Rachel Buehler’s Advice on Injury Recovery

Posted on 02/26/2013 by Dev Mishra MD
by Mike Woitalla, February 21st, 2013note: this article appeared in Soccer America’s Youth Soccer Insider.  Here’s outstanding advice from a US Women’s National Team soccer veteran for young athletes recovering from injury.

 Interview by Mike Woitalla

Rachel Buehler suffered ACL injuries, in separate incidents, in both knees, as a teenager. Now 27, she has won two Olympic gold medals, a U-20 World Cup, a WPS title (Gold Pride), and has played 99 games for the USA, including five at the last World Cup. We asked Buehler, who starred at Stanford University and now plays for the NWSL’s Portland Thorn, to provide some advice for young players faced with the challenge of rehabilitating from injuries.

SOCCER AMERICA: What’s your advice for players who are injured and face a lengthy recovery?

RACHEL BUEHLER: When you’re a young kid, it’s really devastating at the time – because soccer’s your life, and you’re loving it, and there’s the unknown.
But they will come back just fine. The most important thing is keeping everything in perspective and taking one step at a time.

SA: What helped motivate you during recovery?

RACHEL BUEHLER: For me, physical therapy was great. Not just because it helped me get better and better and better, but it gave me something to focus on – each little step.
I focused on a goal for each week: This week I want to gain two more degrees of extension or inflection, or whatever it is. I thought in terms of small goals and then felt like I accomplished something and was making progress. When I reached that goal, I got excited about it. That was a positive way for me to work.

SA: How does one console players who fear their injury will affect their long-term success as a player?

RACHEL BUEHLER: Let them know that everyone at our level, at the national team level, has had a serious injury. There are very few players who haven’t had an injury that required a six-month recovery.
Do what you really need to do to come back, and if you’re committed to it, you’re going to be fine.

SA: Was there anything your coaches, parents and teammates did or said that helped you?

RACHEL BUEHLER: I got flowers and cards, things like that. And those things are good, because it makes you feel loved and supported. …

The things that my doctor told me, my physical therapist, and my parents were like — “This isn’t the end of the world. You’re young. Young people heal very well and very quickly. You have a lot of opportunities and career still ahead of you.”

Focus on the positive, because I think kids sometimes are so emotionally hyped up about the negative aspects. As long as they’re diligent in their recovery, they heal well from injury. …

I had an awesome physical therapist who explained everything that was going on with the process. Why you have to do this first, and then that, and then this … So I became so educated about my body. I learned so much about rehab, and I think understanding that each step leads to another, to more progress — that really helped me mentally and physically.

SA: Besides focusing on your physical therapy, how did you cope with the frustration of not being able to play?

RACHEL BUEHLER: I became even more focused on my academics. I put a lot of enery into it. I remember getting a 100 percent on my math final, because I just really put a lot of energy into studying. For me that was a good outlet.

And I really began appreciating my time with my family and my friends. Dealing with my injury gave me a lot of perspective. It made me remind myself, yes, I love soccer, and it’s a big part of my life, but there are so many other things in life that are important to me, like my family, my friends, my school.

I think even at that young age, being injured like that gives you perspective on what’s important in life.

I’m lucky that I’m a pretty positive person in general, so emotionally I bounced pretty quickly. I thought, “Well, this is bad, but what am I going to do about it?” I think I took a proactive approach and never questioned myself — why did this happen to me? …

And as long as you feel really comfortable with the pace you’re progressing at – and you’re not rushing it, you have someone to help monitor you, and you make sure you’re doing what your body and mind feel comfortable with, that leads to a better, more confident recovery.

You have a lot of soccer still ahead of you.

(Rachel Buehler will be playing for the Portland Thorns in the inaugural season of the NWSL.)

(Mike Woitalla, the executive editor of Soccer America, coaches youth soccer for East Bay United/Bay Oaks in Oakland, Calif. He is the co-author, with Tim Mulqueen, of The Complete Soccer Goalkeeper. Woitalla’s youth soccer articles are archived at YouthSoccerFun.com.)

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The “Coolness Under Pressure” Gene

Posted on 02/19/2013 by Dev Mishra MD

By Dev K. Mishra, M.D.

President, Sideline Sports Doc

The scientific quest to discover the genetic basis for behavior and performance is only in its infancy.  Recent evidence suggests that there is a gene that helps to control a person’s ability to handle pressure, at least academic pressure. A recent article titled “Why Can Some Kids Handle Pressure While Others Fall Apart?” provides a nice overview of what’s currently known.  It mainly deals with academic pressure but I suspect there will be some carryover of these principles to athletic performance as well.  basketball freethrow

“Warriors or Worriers”

Not all stress or pressure is bad, in fact we need some of both in our lives to help us perform at our best.  How each person handles that stress or pressure can determine whether it turns out to be a healthy growth experience or one with negative consequences.  Behavior is a very complex phenomenon affected by our upbringing, environment, hormonal influences, genetics, and other factors.  In very broad terms those who perform well under pressure are “warriors” and those who may not are “worriers”.

It turns out that stress is much more complicated than we assume but more under our control than we once thought.  Short term stress can help people perform to their best and if it’s viewed that way it can change the effect and minimize the consequences. Research is pointing towards the right kind of competition to improve our response to stress, not to completely removing stress from a young athlete’s life.

The COMT gene and dopamine

Without getting overly technical, the COMT gene appears to be particularly important in any individual’s ability to handle stressful situations.  This gene codes for an enzyme that in turn controls the removal of a substance called dopamine from the brain.  You need just the right amount of dopamine- not too much, not too little.  The enzyme helps to remove dopamine quickly for some people and slowly for others.  High stress increases the amount of dopamine in the brain and those people who are able to clear dopamine quickly are at an advantage in highly stressful situation.

Turing worriers into warriors

So what about the part of handling stressful behavior that’s under our control?  Many strategies have been suggested but one of the simplest is simply to repetitively practice the task likely to be encountered in a stressful situation.  Pilots with slow dopamine removal have been trained to handle highly stressful inflight problems through repetitive exposures in a flight simulator.  This doesn’t necessarily mean that someone can become a “warrior” in all parts of their lives but specific situations can be improved.

Successful repetition to improve specific sport performance

For athletes it would seem then that discrete controlled game situations would be most easily improved.  For soccer players: the penalty kick.  For basketball: free throws.  For golf:  putting.  I would think that it’s harder to coach calmness in frantic run of play situations but even that can probably be improved.  This is why young quarterbacks practice multiple third down scenarios, two-minute drill, etc.  Coaches have trained athletes this way for years but now we know there’s a genetic and biologic basis for success. The bottom line is that genetics can be an important factor but proper training can still make you better in the clutch situations.

 

 

 

 

 

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Creating the Best Youth Sports Culture For Professional Success- No Easy Way

Posted on 02/12/2013 by Dev Mishra MD

By Dev K. Mishra, M.D.

President, Sideline Sports Doc

Ed Reed and Jacoby Jones will soon be wearing their Super Bowl rings.  They’ll be able to show them off to their friends and relatives around New Orleans where both grew up.  And this marks the 16th consecutive Super Bowl involving players from New Orleans or the immediate vicinity.  What is it about southern Louisiana, south Florida, or Texas along I-20 that produces so many NFL players?  Why would a disproportionate number of Major League Baseball players come from the Dominican Republic?  Why are so many santo-domingo-dominican-republic-summer-sports-society-baseball-abroadworld-class soccer players born and raised in Brazil?  What happens to the 99+% of kids who don’t make it to the pros?

Intense cultural bond, play early pickup ball, highly driven

Many books and articles attempt to answer these questions. I am definitely not a sociologist, but from the standpoint of player development and its impact on the young athlete I find this a fascinating topic.  No one factor (or even ten factors) provides the perfect formula for success but each of the areas above geographies have some common characteristics: an intense cultural bond for sport that passes from the youngest athletes up through adulthood; opportunities for involvement in sport for even the youngest kids (note that this often involves pick-up or street ball…); exposure to sophisticated coaching in adolescence; highly driven athletes; and perhaps the most complicated factor of all: economic disadvantage.

Leading up to the Super Bowl this article in the New York Times provided some insight into the way kids grow into the culture of football in the areas around New Orleans.  There’s description of the intense football culture that is handed down through the generations, young kids playing pickup tackle ball until they are old enough to put on pads, and high school coaches running sophisticated SEC-style offenses.  Success from players like Reed and Jones means that “in Louisiana you are always one or two players removed from the NFL”.

Economic disadvantage

In MLB it is now estimated that almost 50% of minor league players are foreign born, with a substantial number originating from the Dominican Republic.  There too you’ll find an intense multi-generational culture that is ruled by sport, kids playing pickup ball on a variety of field surfaces (dirt, streets, sometimes even grass), and then in early adolescence exposure to structured year-round coaching.  But there’s a dark side of Dominican baseball- at around age 12 players drop out of school to focus full time on baseball at various academies.  The process is outlined in a documentary titled “Ballplayer: Pelotero”.  The odds against the player are daunting.  It’s estimated that there are 100,000 boys in the 12-18 age groups competing for a couple of hundred minor league American contracts each year.  These players are signed for next to nothing thus there is little benefit for the family even for those players who are “successful”.  The rest of the players are essentially commodities with little ability to earn a meaningful wage outside baseball.  In Brazil the issues are further complicated by threats of violence, although the situation is reportedly improving quite a bit in recent years.  Brazilian legend Rivaldo noted several years ago “The pressure in Brazil is a little complicated. They threaten your family, they damage your car, and it’s a little complicated.”  For those players in the Dominican Republic and Brazil there’s unquestionably an intensely ingrained culture of sport, fantastic professional players to emulate, great coaching…and the very real prospect that sport is their only way out of a possibly dismal existence.

This post is a brief generalization and every sport, every geography, and every young athlete in the U.S. will have unique issues.  And for sure there are economic disparities in the U.S. that create mismatched educational opportunities, but I’m grateful that we are at least trying to make sure all of our kids have a safety net of reasonable opportunity if sport should fail.

 

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More Reasons To Be Careful About Return To Play After Concussion

Posted on 02/05/2013 by Dev Mishra MD

By Dev K. Mishra, M.D.

President, Sideline Sports Doc

It seems we are bombarded with new information about concussions on an almost daily basis, and here is even more information to cause us to stop and consider the best time to return a young athlete to play.  A recently published study showed that cognitive and functional deficits persisted in young athletes after sport related concussion out to 2 months after the concussion.  A group of concussed athletes were followed after girls soccer headerconcussion and tested at certain intervals.   The concussed athletes were compared to a normal group of athletes also tested at the same time periods.  The study showed statistically significant deficits in the concussed group compared to the control group in attention and task-switching at all time points tested, although the concussed group did improve over time.

Based on these study results as well other study data, the researchers suggest that adolescents may require an extended recuperation time to completely recover brain function following concussion, and that specific concussion tests can provide valuable information for physicians carrying out follow-up assessments and determining proper time points for return to play.

“If a person goes back to the playing field without a full recovery, that person is put into great danger of being re-injured,” emphasized study author Li-Shan Chou quoted here. “In any given season, if you suffer a concussion, the chances of your suffering a second one is three to six times higher and suffering a third is eight times higher. There are accumulations in this kind of injury. It doesn’t go away easily.”

“The differences we detected may be a matter of milliseconds between a concussed person and a control subject, but as far as brain time goes that difference for a linebacker returning to competition too soon could mean the difference between another injury or successfully preparing to safely tackle an oncoming running back,” said co-author David Howell.

What Can We Take Away From This Study?

This was a well-conducted study that adds to our knowledge base about concussion.  Sophisticated testing can often find differences that are very subtle, even to a properly trained physician skilled in concussion management.  The field of concussion testing is evolving and we don’t yet have a consensus on which of the various test methods is best.  Most physicians at the college and professional team level use some form of the paper-based evaluation known as SCAT2.  Ideally, the athlete has had preseason testing when he or she was functioning normally.  That baseline is then used later to determine the amount of deficit when compared to the post-concussion tests.  Ideally you want the player back to their normal baseline before returning to play.

The key takeaway for me is that young athletes may have deficits in brain function far longer than we would otherwise suspect from our standard office based exam.  More reason to be cautious in return to play after concussion.

 

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Young Tennis Players At Risk For Hip Impingement

Posted on 01/29/2013 by Dev Mishra MD

By Dev K. Mishra, M.D.

President, Sideline Sports Doc

The recently concluded Australian Open Tennis Championship produced some fantastic tennis, with a number of phenomenal teenage up-and-coming stars.  Like every other sport that requires countless hours of dedication and physical effort, subjecting a young body to repetitive stress can take a toll.  A particular type of hip problem called “femoroacetabular impingement” (FAI) may be on the rise and related to number of years playing competitive tennis.  iStock_000014536937XSmall

A study was presented at the European Society of Sports Traumatology, Knee Surgery and Arthroscopy Congress in Geneva, Switzerland. Investigators found a risk for femoroacetabular impingement (FAI) was highest among players who first started playing tennis at an early age, which lends support to the idea that increased years in sports at a young age may predispose athletes to this risk.

“Femoroacetabular impingement (FAI) has been well described in the literature as a source of hip pain in elite-level athletes,”noted Robert E. Boykin MD, the lead author of the presentation.  “It is associated with structural abnormalities including cam lesions of the femur and pincer lesions of the acetabulum. [The] injuries seen may be due to repetitive motion and overuse in sports.”

The researchers enrolled 148 tennis players from an elite academy in Barcelona, Spain. The players averaged 15 years old at the time of the study and stated they started playing at about 6 years old. Overall, they played in 20 tournaments a year and averaged 47 weeks per year of playing competitively.

Comparing at-risk hips with those not found to be at risk, Boykin and colleagues found no difference in age, tournaments played per year or weeks played per year. However, “the subjects with an at-risk hip had played tennis longer — on average 9.5 years compared with those without any clinical signs of risk at 8.6 years — and this was statistically significant,” he said.

“We believe this study further supports the idea that increased years in sports at a young age may predispose athletes to a risk for developing FAI,” he said.

Boykin and his colleagues plan to continue enrolling patients and studying the risk in this population to develop modified techniques and training regimens to prevent hip injuries.

 While I agree that overexposure to repetitive stress may predispose a young tennis player to hip problems, the number of factors leading to development of hip impingement is complex.  Inherited factors, the speed and power combined with torque that makes up competitive tennis today, and likely some factors yet to be discovered all play a role in developing hip impingement.  Not all elite level young players are destined for hip impingement. This area is not the black box it once was but we still have much to learn.

Hip impingement can be treated a number of ways but for elite level players who have failed nonsurgical treatment, hip arthroscopy is a reliable way to treat the problem.  Tennis players Gustavo Kuerten, Lleyton Hewitt, Tommy Haas, and Brian Baker have all had hip arthroscopies, with varying “success” in return to top-level tennis.

While surgery is becoming an increasingly reliable way to treat the problem this is yet another developmental or overuse issue that’s best prevented.  If you’re a young tennis player with persistent hip pain get proper evaluation and treatment early.  You may just be able to avoid further problems with changes in your training regimen, avoid surgery, and enjoy a high level of tennis for a long time.

 

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Some Good News To Start The Year: Childhood Obesity Rates May Be Falling

Posted on 01/22/2013 by Dev Mishra MD

By Dev K. Mishra, M.D.

President, Sideline Sports Doc

Finally, some good news on the childhood obesity front:  obesity rates may actually be falling in a number of major metropolitan areas.  The exact reasons for the falling rates are unknown but it appears this is not just manipulation of statistics to try to prove a point:  the changes appear to be real.  The various studies and possible explanations are summarized nicely in a New York Times article from a few weeks ago.  The drops are small (5% in Philadelphia and 3% in Los Angeles) but after years of rising obesity rates in children these findings offer the first signs of hope that we may be able to reverse the problem.  generalyouthbasketball

There are hundreds of diets, exercise programs, medical and surgical treatments, food supplements, etc. all reported to be a critical factor in a person’s ability to lose weight and body fat. The fat industry is a multi-billion dollar business.  It’s widely known that one of the least expensive, and potentially most effective methods of combating childhood obesity is to prevent it in the first place.  But this is also extremely difficult for many people because it involves overcoming years of poor diet and exercise behavior.

For all of us involved in the world of youth sports we need to instill in these kids a lifetime of healthy habits.

It’s really easy to come up with multiple excuses for lack of exercise and improper eating habits, so we’ll leave that to someone else.  What I’d like to have us focus on is positivity and simple steps to imprint the habits that will hopefully lead to a lower risk for obesity as these young people enter adulthood.

  1. Don’t Eat Out Of A Box Or Bag (Eliminate processed or “white” carbs)

Encourage the least processed food you can possibly find.  I don’t think there’s a need to get too caught up in reading percentages of proteins, carbohydrates, and fats in a food label but a simpler way of dealing with this is to eat and drink the most natural foods you can.  But there are two things you need to actively avoid: processed sugars and trans fats.  See more specifics in our blog on What To Eat.

2. Drink Water As Often As Possible

Water has been the preferred drink of human beings for billions of years.  No need to change that now, it still works for young athletes.

3. For All Kids- Athletes Or Not- 60 Minutes Of Physical Activity Every Day

Anyone who’s watched an NFL game has seen their public service announcements for their “Play 60” initiative.  Kids need 60 minutes or more of moderate physical activity every day.  This can be unstructured play, activity at school, competitive sports teams, etc.

4. For Coaches- Make Your Practices Active!

Some sports practices involve remarkably little movement and activity.  I wrote about this in a prior blog post.  Re-evaluate your practice plans and look at places you might be able to put more activity in the session.  Could you consider a portion of each practice devoted to conditioning?  How about a portion of each week?  This can be tough, and will need careful planning ahead of the practice but it can be done.

5. For Parents- Be A Positive Role Model And Keep Yourself Fit

There’s not much surprise here.  Parents, other influential adults, and even siblings can have a profound effect on just about every aspect of a young person’s life.  Do them a favor and help yourself at the same time, lead by example.

 

 

 

 

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The Brain Doesn’t Care What Sport It’s Playing

Posted on 11/21/2012 by Dev Mishra MD

By Dev K. Mishra, M.D.
President, Sideline Sports Doc

Did anyone see these comments from New Orleans Hornets coach Monty Williams over the past weekend? I found them published on ESPN online, with Williams commenting on his big man Anthony Davis, who had been diagnosed with a concussion on contact that Williams apparently considered insignificant: “When you’re dealing with the brain, I guess what’s happening in football has impacted everybody. He got touched up a little bit last night. That happens a lot in basketball. It’s just that now they treat everybody like they have white gloves and pink drawers and it’s getting old. It’s just the way the league is now.”

Later in the article Williams tried to back down a bit by saying “”We’ve got to protect the players, but I think the players should have more say so in how they feel.” There are several implications from the comments that I’ll expand on here.

The brain doesn’t care if it got hurt in a car, on the football field, on the basketball court…
One of the implications of the comments is that there is somehow a sport specific concussion, that football concussions are just not the same as basketball concussions. This is flat out not true. What changes from sport to sport are the forces involved, level of head protection, surfaces hit, etc. There’s a lot we have yet to learn about concussions but what we do know is that Dale Earnhardt Jr. can get a concussion in a very well protected car with a state of the art helmet protecting his head the same way Jahvid Best can. And for that matter players without helmets, like Anthony Davis, can get one too. Symptoms may differ, recovery times may differ, every person will respond differently but the brain doesn’t care if it was playing a sport when it got hurt.

Players should have a say in return to play?
I’m definitely not a lawyer but I do know that athletes in any sport assume a certain level of risk when playing. There are medical waivers, release of liability, arbitration agreements, etc., all designed to limit risk to the caregivers and allow for some personal responsibility from the adult player. Williams seems to be asking whether a player in the NBA can simply assume the liability of playing and override the medical professionals’ opinion. Certainly all medical professionals will discuss options for treatment, risks of the available options, and benefits of the options with the injured player in a process we call “informed consent”. But no medical professional would present an option known to cause probable harm, based upon the best available evidence. For concussions our best available evidence calls for specific testing and return to play protocols. Until the evidence changes I don’t see us allowing players to put themselves in a position we currently believe may cause permanent damage.

Let’s play doctor!
Who gets to diagnose and manage a player with a concussion? I won’t belabor the point but concussions are tricky to diagnose and manage, we generally defer to physicians specifically trained in sport concussion management. Mr. Davis likely had a very thorough concussion evaluation. In the world of major professional sports in the U.S. that task typically falls to a neurologist with no specific ties to the team. The testing is very comprehensive; players can’t really “cheat” their way through a test as easily as once possible. As much as we want to see the professionals at their craft we still need to treat them as we would any patient with a suspected concussion. Caution rules the day.

And if you’re a kid?
You’ve got 70…80…maybe 90 years of your life left. If you think you’ve had a concussion get treated properly from the start. Your best game is right around the corner.

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The Paradox of Football Helmet Safety: Is It Possible That More Concussions Will Be The Result?

Posted on 10/24/2012 by Dev Mishra MD

By Dev K. Mishra, M.D., President, Sideline Sports Doc

There’s an interesting murmur I hear coming from the mouths of some of the high school athletic directors I work with: is it possible that safer football helmets will embolden young players to become more reckless with their tackles, actually leading to an increase in concussions?

It’s an interesting question, and I doubt an increase in concussions will actually happen with improved helmet safety.  But the argument will require some ongoing data to solve the dilemma.  Some say that the rate of concussions is higher now than it was “back in the day” in football because “helmets” were simple leather coverings, and players did not propel themselves headfirst into another player due to fear of head injury.  It’s impossible to compare concussion rates across eras due to the changed size and strength of the players, rule changes, and concussion awareness, amongst other things.  Similarly, a comparison of concussion rates to rugby (where headgear is generally not used) is not possible due to different rules and game objectives.

What I’d like to see are small pilot studies at the least, and some larger clinical trials if possible.  It’s an important question that should be answered scientifically.

Making football helmets as safe as possible certainly seems like the right thing to do.  We then need to take some practical steps to make sure young players have incentive to play as safe as possible, and I’d suggest these steps at a minimum:

Coaches Need To Coach Heads Up Tackling

We can do this right now and it should make a big difference towards reducing concussion rates.

Youth Sports Rules Need To Be Uniformly Applied

Here’s another one we can effectively emphasize right now- referees should uniformly enforce existing rules designed to improve player safety.  This starts with equipment rules and runs through game play.

Coaches Must Recognize a Possible Concussion And Remove Players From Play

This is something I emphasize every time I speak to a coach: you do not need to know how to diagnose a concussion, you only need to know if you think a player might have one.  Several resources are available on the Sideline Sports Doc site and others.  Remove the player from play, no matter how the game situation will unfold, and seek qualified medical help.

We Need To Foster Innovation

Multiple new technologies are under development for concussion diagnosis, impact-sensing technology, force reduction technology, return to play testing, etc.  We need to provide an environment of entrepreneurship that fosters innovation.  Big topic that we can cover another time…

We Need To Support Research That Turns Innovation Into Practical Reality

It’s not enough to measure the impact from a single hit or repetitive hits, for example.  We need research that allows us to then predict a player’s concussion risk.  This is a large, complicated task, and that’s what good research is for.

The culture of youth sports in terms of tolerance for certain injuries as “part of the game” is changing slowly and for the better.   I applaud USA Hockey’s new development model in particular, and they have made substantial inroads in age appropriate player development.  For football to do the same it will take some courage to accept the changes, but the sport should be better off for the long term.

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Food For Thought From One Of The World’s Foremost Concussion Experts

Posted on 10/10/2012 by Dev Mishra MD

By Dev K. Mishra, M.D., President, Sideline Sports Doc

In this past Sunday’s New York Times, Dr. Robert Cantu presented some of his views in an article titled “Preventing Sports Concussions Among Children”.  Dr. Cantu has spent a good portion of his 40-year professional life as a neurosurgeon championing the cause of concussion prevention, as well as concussion recognition and management.  His work is hugely influential and has helped considerably to change the way sports physicians think about concussion.

In the article, Dr. Cantu states “We cannot eliminate head trauma from youth sports. What we can change is our mind-set so protecting the head and the brain is always a top consideration. The guiding principle should be that no head trauma is good head trauma. Let’s re-examine youth sports and take steps to keep young athletes safe.”  I would agree fully with those statements.

He then goes on to offer recommendations based upon his experience and research.  Among the recommendations are these, with some of my commentary included:

Hockey

I believe USA Hockey is the most progressive and safety-conscious organization I’ve encountered in youth sports.  They’ve taken firm and even courageous stands (the culture of youth hockey runs deep…), and as of 2011 have banned body checking before the age of 13.  Dr. Cantu suggests this be changed to age 14, but overall my opinion is that USA Hockey gets it right.

Football

He recommends no tackle football until age 14.  This recommendation is sure to raise the ire of many but he has literally seen it all over his career and feels strongly enough to place his reputation on the line by stating it publicly.  He also states that “more worrisome is what we don’t know”, meaning that new research could likely lead to a change in how we think about football concussions.

Soccer

Much debate exists about the proper age to teach heading, and proper technique.  Most of the discussion focuses on the effects of cumulative heading of the ball but Dr. Cantu points out that most concussions in soccer occur when two players go up to head the ball at the same time, and concussion occurs from head to head contact between players.  He suggests that heading not be allowed until age 14.

Baseball and Softball

The mechanism of head injury in baseball and softball is different than in most other sports, so recommendations here mainly involve strengthening of existing rules.  Namely, use chin straps on helmets to make sure they stay on, and eliminate head first slides.  These recommendations make complete sense and I would think they are easy to implement since sliding would still be allowed, just not head first.

Field Hockey and Girls’ Lacrosse

Here, Dr. Cantu argues for use of full protection helmets in both sports, and enforcement of already existing rules that ban contact to the head.  This also seems reasonable given that the rules already exist and enforcement should not result in a significant change to the way the game is played.

So it’s time for us to continue the hard thinking about concussion and our kids.  Some of these recommendations will be met with a lot of resistance but I believe in time that the evidence will prove Dr. Cantu right.

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How “Clean” Were The London Olympics And What Does It Mean For Middle-Schoolers?

Posted on 09/28/2012 by Dev Mishra MD

By Dev K. Mishra, M.D., President, Sideline Sports Doc

Organizers at the recently concluded summer Olympics in London took an aggressive stance towards identifying and imposing sanctions on anyone testing positive for banned or performance-enhancing substances.  According to Reuters, intelligence gathered from everyone from Olympic village cleaning staff to customs officials at Britain’s border controls helped authorities target drug testing before and during the Games at the right countries, sports and athletes.

This intelligence-led approach, which anti-doping authorities learned from law enforcement experts, took time to adopt but apparently paid off in London.

Many athletes were tested under the new comprehensive blood and urine testing prior to the Games beginning, and according to the World Anti-Doping Agency (WADA), 107 athletes were banned from qualification before the start of the Games.  The banned substance list included many anabolic steroids, stimulants, masking agents, and an improved test for human growth hormone.

During the Games itself, 11 athletes tested positive for banned substances and were excluded from participation, with stiff penalties for future participation.  In total about 5000 tests were administered and samples will be kept on many of the athletes for 8 years.  In theory, athletes using substances now for which we don’t have a test could be tested later and found guilty of doping retrospectively.  As quoted in the Reuters article Phil Watson an exercise physiologist who knows David Cowan, head of the Drug Control Centre at King’s College London and the man who led the 2012 anti-doping scientists, praised the systems as “absolutely 100% state of the art”.

“WADA and the anti-doping agencies are doing all they can,” he said. “But there are always going to be people who are one step ahead. That’s the reality. There’s a lot of money to be made in producing medal winners. And some of the people helping athletes cheat are very sophisticated.”

So how young can cheaters be and to what lengths will people go to try and create a champion?  16-year-old Ye Shiwen of China faced accusations of doping after phenomenal improvements over her previous times, and especially after she swam the final 50 meters of the 400IM faster than Ryan Lochte in the men’s race.  The Chinese delegation vehemently denied the accusations and Ye tested negative in multiple samples.

And now coming to a middle school near you: drug testing as a condition of participation.  An article this weekend in the New York Times noted that several states have laws allowing for testing of middle school students, but so far no one has tested positive for anything other than marijuana.  The school districts state that they are doing testing to raise general awareness of the perils of drug use.  Parents are saying that it’s an invasion of privacy and unnecessary.   The jury’s out (literally) but two things are for sure:  younger and younger athletes will unfortunately try to gain an edge through doping and testing will definitely happen.

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