In many manufacturing industries, there are problems that arise between the interaction of the product being made and the machinery being used. Bakeries needed to find a solution that would keep their dough from sticking to the cutters.
Before most of the more than 12 million student athletes in the United States are allowed to kick, throw or hit a ball, they must fill out several pages of health forms, often called pre-participation evaluations. This is typically done by hand, as are injury updates, making it difficult for doctors or researchers to draw conclusions about the scale and impact of student athlete injuries.
Now, Stanford physicians have produced a three-year medical report of the university's nearly 1,700 student athletes during that period, providing insight into the lasting impact of injuries in greater detail than ever. The findings also support the value of electronic pre-participation evaluations (ePPE), which were used to track the students' medical records.
Led by Gordon Matheson, a professor of orthopaedic surgery (sports medicine) at Stanford Health Care, researchers collaborated with the athletic department to enroll the school's athletes into an ePPE program.
Students and physicians filled out the cloud-based program with multiple layers of branch-chain questions, which allowed for more thorough recordkeeping than standard handwritten forms.
Injuries that caused student athletes to miss time were recorded. These were mostly musculoskeletal injuries, but also included concussions, eating disorders and illnesses such as infectious mononucleosis. In total, students reported 3,126 injuries – 1,473 for women and 1,653 for men – causing each athlete to miss an average of 31.4 days of competition.
Among the findings, 11 percent of the students still suffered symptoms from a previous injury at the time of their next ePPE. Head injuries accounted for 9 percent of all injuries. Although only 3 percent of women reported a diagnosed eating disorder, 15 percent of all women reported a history of stress fractures, which can be associated with low body fat, from either disordered eating or overtraining.
Matheson said that although the data are eye-opening, interpreting the material and deciding what is particularly meaningful may be an even bigger effort.
"We know that student athletes have a lot of injuries from sport participation. But unless we have pooled, aggregate data like this, it's difficult to measure trends and spot areas of concern applied to prevention," Matheson said.
Going forward, Matheson said that he'd like to drill down on specific types of injuries, such as concussions, or investigate why so many students are still symptomatic at the time of follow-up ePPEs. These types of insights, however, will require a significantly larger and more diverse data set.
"I'd love to collaborate with other schools. Several thousand groups of data would really help us see what the trends are in sport injury and what's going on in this population," Matheson said. "For example, lingering symptoms might mean the offseason isn't long enough for full recovery. Or, what are the criteria to use when determining participation status for a student athlete with characteristics of disordered eating? I think there are findings that could make sports safer."
The study was published in the July issue of The American Journal of Sports Medicine and was co-authored by Scott Anderson and Kevin Robell, also of Stanford.
The regular physical trauma that appears to put professional football players at risk for degenerative brain disease may also increase their risk for hypertension and cardiovascular disease, researchers say.
The frequent hits football players experience, particularly frontline defenders such as linemen, likely continually activate the body’s natural defense system, producing chronic inflammation that is known to drive blood pressure up, according to a study in The FASEB Journal, published by the Federation of American Societies for Experimental Biology.
While strenuous physical activity clearly has its benefits, it also produces skeletal muscle damage, which literally tears some cells apart, said Dr. R. Clinton Webb, cardiovascular researcher who chairs the Department of Physiology at the Medical College of Georgia at Georgia Regents University.
As an example, long-term, muscle cell tears actually help build muscle, but short term they spill cell contents, including damage-associated molecular patterns (DAMPs), which capture the attention of the immune system, said Cam McCarthy, a fifth-year graduate student working in Webb’s lab and the study’s corresponding author.
DAMPs activate what should be a short bout of inflammation to deal with the danger, but in football players, this likely happens over and over again in just a single game. “We think that this increase in blood pressure we see in football players is due to the repeated trauma and immune system activation,” McCarthy said.
The trauma can be significant. The sheer size and strength of linemen today mean that those on the offensive and defensive line repeatedly smash into each other at a force equivalent to about a 30-mph car crash, the researchers write. Resistance training done off the field to improve lean muscle mass, likely results in more torn cells and additional activation of the immune response.
Higher blood pressure has been associated with professional and even college football, but exactly why remains unclear, Webb said. He noted that the cause is likely multifactorial and not simply the obesity found in the preponderance of players. While players’ blood pressure tends to drop toward normal after each season, a long-term impact is likely, the researchers said. Professional football players, for example, have a higher incidence of cardiovascular disease than the general population and live, on average, 10 years less.
The researchers hope that by fully understanding the cause, preventive strategies, maybe even something as simple as taking a daily baby aspirin to reduce inflammation, can reduce the short- and long-term impact of higher blood pressure.
Webb and his team have evidence that – at least in rats – circulating levels of DAMPs are increased in hypertension and increasing evidence of their direct role in hypertension. DAMPs appear to raise blood pressure by activating toll-like receptors on endothelial cells, which comprise the single-cell-thick lining of blood vessels. Toll-like receptors are located in all tissue and cell types and these pattern-recognition receptors are always on the lookout for danger and invaders, such as bacteria, McCarthy said.
The researchers theorize that toll-like receptors are activated a lot in football players, particularly linemen, who may be involved in 100 hits per game. Results include arteries that are stiffer and less able to dilate, and higher blood pressure.
The researchers suspect that release and downstream effects of DAMPs likely play a role as well in the damage to the brain, called chronic traumatic encephalopathy, which can occur in these athletes from years of blows to the head.
While increased hypertension in professional athletes may seem like a paradox, the researchers note that hypertension is the most common cardiovascular complication seen in competitive athletes, even ultramarathon runners.
In fact, reports in the lay literature of elevated blood pressure in football players prompted McCarthy and Webb to do a scientific literature search where they found more evidence of the problem, but not the complete cause behind it. That led to their published hypothesis and to their current pursuit of funding to measure DAMPs levels before, during and after season in college football players.
Webb and McCarthy’s FASEB study was supported by the American Heart Association and the National Institutes of Health.
The athletic training community lost a dear friend on Sept. 4 with the passing of Paul DeMartinis, director of sales and marketing for Medco Sports Medicine. “Pauly D” was a huge proponent of athletic training and many in the field have lost a best friend. He would have turned 60 on Sept. 16.
Paul died in his town of Tonawando, N.Y., located just north of his birthplace of Buffalo. He graduated from Bishop Fallon High School in 1973, and from Canisius College with a degree in business management in 1977. Paul loved sports, and athletics was always a huge part of his life. He played Buffalo MUNY baseball for the North Side Giants in the 1970s, and coached his sons in Little League and hockey. He was a Buffalo Bisons season ticket holder since 1988, and in 2006 was named the team’s Fan of the Year. He also was a Buffalo Bills season ticket holder for all but one year since 1973.
Paul served two terms on the Board of Certification Board of Directors, and in 2012 received the Dan Libera Service Award for outstanding service to that organization. The Professional Baseball Athletic Trainers Society recently announced the Paul DeMartinis Scholarship Fund to benefit minor league athletic trainers and PBATS internship candidates.
Paul leaves behind his beloved wife of 36 years, Peggy; his children Maria, Brian and Mark; and a brother, William.
Brian Ross deeply misses his co-worker. “I worked with Pauly for 25 years at MedCo,” says Brian. “He was my boss, mentor, and friend, and I always knew he was special. He was always laughing, singing, and joking. He loved music and had a huge record collection. He may have single-handedly brought vinyl back, because his basement is filled with hundreds of records--oldies, current, everything.
“We threw a benefit for Pauly in July, and more than 800 people showed up. Prizes, giveaways, and all the other things needed for the benefit were donated by people from across the country. Everyone wanted to help because it was for Pauly D—no other reason. Everyone who knew him loved him. On July 29, I got an email from his wife saying they were stopping Paul’s treatments because it wasn’t going to work. Everyone was upset. Then she sent me a text: Paul wants to know how you’re doing. That’s the kind of man Paul was—always thinking of everyone else. It’s hard to accept that he’s gone. It’s going to take time, and I’m trying to focus on all the fun times I had with him.”
“Pauly D was a special man,” says Denise Fandel, executive director of the BOC. “We came to know Paul when Medco became an approved provider with the BOC, offering CEUs at no cost to athletic trainers. He was highly recommended to fill a position on our board, and was appointed to one of the three non-credentialed spots on the board in 2006.”
One of the BOC’s responsibilities is to ensure that the exams and standards produce competent ATs, Denise explains. “Pauly’s focus was always on what the BOC was doing to protect the public, and he always reminded us that we’re here to make sure that patients receive the best possible care. If anything came up about that, we knew Paul would be the one to ask the question. He was well respected by the board, and was elected treasurer in 2009 and held that position until he went off the board in 2012. Paul did a lot to help us move to our downtown offices, and helped put the BOC on firm financial footing. Most importantly, he was a great role model--a highly ethical man of remarkable character, integrity and honesty. The BOC is naming a conference room after Paul, and we’ll be talking with his family about how to most appropriately recognize Paul in the area of public advocacy in the athletic training community.”
Dave Groeschner, head athletic trainer for the San Francisco Giants, first met Paul in 2000. “He was a super friendly person, and not a pushy salesman at all. He was just really fun to talk to—he even made it fun to order supplies because he was such a fun -loving guy. Even though he was from Buffalo, he was a Giants fan going back to when the team was in New York. He would send a text when we were in the playoffs, and he shared his excitement when we won the World Series. Our relationship started out as professional, but it also became personal because he enjoyed our team so much.
“Pauly was there every year at the baseball winter meetings. He showed us the new stuff he had for the year, but we talked more about the team. He had a vested interest in our guys and what we were doing, but he was also doing his job and helping us out. He and his guys at Medco were always there to help us out when we needed something. Such good people. They cared about our athletic trainers and our team. My staff and I will miss Pauly so much.”
The industry has lost a true treasure. Paul D made an invaluable
impact on the profession of athletic training and the field of sports
medicine that cannot be calculated or put into words. We extend our
deepest condolences to his family, friends and loved ones.
Keeping the Squad in Condition to Play (excerpts)
By Jack Hulme, Athletic Trainer, Pennsylvania State College
Jack Hulme is one of the most alert trainers in the country. He is thorough and deep-thinking and proves the value a trainer can be to his coach. His ideas will be helpful to the coach who, of necessity, must be his own trainer.
There are few set rules for keeping a squad in condition to play because boys come from widely different backgrounds and each presents a separate problem for a coach or trainer. For this reason, the coach should make it his business to acquaint himself with the home life of the boy, he should know whether his player comes from a farm, a town, or a big city and govern his training regulations accordingly.
SPECIAL TRAINING HINTS
· Stay out of crowds; a boy in training should stay out of crowds because the ventilation is usually poor and germs of many diseases are present.
· Keep the feet dry.
· Make a habit of having rest periods during the day.
Home games are often difficult to win because the visitors are more determined. Therefore, the coach should see that his squad takes full advantage of home facilities by getting additional rest, etc.
A trip should have only one meaning to a squad. It should not be a social trip. If the journey is made on a bus, particular care should be taken to protect the players from cold, draft, and gasoline fumes. The best seats should be reserved for the best players and they should be kept away from the rear of the bus where the fumes are most evident.
Private cars for trips are not desirable. When the team breaks up, the boys lose contact with one another. When the stay together, they are more apt to keep their minds on the game where it should be.
COMMON INJURIES WHICH RETARD TRAINING ACTIVITIES
Trouble with the feet: The care of the feet is extremely important. The coach should take particular care to check the shoes of his squad before the season starts. Blisters should be treated immediately. The first one should be treated to avoid the second one.
A few hints to avoid trouble with the feet:
· Pull socks tight
· Be sure shoes fit
· Paint feet with Benzoin
· Guard against infection: REMEMBER GERMS WORK ON SUNDAY
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