Jan 29, 2015
Bulletin Board

Calif. Addresses Sports Medicine Concerns

When it comes to protecting high school athletes, more and more Californians are noticing their state’s shortcomings. California is one of only three states still without ATC licensure, and its laws regarding return to play after concussions and mandatory education for coaches lag behind those of its more proactive neighbors. But with help from the state legislature, change may be on the horizon.

A bill currently under consideration in the state assembly would require that instruction on head injuries, heat stroke, asthma, and cardiac arrest be added to the required CPR and first-aid education programs public high school coaches and athletic trainers must complete. A companion bill asks for tougher return-to-play standards after an athlete suffers a concussion.

“We need to do more to protect our kids, and we can do that by training the adults closest to them at the time of injury,” Mary Hayashi, the assemblywoman sponsoring both bills, told Capitol Weekly. “We need to train coaches to be better able to recognize the symptoms of a concussion or serious injury. They can make all the difference in saving a student’s life.”

The two bills were introduced in January during the same week the California senate held a hearing on brain injuries. The California Brain Injury Association (CBIA), a non-profit organization established in 2005, had pushed for the hearing to take place.

“There needs to be more done,” Paula Daoutis, Administrative Director of the CBIA, told the San Jose Mercury News. “If you see a player take a hit on the head, you should take them off [the field] until they can be evaluated. When they get back in too soon and another concussion occurs, this is where more serious injuries are going to happen.”

Meanwhile, the California Athletic Trainers’ Association told the Sacramento Bee in January that it is working to reintroduce a bill to bring ATC licensure to the Golden State. The state legislature passed a similar measure in 2006, but it was vetoed by Governor Arnold Schwarzenegger.

The bills on educating coaches and return-to-play guidelines are expected to be heard by a California state assembly committee this spring. To check on their status, go to: www.leginfo.ca.gov/bilinfo.html and type “1646” and “1647” into the search window.

A Warning On NSAID Use

Non-steroidal anti-inflammatory drugs (NSAIDs) are often recommended to reduce swelling and pain after an injury. But surveys and other research have shown that many athletes ingest NSAIDs before workouts and competition, hoping to guard against inflammation and soreness. Medical experts have recently begun speaking out against this practice.

Their main concern is that NSAIDs could mask an injury sustained during athletic activity. If the athlete continues to play because he or she doesn’t feel pain, the injury could become more serious.

Stuart Warden, PhD, PT, FACSM, Assistant Professor and Director of Research at Indiana University, wrote an August 2009 editorial in the British Journal of Sports Medicine warning athletes against preventative NSAID use. “These agents are treatments for the symptoms of an injury, not the injury itself,” Warden told Medical News Today. “They may allow an athlete to exercise or train at a certain level, but pain occurs for a reason. It is basically the body’s mechanism of saying, ‘Hang on, you’ve got some sort of injury that should not be ignored.'”

Masking an injury isn’t the only reason to caution athletes against NSAID overuse. Warden also wrote in his editorial that those who regularly take NSAIDs before workouts may see reduced tissue adaptation to physical demands placed on the body, which could predispose them to future injury.

Various studies have shown that prolonged NSAID ingestion delays the healing of ligaments, muscles, and tendons. And overuse of NSAIDs may also be linked to increased risk for cardiovascular problems and stomach ulcers.

“I want people, including recreational athletes, to think about the perceived benefits versus potential risks of taking NSAIDs, and to ask themselves why they are taking these agents,” Warden told Medical News Today. “They need to ask, ‘Do the benefits outweigh the risks?'”

To read the full text of Warden’s editorial in the British Journal of Sports Medicine, go to: bjsm.bmj.com, click on “Archive,” then “2009,” then “August.”

What Builds Healthy Bones?

Weight-bearing activity has long been touted as a pathway to better bone health–conventional wisdom holds that bones respond to stress by adding new cells, which in turn strengthens them. But new research is challenging that assumption, finding other types of exercise may achieve the same effect.

Last fall, Medicine & Science in Sports & Exercise recapped an American College of Sports Medicine symposium titled “Muscle Forces or Gravity: What Predominates Mechanical Loading on Bone?” and published a series of papers on what other factors besides weight stress could lead to bone cell growth. The primary paper was written by a group of University of Colorado professors, who concluded that high-impact exercise was no better for bone health than low- or non-impact exercise.

“There is no conclusive evidence from clinical studies that either muscle forces or gravitational forces play a more prominent role in regulating bone metabolism,” they wrote in their conclusion. “When exercise training programs that included activities that generated ground-impact forces (e.g., walking, running, stairs) were compared with those that did not (e.g., weightlifting, rowing), both were found to have beneficial effects on bone mineral density.”

One reason weight-bearing exercise is thought to improve bone health better than non-weight bearing exercise is the prevalence of low bone mineral density in athletes who participate in low- to no-impact activities, like cycling and swimming. The paper’s authors say those low levels likely have other causes.

“It is important to acknowledge that the relatively low bone mineral density levels observed in some athletes, such as cyclists, swimmers, and even long-distance runners, may result from factors other than the loading characteristics of the activity,” they wrote. “It has been estimated that dermal calcium loss (i.e., sweating) during moderate to vigorous exercise is ~70 mg.h-1 [approximately 70 milligrams per hour]. Thus, competitive cyclists and swimmers, who typically train more hours per week than athletes in other sports, may have increased calcium requirements.”

Based on that theory, the authors hypothesize that too much exercise for too long could be detrimental to bone health due to calcium loss through sweat, though they were careful to point out there is currently no solid evidence to prove it. The take-home message is that exercise–of any type–is good for bone health in most circumstances, but more research is needed to determine what kinds of exercise regimens are best for bones.

“Anti-Gravity” Treadmill Simulates Moonwalking

It can be difficult for injured or rehabbing athletes to keep in shape when their workouts are limited to a bike or the pool. But what if athletes could continue running while rehabbing, without the downside of impact forces? Lost muscle mass and diminished aerobic capacity would be far less likely, and they could return to play more quickly if their training level never waned during the rehab process.

That’s exactly what the AlterG Anti-Gravity Treadmill aims to do. Based on a NASA prototype first developed more than a decade ago, it allows users to reduce the force of gravity on their legs by up to 80 percent, essentially simulating the effect of walking or running on the moon.

The user wears a pair of shorts that zip into a waist-high enclosure called the cockpit. Once sealed in, air pressure counteracts the force of gravity, allowing for a low-impact workout. The runner’s upper half remains outside the cockpit, and the enclosure has four clear plastic walls so a physical therapist or athletic trainer can see the athlete’s running form while they’re on the treadmill.

“You don’t feel as if somebody’s lifting you,” Charles Burgar, MD, Medical Director of the VA Palo Alto Health Care System and a professor at Stanford University, told the San Jose Mercury News. “You feel like you are in water that has no viscosity, like you’re floating, but when you move your legs there’s no resistance… You can teach a person to run very, very fast by off-loading their weight, and then building strength and endurance by increasing the weight.”

AlterG’s growing customer base–which already numbers in the hundreds–includes pro sports teams, college athletic departments, and physical therapy clinics. At $75,000 each, the Anti-Gravity Treadmill is a major investment, but a new model costing around $25,000 recently debuted, and AlterG expects sales to continue increasing as a result.

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