mean difference of day 0 SAC scores in concussed players was significantly decreased as compared to their paired, nonconcussed controls. No significant difference was seen on day 1. On day 0, 29% of concussed players achieved a SAC score greater than their baseline score, and 100% of those players were symptomatic at the time of testing. Conclusions: The SAC is a reliable test. The clinical utility of the SAC is limited since 1/3 of players were able to improve their SAC score while still symptomatic from a concussion. Cumulative Effects of Concussion in High School and College Athletes Douglas B. McKeag,* Micky Collins,† Mark R. Lovell,† Corrine Ganglion.‡ *IU Sports Medicine, Indianapolis, IN, †UPMC Center for Sports Medicine, Pittsburgh, PA, ‡Sports Concussion Program, Pittsburgh, PA. Purpose: The potential cumulative effects of concussion are poorly understood. One prior study (Collins et al., JAMA. 1999;282:964–970) utilized traditional neuropsychological measures in college athletes and found deficits in speed of processing in those sustaining 2 or more prior concussions. With the recent advent of computerized neuropsychological testing, potential exists for large databases of pertinent information regarding concussion. Moreover, there is no current data examining the cumulative effects of concussion in high school athletes. The current study was designed to evaluate these issues in a very large sample of high school and college athletes. Methods: A total of 2553 high school and college athletes underwent preseason computerized neuropsychological testing utilizing ImPACT. Controlling for years of education, 3 groups were compared on their baseline ImPACT performance: those with no history of concussion (43%; n = 1098), those with 1 prior concussion (37%; n = 945), and those with 2 or more prior concussions (20%; n = 510). Results: Multivariate analysis of covariance revealed significant differences between the three groups across processing speed (PS) and reaction time (RT) composite scores (F = 4.18; P < 0.002). There was a significant decrease in processing speed and increase in reaction time (both worse performances) in the 1 (PS, mean = 35.8; RT, mean = .579) and 2 or more (PS, mean = 35.0; RT, mean = .587) concussion groups when compared to those sustaining no prior concussions (PS, mean = 36.1; RT, mean = .568). Conclusions: The cumulative effects of concussion appear to involve a decrease in mental processing speed and increase in reaction time. These data derived from ImPACT are consistent with previous data utilizing paper and pencil measures. The current analysis is the first to suggest cumulative effects of concussion in high school athletes. The Neuropsychological Consequences of Participation in an Amateur Boxing Tournament James Moriarity,* Alexander Collia,†‡ David Olson,§ John Buchanan, Patrick Leary,* Michael McStephen,† Paul McCrory.‡ *University of Notre Dame, Notre Dame, IN, †CogState Ltd., Melbourne, Victoria, Australia, ‡University of Melbourne, Parkville, Victoria, Australia, §Wauwatosa, WI, Mercy Walworth Medical Center, Lake Geneva, WI. Context: Participation in professional boxing has been demonstrated to cause chronic cognitive injury. Few studies have reported the acute cognitive function in amateur boxers postbout and none have documented the effects of repeated boxing bouts within a short time frame. Objective: To determine whether repeated concussive and subconcussive head trauma sustained by amateur boxers during a 7-day tournament causes an acute deterioration in cognitive performance. Study Design: Prospective study of 82 collegiate amateur boxers with no history of recent concussion or past history of brain injury who participated in a 7-day single-elimination boxing tournament. Neuropsychological assessment using the CogSport computerized test battery was performed at baseline and after each bout. Main Outcome Measure: Change in postbout neuropsychological performance when compared to the boxer’s own baseline performance. The cognitive tests administered in this study are simple reaction time, complex reaction time, 1-back, and continuous learning. These tasks measure psychomotor function/information processing, decision-making, working memory, and new learning, respectively. Results: The 82 study subjects fought a total of 159 times. CogSport testing was performed in 142 of the possible 159 postbout opportunities for testing. The postbout neuropsychological performance of boxers participating in 3 bouts was equivalent to that of boxers participating in 1 bout or 2 bouts. No significant changes from baseline performance were observed in any individual boxers, including those receiving standing 8 counts or for whom the referee stopped the contest. Conclusions: Amateur boxing conducted in a supervised competition does not result in acute cognitive impairment, even in boxers subjected to repeated bouts over a short time frame. CHAMPS: Characteristics of Athletic Medical Providers Study: A National Look at Sports Medicine Within Primary Care 2002 Christy Tharenos, Dan Vinson. University of Missouri–Columbia, Columbia,

Subacute subdural hematoma in a Karate instructor after noncontact head trauma.

Introduction Subdural hematomas (SDH) are caused most commonly by head trauma from motor vehicle accidents, assaults, and falls (1). SDH form between the dura and the arachnoid membranes. Direct head trauma is the most frequent cause of SDH in sports, although a few cases of subacute SDH and chronic SDH without known direct head trauma have been reported from roller coaster rides and capoeira (AfroBrazilian art form that combines elements of martial arts, music, and dance) (12,18,20). Karate is a sport where head trauma can occur, although a retrospective study of karate injuries found that reported head injuries were predominately facial hematomas, and no cases of SDH were noted (4). This study also found that 83% of the injuries sustained during training occurred with free-style sparring activities, and high-level karate athletes (brown and black belts) had more injuries than lower-level karate athletes. This case report describes the first reported case of a noncontact, subacute SDH in a high-level karate instructor.

SCAT3 assessment of non-head injured and head injured athletes competing in a large international youth soccer tournament

ABSTRACT To our knowledge, no study has evaluated Sideline Concussion Assessment Tool −3rd Edition (SCAT3) scores during competition in athletes who have not had a head injury. The purpose of our pilot study was to compare SCAT3 scores in non-injured (NI), injured (but not head injured) (I), and head injured (HI) youth soccer players during competition and to establish preliminary baseline data for non-head injured athletes in a competitive setting. The HI group demonstrated significantly more symptoms (M = 9.7, SE = 0.8) than the I and NI (3.3, SE = 1.2, and 3.2, SE = 0.7, respectively) groups. The HI group also demonstrated a significantly higher symptom severity score (25.3, SE = 2.8) than the I and NI groups (7.7, SE = 4.1, and 5.9, SE = 2.5, respectively). There were no statistically significant differences in mean total Standardized Assessment of Concussion (SAC) scores and mean subsection SAC scores between the groups. Clinicians should also be aware that non-injured in-competition athletes may report more symptoms on the SCAT3 than those evaluated in a non-competition setting.

Cardiovascular risk factors in football players

Cardiovascular disease is a leading cause of death in the United States. Football players represent a subpopulation that may have a unique risk profile pattern. Studies have suggested that football players may be at increased risk for cardiovascular disease. Paradoxically, there may be a cardioprotective effect associated with activity in general and, specifically, participation at higher levels of football. Our review will attempt to outline the pertinent evidence in regards to cardiovascular risk factors in football players. Specifically, hypertension, hypercholesterolemia, obesity, and sedentary lifestyle will be considered. In addition, we will discuss potential risk factors for investigation including C-reactive protein, homocysteine, insulin resistance, and sleep-disordered breathing. Studies at all levels of competition will be considered, including retired players whose findings may represent lifelong changes that occur as a result of participation in football. Further investigation will be needed to help clarify the relationship between football participation and cardiovascular risk.

Medical issues in synchronized skating

AbstractSynchronized skating is a unique sport of team skating and currently represents the largest competitive discipline in U.S. Figure Skating. Synchronized skating allows skaters to compete as part of a team with opportunities to represent their country in international competitions. As the popularity of the sport continues to grow, more of these athletes will present to sports medicine clinics with injuries and illnesses related to participation in synchronized skating. The purpose of this article is to review the common injuries and medical conditions affecting synchronized skaters.

Medical coverage of gymnastics competitions.

Medical coverage of gymnastics competitions can be a challenging task for the sports medicine physician and other medical personnel because of the complexity and aerial nature of the sport. A broad understanding of the six gymnastics disciplines, along with the type of competitions, injury epidemiology, and the common acute gymnastics injuries will help sports medicine professionals in planning and delivering optimal care to the injured or ill gymnast.