Thursday, December 29, 2011

Field Hockey Injuries: Care, Prevention, Training

Seminar: Saturday, January 7, 2012 at Champions Field House in Rockville from 5pm to 6pm.

For the past month we have had a wonderful intern from Syracuse University, Shannon Connolly. She played field hockey at Springbrook High School and went on to play three years at the Division 1 level. She is now looking at sports medicine as a profession and is compiling sports injury data on the sport of field hockey.

Shannon and I are going to make a presentation on Saturday which will review all the current research on field hockey injury care, prevention, and training. The seminar is FREE so please join us! 
Check out Shannon's new blog: Live, Learn, and Play Hockey!

Sunday, December 4, 2011

Lightning Safety

Great article in Emergency Medicine, Vol. 43, No. 10 October 2011.

Emergency care:
1. CPR - Compression, Airway, Breathing - if victim unresponsive
2. As long as victim is breathing a care survey of the entire body must be done and a history from any witnesses must be taken.
3. Exam must include eyes, ears (ear drum rupture is common, bleeding in the ear), extremities (pulses, sensation, cold/clammy), abdomen, neurologic exam, look for burns.

"Lightning causes an estimated 50 to 300 deaths per year and approximately five times as many nonlethal injuries1,2; however, injuries and deaths due to lightning are believed to be underreported."

"Lightning generates intense heat around it, rapidly heating the air to 20,000°C, which is three times the  temperature of the surface of the sun. This rapid heating generates a supersonic shock wave that decays to an acoustic wave heard as thunder."

"Lightning produces injury and death by multiple mechanisms.6"
Electrical effect, direct strike, splash mechanism, contact injury, concussive force

"the victim of a lightning strike is unlikely to die since cardiac activity will resume spontaneously. Furthermore, when first examined, the patient may be in cardiac arrest with ventricular fibrillation."

"Telltale signs of lightning injury include an arborealtype burn (ie, Lichtenberg figures), tympanic membrane
rupture, and disheveled appearance of the patient (including clothing that is blasted apart). The patient is
also likely to be confused or amnestic to prior events."

"Recommended laboratory tests include electrolyte measurement, assessment of renal function, complete
blood count, and cardiac enzyme studies, including creatine kinase and troponin assays. ECG is mandatory,
as is cardiac monitoring. The decision to order radiologic evaluation depends on the patient’s presentation and the physician’s assessment. CT of the head may be warranted in patients with altered mental status. Further CT scans may be indicated."


I have been asked about Crossfit quite frequently, so here is my take: NO!

As with any trainer or training method, the problem is usually the trainer, not necessarily the method. In the Crossfit case it is both the method and the trainers with which I have a problem.

On the Crossfit website it states, 
"The CrossFit program is designed for universal scalability making it the perfect application for any committed individual regardless of experience. We’ve used our same routines for elderly individuals with heart disease and cage fighters one month out from televised bouts. We scale load and intensity; we don’t change programs."

Problem #1: Use of the same program regardless of experience. Since Crossfit uses not only standard lifts, but Olympic lifts, kettlebells and other training that is highly technique intensive, the same program CANNOT be used regardless of experience. This just sets the trainee up for injury.

Problem #2: Intensity. Every Crossfit workout I have ever seen in person has been high intensity for all comers and has not been scaled. The posted WOD (workout of the day) is not scaled for load and intensity either.

Problem #3: Injury rate. I have seen many injuries due to the lack of technique focus and high intensity of the workouts. When I have asked my patients to demonstrate the lifts they perform, I have NEVER seen a patient do a movement correctly. This is a BIG problem. Watch the video below...OUCH!

Problem #4: Cultish. Read this article in Men's Health magazine: Inside the Cult of Crossfit. The fact that a workout that caused rhabdomyolysis in a trainee was named for that trainee is beyond disgusting.

There you have it. Be careful. Learn technique. I have no problem with training hard and still train hard at 51 years old, but you must train in a thoughtful manner with regard to your goals. Even for professional and Olympic athletes, overtraining is a common problem.

Saturday, December 3, 2011

AHA Recommendations for Preparticipation Cardiovascular Screening of Competitive Athletes

*Parental verification is recommended for high school and middle school athletes.
†Judged not to be neurocardiogenic (vasovagal); of particular concern when related to exertion.
‡Auscultation should be performed in both supine and standing positions (or with Valsalva maneuver), specifically to identify murmurs of dynamic left ventricular outflow tract obstruction.
§Preferably taken in both arms.37
Medical history*
Personal history
1. Exertional chest pain/discomfort
2. Unexplained syncope/near-syncope
3. Excessive exertional and unexplained dyspnea/fatigue, associated with exercise
4. Prior recognition of a heart murmur
5. Elevated systemic blood pressure
Family history
6. Premature death (sudden and unexpected, or otherwise) before age 50 years due to heart disease, in ≥1 relative
7. Disability from heart disease in a close relative <50 years of age
8. Specific knowledge of certain cardiac conditions in family members: hypertrophic or dilated cardiomyopathy, long-QT syndrome or other ion channelopathies, Marfan syndrome, or clinically important arrhythmias
Physical examination
9. Heart murmur
10. Femoral pulses to exclude aortic coarctation
11. Physical stigmata of Marfan syndrome
12. Brachial artery blood pressure (sitting position)§