Jan 29, 2015
Bulletin Board

NCAA Antiestrogen Ban Begins

Following the advice of its Committee on Competitive Safeguards and Medical Aspects of Sports, the NCAA has added the class of drugs known as antiestrogens to its list of banned substances. The ban took effect starting Aug. 1.

Antiestrogen is a general name for two different types of drugs–aromatase inhibitors (AIs) and selective estrogen receptor modulators (SERMs)–that regulate the production and absorption of estrogen in the body. Under brand names such as Arimidex, Femara, Aromasin, and Nolvadex, these drugs are usually prescribed to middle-aged and older women with breast cancer and those with an increased risk for the disease due to family history. By depriving the cancer cells of estrogen, these drugs can halt or slow the disease’s spread.

In the athletic community, some less-than-scrupulous pharmaceutical Web sites have touted antiestrogens for their performance-enhancing benefits, claiming (among other things) that they can speed up recovery after workouts. Some sites have also claimed that antiestrogens can reduce the “estrogenic” effects for men taking anabolic steroids, such as breast enlargement and female fat distribution.

Those claims are not backed up by research, and there are definite health risks associated with using these drugs. “AIs, by reducing estrogen levels in basically healthy men, may have a deleterious impact on bone turnover as well as potential impact on the central nervous system, lipid metabolism, vascular physiology, and cardiovascular risk, dangers that are not counterbalanced in any way by disease treatment or prevention of disease,” wrote D. Lawrence Wickerham, MD, Associate Chair of the National Surgical Adjuvant Breast and Bowel Project, in The NCAA News. “SERMs are known to increase the risk of major blood clots, which obviously can be life-threatening.”

High Schools Adjust Sports-Medicine Rules

A new school year usually brings with it some high school rules changes on player safety, and this year is no exception. For 2007-08, the NFHS and state associations addressed issues involving mouthguards and softball pitcher safety.

In Massachusetts, a mandatory mouthguard rule in basketball had been a magnet for criticism ever since the Massachusetts Interscholastic Athletic Association (MIAA) voted it in four years ago. Coaches complained that the mouthguards inhibited communication on the court and said they were unsanitary, since players would frequently drop them on the floor and have to put them back in their mouths. The MIAA’s Sports Medicine Committee, meanwhile, argued they were essential to preventing orofacial injuries and concussions.

By a 10-6 vote this spring, the MIAA decided to eliminate the mouthguard requirement, despite objections from the Sports Medicine Committee. “Definitely, we still have to have a sensitivity about the safety of our athletes,” one coach told the Massachusetts Sun Chronicle. “[But the rule] was very difficult to enforce… it’s really a sanitary issue.”

At the national level, the NFHS Ice Hockey Rules Committee voted to eliminate a requirement for both boys and girls that mouthguards be attached to a player’s facemask. The committee noted that attached mouthguards make it easier for players to let the guards dangle, and believe this rule change will encourage more players to wear them properly.

In another safety-related change, back in Massachusetts, the MIAA decided to move its softball pitching rubber back three feet, to 43 feet away from home plate. Association officials said that in addition to boosting offense, the change will give pitchers more time to react to line-drive hits. It also brings the state in line with college softball’s dimensions.

This past year, Florida was the only state in which high school softball pitches traveled 43 feet. The Florida High School Athletic Association made the change for 2006-07 on an experimental basis, and association officials are gauging the reactions of players, coaches, and umpires before deciding whether to continue it.

New Study Analyzes Tommy John Surgery

In the 33 years since the first Tommy John surgery was performed, countless pitchers from high school to the Major Leagues have sworn by its ability to resurrect careers. Now, for the first time, there is peer-reviewed research to support the notion that pitchers who undergo the elbow surgery come back as good as new.

In a study published in the April 2007 issue of the American Journal of Sports Medicine, researchers from the Penn Sports Medicine Center looked at 68 Major League pitchers who had ulnar collateral ligament surgery (the procedure named after Tommy John) between 1998 and 2003. Of the 82 percent who returned to pro baseball, there was no statistically significant change in their performance as measured by ERA, walks, or average number of hits allowed per inning pitched.

Some pitchers have even credited the surgery with improving their performance, but Glenn Fleisig, PhD, Research Director at the American Sports Medicine Institute and a colleague of world-famous orthopedic surgeon Dr. James Andrews, says that’s a false conclusion. “When performance improves after Tommy John surgery, it’s usually due to a combination of three things,” Fleisig explains. “First, the rehab exercises don’t just strengthen the elbow ligament, they strengthen all the muscles of the pitching arm–in many cases making them stronger than they had ever been before. Second, if a pitcher was overusing his arm before the injury, taking time off after surgery gives his body the rest it badly needed. Third, a lot of pitchers re-assess their mechanics when they come back from surgery, and they may end up adjusting their pitching motion and improving performance that way.”

All those factors have one important thing in common: A pitcher doesn’t have to undergo surgery to take advantage of them. “If a healthy pitcher wants to get the benefits they see rehabbed pitchers getting, they can do the same things and just skip the injury,” Fleisig says. “Any good strength and conditioning program for baseball pitchers will incorporate the same basic exercises as a post-Tommy John surgery rehab, and a stronger arm can often lead to improved performance.”

The study, “Ulnar Collateral Ligament Reconstruction in Major League Baseball Pitchers,” can be found in the April 2007 issue (Vol. 35, Issue 4) of the American Journal of Sports Medicine. To view the abstract for free, and for paid access to the full text, go to: ajs.sagepub.com/cgi/content/abstract/35/4/575.

Bad Combination: Overtrained and Underfed

Overtraining Syndrome (OTS) can occur when athletes combine excessive physical and psychological stress with inadequate recovery periods–it’s characterized by persistent fatigue, muscle soreness, depression-like symptoms, and decreased athletic performance. And according to new research, OTS sufferers are likely to compound their problems by being undernourished.

In a study presented at the annual meeting of the American College of Sports Medicine in May, researchers from the University of Pretoria in South Africa evaluated 33 athletes from ages 12 to 48. The subjects filled out detailed questionnaires about their nutritional intake each training day, time spent training per week, and emotional state. In addition, clinical examinations were performed on each athlete.

Based on this data, the subjects were divided into two groups: OTS athletes and non-OTS athletes. Researchers found that on average, the OTS athletes had significantly lower energy intake per hour of training (adjusting for differences in body weight). Specifically, the OTS athletes came up short in two important macronutrient categories: protein and carbohydrates.

Lead author Dina Christina Janse van Rensburg, MD, noted that OTS athletes were more likely than non-OTS athletes to skip a recovery meal after physical activity. “Overtrained athletes… don’t take in enough calories, but they don’t lose weight,” she told Medscape Medical News. “Their bodies go into a sort of starvation mode.

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