Preventing catastrophic injury and death in collegiate athletes: interassociation recommendations endorsed by 13 medical and sports medicine organisations.

The following organisations endorsed this document: American Association of Neurological Surgeons, American Medical Society for Sports Medicine, American Orthopaedic Society for Sports Medicine, American Osteopathic Academy of Sports Medicine, College Athletic Trainers' Society, Collegiate Strength and Conditioning Coaches Association, Congress of Neurological Surgeons, Korey Stringer Institute, National Athletic Trainers' Association, National Strength and Conditioning Association, National Operating Committee for Standards on Athletic Equipment, Sports Neuropsychology Society. The following organisation has affirmed the value of this document: American Academy of Neurology. The Second Safety in College Football Summit resulted in interassociation consensus recommendations for three paramount safety issues in collegiate athletics: (1) independent medical care for collegiate athletes; (2) diagnosis and management of sport-related concussion; and (3) year-round football practice contact for collegiate athletes. This document, the fourth arising from the 2016 event, addresses the prevention of catastrophic injury, including traumatic and non-traumatic death, in collegiate athletes. The final recommendations in this document are the result of presentations and discussions on key items that occurred at the summit. After those presentations and discussions, endorsing organisation representatives agreed on 18 foundational statements that became the basis for this consensus paper that has been subsequently reviewed by relevant stakeholders and endorsing organisations. This is the final endorsed document for preventing catastrophic injury and death in collegiate athletes. This document is divided into the following components. (1) Background-this section provides an overview of catastrophic injury and death in collegiate athletes. (2) Interassociation recommendations: preventing catastrophic injury and death in collegiate athletes-this section provides the final recommendations of the medical organisations for preventing catastrophic injuries in collegiate athletes. (3) Interassociation recommendations: checklist-this section provides a checklist for each member school. The checklist statements stem from foundational statements voted on by representatives of medical organisations during the summit, and they serve as the primary vehicle for each member school to implement the prevention recommendations. (4) References-this section provides the relevant references for this document. (5) Appendices-this section lists the foundational statements, agenda, summit attendees and medical organisations that endorsed this document.

Vitamin D Practice Patterns in National Collegiate Athletic Association Division I Collegiate Athletics Programs.

CONTEXT: Vitamin D status has been associated with performance, health, and well-being in athletic populations. The measurement of vitamin D status via 25-hydroxyvitamin D [25(OH)D] testing has increased in the general population, as has vitamin D supplement use. It is unclear if similar patterns exist in collegiate athletics programs. OBJECTIVE: To describe the clinical care related to the prevention, evaluation, and treatment of vitamin D deficiency and insufficiency used by sports medicine providers with National Collegiate Athletic Association (NCAA) Division I programs. DESIGN: Cross-sectional study. SETTING: Population-based online survey. PATIENTS OR OTHER PARTICIPANTS: All NCAA Division I head athletic trainers. MAIN OUTCOME MEASURE(S): Information related to 25(OH)D testing, vitamin D supplementation, vitamin D-related protocols and procedures, and characteristics of athletic programs and participants. RESULTS: We received 249 responses (72% response rate). Use of 25(OH)D testing was described by 68% of participants, with the most common indicators being health status/history (78%) and injury status/history (74%). One-fifth of participants stated that vitamin D testing was conducted as screening (without a specific cause or indication). Target blood vitamin D concentrations were highly variable. A range of 8 to 1660 annual vitamin D blood tests was reported at a cost of <$50 (8%), $51 to $100 (51%), $101 to $150 (20%), and >$150 (10%). Forty-two percent of programs covered the cost of vitamin D supplements. More than half of the participants indicated that vitamin D blood testing and supplements were not a good use of program funds. In comparison with Football Championship Subdivision programs, Football Bowl Subdivision programs were more likely to conduct vitamin D testing and pay for vitamin D supplements, and their providers were more likely to believe that testing and supplements were a good use of program funds. CONCLUSIONS: A great deal of variability was present in vitamin D-related clinical practices among NCAA Division I athletics programs, which reflects existing contradictions and uncertainty in research, recommendations, and guidelines. Knowledge of current practice patterns is important in evaluating and establishing best practices, policies, and procedures for sports medicine and sports nutrition professionals in the collegiate setting.

Medical care in unlicensed combat sports: A need for standardised regulatory frameworks.

OBJECTIVES: To explore the provision of medical care at 'unlicensed', full-contact amateur and lower-level professional combat sports competitions in England. DESIGN: Qualitative, mixed methods. METHODS: Observations totalling 200h of fieldwork shadowing medical professionals at 27 individual combat sports events, alongside formal, semi-structured interviews with 25 medical professionals, 7 referees and 9 promoters/event staff. RESULTS: Practices and standards vary widely. Event organisers and promoters often have very little understanding of how different types of medical practitioners operate. They rarely, if ever, check that the staff they are hiring are qualified, sometimes resulting in unqualified staff being used to provide medical cover at events. Venues are often poorly equipped to accommodate basic medical procedures. Patient confidentiality is very often compromised. Medical professionals often have limited autonomy within the combat sports milieu and may find themselves marginalised, with their judgements overruled by non-medical staff during competitive events. Some practitioners are cognisant of the dangers such working environments pose to their professional reputations and livelihoods, but remain working within combat sports regardless. CONCLUSIONS: Despite pockets of good practice, the lack of standardised rules for medical care provision creates substantial risks to athletes, to practitioners and the standing of the profession. The development and implementation of standardised, enforceable regulatory frameworks for full-contact combat sports in England is urgently needed.

Regenerative Sports Medicine: Past, Present, and Future (Adapted From the PASSOR Legacy Award Presentation; AAPMR; October 2016).

Regenerative medicine has shown dramatic expanse and evolution in the past decade. Within that milieu, physiatrists are taking an active role in research, clinical care delivery, and education. The purpose of this review is to provide a balance among evidence, theory, experience, clinical trends, and the foreseeable future. We focus on the literature that reports the research with the best methodology in each practice area, recognizing that the level of evidence varies substantially among different treatment modalities and conditions. The following elements are included: an overview of the evolution of currently available regenerative techniques, evidence base for each available modality (prolotherapy, platelet rich plasma, bone marrow aspirate concentrate and stem cells, adipose-derived stem cells, and amniotic tissue products), general principles in the application of these treatments, and discussion and a vision of what lies ahead. We expect that practitioners will use this review to facilitate clinical decision making and to provide a core knowledge base to assist when counseling patients. LEVEL OF EVIDENCE: IV.

Selected Issues in Injury and Illness Prevention and the Team Physician: A Consensus Statement.

This document provides an overview of selected medical issues that are important to team physicians who are responsible for the care and treatment of athletes. It is not intended as a standard of care, and should not be interpreted as such. This document is only a guide, and as such, is of a general nature, consistent with the reasonable, objective practice of the health care profession. Adequate insurance should be in place to help protect the physician, the athlete, and the sponsoring organization. This statement was developed by a collaboration of six major professional associations concerned about clinical sports medicine issues. They have committed to forming an ongoing project-based alliance to bring together sports medicine organizations to best serve active people and athletes. The organizations are the American Academy of Family Physicians, American Academy of Orthopaedic Surgeons, American College of Sports Medicine, American Medical Society for Sports Medicine, American Orthopaedic Society for Sports Medicine, and the American Osteopathic Academy of Sports Medicine.

Internal social processes of discipline formation: the case of kinanthropometry.

In 1972, the term 'kinanthropometry', derived from the Greek words 'kinein' (to move), 'anthropos' (human) and 'metrein' (to measure), was launched in the international, Francophone journal Kinanthropologie by the Canadian William Ross and the Belgians, Marcel Hebbelinck, Bart Van Gheluwe and Marie-Louise Lemmens. The authors defined this neologism as 'the scientific discipline for the study of the size, shape, proportion, scope and composition of the human being and its gross motor functions'. Presenting a theoretical framework for the analysis of the internal social processes of discipline formation - derived from the social history-of-science tradition - this article critically examines whether kinanthropometry was indeed promoted and developed by its community members as a scientific discipline. Therefore, the focus will be on its conceptualisation and positioning within the field of kinanthropology/kinesiology and on its development by a scholarly association, i.e. the International Working Group on Kinanthropometry (IWGK). The strong emphasis of the kinanthropometry community on the standardisation of measurement techniques and its practical and professional application hampered its disciplinary development. Findings of this study could serve as a basis for future 'fundamental' investigations addressing questions of disciplinary development within the field(s) of physical education, kinesiology and sport science(s).

Emergency preparedness in high school-based athletics: a review of the literature and recommendations for sport health professionals.

Approximately 7.6 million high school students in the United States participate in sports. Although most sport-related injuries in adolescents are considered minor emergencies, life-threatening illnesses or injuries may occur, such as sudden cardiac arrest, heat stroke, status asthmaticus and exercise-induced asthma, catastrophic brain injuries, cervical spine injuries, heat- and cold-related illness, blunt chest/abdominal injuries, and extremity fractures resulting in compartment syndrome. Emergency preparedness in athletics involves the identification of and planning for medical services to promote the safety of the athlete, to limit injury, and to provide medical care at the site of practice or competition. Several national organizations have published guidelines for emergency preparedness in school-based athletics. Our article reviews guidelines for emergency preparedness put forth by the Sideline Preparedness collaboration (comprised of 6 major professional associations, including the American Academy of Family Physicians, American Academy of Orthopedic Surgeons, American College of Sports Medicine, American Medical Society for Sports Medicine, American Orthopaedic Society for Sports Medicine, and American Osteopathic Academy of Sports Medicine), the National Athletic Trainers' Association, the American Academy of Pediatrics' Committee on School Health, and the American Heart Association. Additionally, we review published data examining compliance of US high schools with these recommendations for emergency preparedness in school-based athletics, determine deficiencies, and provide recommendations for improvement based on these deficiencies.

Evaluación de la adaptación a un entrenamiento de alta intensidad con diferentes estrategias de intervención en ciclistas / Assessment of adapting to high intensity training by cyclists using different strategies

El entrenamiento regenerativo está siendo de gran interés tanto para entrenadores como para atletas, ya que puede evitar situaciones de sobrecarga o sobreentrenamiento y mejorar el rendimiento. Así, el objetivo de este estudio preliminar fue evaluar la adaptación de un mismo protocolo de entrenamiento de alta intensidad unido a diferentes estrategias de recuperación sobre variables bioquímicas y de rendimiento en ciclistas amateurs. Quince ciclistas hombres con una edad media de 36,18±5,30 años fueron asignados de forma dirigida a tres diferentes grupos: regenerativo-plus (RP, n=6): entrenamiento interválico intensivo (EII) combinado con sesiones de baja intensidad (50% VO2max) más la suplementación de antioxidantes; regenerativo (R, n=5): EII combinado con sesiones de baja intensidad al 50% VO2max; control (C, n=4): descanso. Realizaron un EII combinado con sesiones de baja intensidad durante 20 días. Antes y después de la aplicación del protocolo se midieron parámetros bioquímicos (bicarbonato [HCO3], lactato [La], pH y presión parcial del dióxido de carbono [PCO2]) y parámetros de rendimiento (potencia máxima [Pmax], resistencia aeróbica [RA] y consumo máximo de oxígeno [VO2max]). Se observó un aumento significativo en la potencia máxima aplicada, sin diferencias en las diversas situaciones estudiadas. En cuanto a la resistencia aeróbica y VO2max, no se observaron mejoras significativas en ninguno de los grupos. Respecto al estado metabólico, solo se observó una menor concentración de lactato (no significativa) tras la aplicación del protocolo en el grupo RP. Los resultados sugieren que este protocolo unido o no a la suplementación de antioxidantes podría ser una estrategia adecuada para asimilar determinadas cargas de entrenamiento(AU)

Regenerative training is very important for trainers and athletes as it could avoid problems of overreaching or overtraining, as well as improve performance. Thus, the aim of this study was to evaluate the effect of a high intensity training protocol combined with recovery sessions on biochemical and performance parameters in amateur cyclists. A total of 15 male cyclists with a mean age of 36.18±5.30 years were assigned to one of three groups: regenerative-plus (RP): high intensity training (EII) with low intensity training (50% VO2max) and antioxidant supplements; regenerative (R): EII with low intensity training to 50% VO2max; control (C): rest. They performed an EII combined with low intensity recovery sessions for 20 days. Several biochemical parameters (bicarbonate [HCO3], lactate [La], pH and partial pressure of carbon dioxide [PCO2]) and performance parameters (maximum power [Pmax], aerobic capacity [RA] and maximum uptake oxygen [VO2max]) were measured before and after applying the protocol. Significant increases were observed in the maximum power with no differences between the different situations. No significant changes were seen in the endurance or VO2max in either group. As regards metabolic state, a lower lactate concentration (not significant) was observed after application of protocol in group RP. It may be concluded that this protocol with or without antioxidant supplements could be an option to assimilate particular training loads(AU)

Assessment of certified athletic trainers' levels of cultural competence in the delivery of health care.

CONTEXT: The concept of culture and its relationship to athletic training beliefs and practices is virtually unexplored. The changing demographics of the United States and the injuries and illnesses of people from diverse backgrounds have challenged health care professionals to provide culturally competent care. OBJECTIVE: To assess the cultural competence levels of certified athletic trainers (ATs) in their delivery of health care services and to examine the relationship between cultural competence and sex, race/ethnicity, years of athletic training experience, and National Athletic Trainers' Association (NATA) district. DESIGN: Cross-sectional survey. SETTING: Certified member database of the NATA. PATIENTS OR OTHER PARTICIPANTS: Of the 13 568 ATs contacted, 3102 (age = 35.3 +/- 9.41 years, experience = 11.2 +/- 9.87 years) responded. DATA COLLECTION AND ANALYSIS: Participants completed the Cultural Competence Assessment (CCA) and its 2 subscales, Cultural Awareness and Sensitivity (CAS) and Cultural Competence Behavior (CCB), which have Cronbach alphas ranging from 0.89 to 0.92. A separate univariate analysis of variance was conducted on each of the independent variables (sex, race/ethnicity, years of experience, district) to determine cultural competence. RESULTS: The ATs' self-reported scores were higher than their CCA scores. Results revealed that sex (F(1,2929) = 18.63, P = .001) and race/ethnicity (F(1,2925) = 6.76, P = .01) were indicators of cultural competence levels. However, we found no differences for years of experience (F(1,2932) = 2.34, P = .11) or NATA district (F(1,2895) = 1.09, P = .36) and cultural competence levels. CONCLUSIONS: Our findings provide a baseline for level of cultural competence among ATs. Educators and employers can use these results to help develop diversity training education for ATs and athletic training students. The ATs can use their knowledge to provide culturally competent care to athletes and patients and promote a more holistic approach to sports medicine.

A review of the effects of martial arts practice on health.

Martial arts are ancient forms of combat, modified for modern sport and exercise. Participation in the martial arts is increasing, particularly for youth. Martial arts provide health-promoting and meaningful exercise for millions of practitioners. Benefits from this practice include better overall health and balance, as well as an improved sense of psychological well being. They do not promote aggression and may be used as a treatment modality for youth who are at-risk for violence. This article provides an overview of martial arts for physicians who may evaluate such injuries in their practice. Physicians may wish to consider recommending martial arts to patients as a beneficial form of exercise. They are relatively safe compared to many other sports, and most martial arts injuries are comparatively minor. Risks can possibly be reduced by limiting exposure of inexperienced students, as well as using protective equipment, including mouthguards, eye/face protection, headgear, and padding.

Martial arts sports medicine: current issues and competition event coverage.

More sports medicine professionals are becoming actively involved in the care of the martial arts athlete. Although there are many different forms of martial arts practiced worldwide, certain styles have shown a potential for increased participation in competitive-type events. Further research is needed to better understand the prevalence and profiles of injuries sustained in martial arts full-contact competitive events. Breaking down the martial art techniques into basic concepts of striking, grappling, and submission maneuvers, including choking and joint locking, may facilitate better understanding and management of injuries. This article outlines this approach and reviews the commonly encountered injuries and problems during martial arts full-contact competitions.

Efectos de la suplementación con beta-hidroxi-beta-metilbutarato (HMB) sobre el daño muscular consecutivo a esfuerzo físico / Effects of HMB supplementation on muscle damage after exercise

Las exigencias físicas de ciertos tipos de deporte y pautas de entrenamiento plantean la necesidad de recurrir al uso de suplementos nutricionales que garanticen un adecuado recambio de aquellas sustancias sometidas a una alta tasa catabólica. El β-hidroxi -β-metilbutarato (HMB) ha demostrado poseer un efecto ergogénico sobre el rendimiento deportivo y prácticamente ningún efecto perjudicial sobre la salud del atleta. La suplementación con HMB pretende, en su aplicación más práctica y conociendo su poder anticatabólico, ayudar al deportista de alto nivel o al deportista poco entrenado a recuperar después de un ejercicio estresante obteniendo un grado de recuperación óptimo para emprender nuevas sesiones de actividad física y/o deportiva específica con el menor daño acumulado en su organismo (AU)

Most of the sport modalities and current training patterns demand high physiological, psycological, tecnical and tactical qualities from the athletes. There is a need for an optimal turnover of those substances with high catabolic rate. Several nutritional ergogenic aids can contribute to optimize these processes. In this sense, β-hydroxi- β-methylbutarate (HMB) has been proposed to have an ergogenic effect on athletic performance without having practically any adverse effect on the athlete’s health. This article reviews the literature about HMB in regard to mechanisms of action, effects on trained and non-trained subjects, optimal dose, and future research. In both highly-and low-trained subjects, HMB supplementation seems to contribute to a better recovery after hard training. This effect can contribute to decrease the accumulative effect on muscle damage caused by daily training sessions (AU)

[Herbal supplements in sports: use and abuse]. / Gli integratori fitoterapici nello sport: uso ed abuso.

The use of natural supplements, included herbal supplements, by athletes has become an habit which often lacks any valid scientific rationale. It appears evident that this habit may entail health risks (including more or less serious adverse effects), consequent either: 1) to the pharmacodynamic effects of the drugs at high doses; or 2) to the occurrence of accumulation especially when their administration is not justified by a reduced synthesis or an increased demand; or 3) to the occurrence of intolerance; or, finally, 4) to the presence of unlabelled ingredients. The abuse of this kind of products always entails risks to the consumer, not only to the elite athlete, that can incur an adverse analytical finding on the occasion of anti-doping tests, but also to the amateur sportsman, for the possible occurrence of adverse drug reactions (ADR).

Iron and the athlete.

Iron is an important mineral necessary for many biologic pathways. Different levels of deficiency can occur in the athlete, resulting in symptoms that range from none to severe fatigue. Iron deficiency without anemia may adversely affect athletic performance. Causes of iron deficiency include poor intake, menstrual losses, gastrointestinal and genitourinary losses due to exercise-induced ischemia or organ movement, foot strike hemolysis, thermohemolysis, and sweat losses. A higher incidence of deficiency occurs in female athletes compared with males.

Influencia del fútbol en la frecuentación de los servicios de urgencias traumatológicas / Influence of soccer on attendance to traumatological emergency services

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American College of Sports Medicine position stand. Exercise and hypertension.

Hypertension (HTN), one of the most common medical disorders, is associated with an increased incidence of all-cause and cardiovascular disease (CVD) mortality. Lifestyle modifications are advocated for the prevention, treatment, and control of HTN, with exercise being an integral component. Exercise programs that primarily involve endurance activities prevent the development of HTN and lower blood pressure (BP) in adults with normal BP and those with HTN. The BP lowering effects of exercise are most pronounced in people with HTN who engage in endurance exercise with BP decreasing approximately 5-7 mm HG after an isolated exercise session (acute) or following exercise training (chronic). Moreover, BP is reduced for up to 22 h after an endurance exercise bout (e.g.postexercise hypotension), with greatest decreases among those with highest baseline BP. The proposed mechanisms for the BP lowering effects of exercise include neurohumoral, vascular, and structural adaptations. Decreases in catecholamines and total peripheral resistance, improved insulin sensitivity, and alterations in vasodilators and vasoconstrictors are some of the postulated explanations for the antihypertensive effects of exercise. Emerging data suggest genetic links to the BP reductions associated with acute and chronic exercise. Nonetheless, definitive conclusions regarding the mechanisms for the BP reductions following endurance exercise cannot be made at this time. Individuals with controlled HTN and no CVD or renal complications may participated in an exercise program or competitive athletics, but should be evaluated, treated and monitored closely. Preliminary peak or symptom-limited exercise testing may be warranted, especially for men over 45 and women over 55 yr planning a vigorous exercise program (i.e. > or = 60% VO2R, oxygen uptake reserve). In the interim, while formal evaluation and management are taking place, it is reasonable for the majority of patients to begin moderate intensity exercise (40-<60% VO2R) such as walking. When pharmacological therapy is indicated in physically active people it should be, ideally: a) lower BP at rest and during exertion; b) decrease total peripheral resistance; and, c) not adversely affect exercise capacity. For these reasons, angiotensin converting enzyme (ACE) inhibitors (or angiotensin II receptor blockers in case of ACE inhibitor intolerance) and calcium channel blockers are currently the drugs of choice for recreational exercisers and athletes who have HTN. Exercise remains a cornerstone therapy for the primary prevention, treatment, and control of HTN. The optimal training frequency, intensity, time, and type (FITT) need to be better defined to optimize the BP lowering capacities of exercise, particularly in children, women, older adults, and certain ethnic groups. based upon the current evidence, the following exercise prescription is recommended for those with high BP: Frequency: on most, preferably all, days of the week. Intensity: moderate-intensity (40-<60% VO2R). Time: > or = 30 min of continuous or accumulated physical activity per day. Type: primarily endurance physical activity supplemented by resistance exercise.