Flat spin and negative Gz in high-altitude free fall: pathophysiology, prevention, and treatment.

INTRODUCTION: Red Bull Stratos was a commercial program that brought a test parachutist protected by a full pressure suit to 127,852 ft (38,964 m), via a stratospheric balloon with a pressurized capsule, from which he free fell and subsequently parachuted to the ground. In light of the uniqueness of the operation and the medical threats faced, medical protocols specific to distinctive injury patterns were developed. One unique threat was that of a flat spin during free fall with resultant exposure to -Gz (toe-to-head) acceleration. In preparation for stratospheric free fall, the medical team conducted a review of the literature on the spectrum of human and animal injury patterns attributable to -Gz exposures. Based on the findings, an emergency medical field response protocol was developed for the rapid assessment, diagnosis, and treatment of individuals suspected of -Gz injury. METHODS: A systematic review was conducted on available literature on human and animal studies involving significant -Gz exposure, with subsequent development of an applicable field treatment protocol. RESULTS: The literature review identified pathophysiologic processes and mitigation strategies that were used to develop a prevention and treatment protocol, outlining appropriate interventions using current best medical practices. A medical field treatment protocol was successfully established for the high-altitude balloon program. DISCUSSION: Available literature provided insight into best medical practices for the prevention and treatment of significant -Gz exposures during high-altitude parachute activity. Using the protocol developed for the field medical response, injuries from sustained -Gz exposure can be effectively managed in similar high-altitude and space operations.

Creatine supplementation and its effect on musculotendinous stiffness and performance.

Anecdotal reports suggesting that creatine (Cr) supplementation may cause side effects, such as an increased incidence of muscle strains or tears, require scientific examination. In this study, it was hypothesized that the rapid fluid retention and "dry matter growth" evident after Cr supplementation may cause an increase in musculotendinous stiffness. Intuitively, an increase in musculotendinous stiffness would increase the chance of injury during exercise. Twenty men were randomly allocated to a control or an experimental group and were examined for musculotendinous stiffness of the triceps surae and for numerous performance indices before and after Cr ingestion. The Cr group achieved a significant increase in body mass (79.7 +/- 10.8 kg vs. 80.9 +/- 10.7 kg), counter movement jump height (40.2 +/- 4.8 cm vs. 42.7 +/- 5.9 cm), and 20-cm drop jump height (32.3 +/- 3.3 cm vs. 35.1 +/- 4.8 cm) after supplementation. No increase was found for musculotendinous stiffness at any assessment load. There were no significant changes in any variables within the control group. These findings have both performance- and injury-related implications. Primarily, anecdotal evidence suggesting that Cr supplementation causes muscular strain injuries is not supported by this study. In addition, the increase in jump performance is indicative of performance enhancement in activities requiring maximal power output.