Rhabdo Recipe: Too Much, Too Soon

In an athletes life, off season workouts now going on may be even more challenging than grinding through the season. Mat drills, endless running, repetitions on end, weightlifting, building a base of strength, breaking down to build up. These days are always a challenging time for those trying to secure the favor of a coach. Recently, we heard of three Oregon football players hospitalized with a condition called Rhabdomyolysis or Rhabdo for short.  Others showed some symptoms requiring workout modificationrefers to the disintegration of muscle fibers in skeletal muscle. That is to say, the muscle begins to dissolve. This releases large amounts of myoglobin, which reach the kidneys via the bloodstream where it can cause major damage, including acute renal insufficiency. In this case medical attention is absolutely and immediately necessary!  This disease can be caused by a variety of factors. A distinction is made between traumatic, non-traumatic, load-dependent and load-independent rhabdomyolysis. Load-dependent rhabdomyolysis may develop from muscle damage that has come from over-strenuous physical activity or overtraining. Simply put, too much high intensity or volume of work, too soon, often after winter break, a period of inactivity or just being de-conditioned.

Prevention involves a gradual exposure to high-intensity training along with proper hydration before, during and after activity and limiting an emphasis on eccentric, movements with high repetitions. For example, loading the muscle ad under tension when not contracted. Nutrition plays a positive role by replacing nutrients lost in exercise with carbohydrates and proteins. Hydrate as well with water and proper sports drinks. Work hard but train sensibly.

Old School Food, New Age Results

Winter sports are up and running, spring (at least in Florida) will be here soon. Sharing thoughts from a recent article in Sports Illustrated Jan. 16, 2017, page 18, by Jamie Lisante. Nutrition is such a big part of an athletes performance and many are looking for healthy alternatives, more than a miracle in a bottle. Imagine becoming a bone broth & stock believer, rich in nutrients, which contain healing and connective tissue building compounds such as collagen and amino acids. Think, fresh seasonal vegetables with salted butter that yield complete proteins, good fats, and antioxidants. These are some recommendations by Dr. Cate Shanahan, nutritional consultant for the LA Lakers. She also recommends meats and fish that are grass fed or wild caught. No vegetable oils or bad fats such as cottonseed, canola or corn oil. Reduce sugar and relyiance on protein products and for a treat, try whole milk and organic dark cocoa powder. Avoid things that causes inflammation as well as empty starches. Most high school athletes are not privy to personal chefs but can take ownership to not rely on a bottle, bag or packaged and processed product. Learn to read food labels, take mom to the farmers market, search for economical options. Takes a little time, but think of the benefits for your improved performance and recovery. Jim Mackie, M.Ed, ATC, LAT

Psychological Considerations & Emergency Preperation for Athletes

With the holidays right upon us it’s a time for gratitude and reflection on the many blessings and freedoms we enjoy. Take some time, to reflect or refresh, it’s good for your own self care. Our mental health is such a valuable aspect and will actually be a primary focus of this years Seventh Annual JSMP First Coast Sports Injury Symposium, scheduled for April 21-22, 2017. At Jacksonville University. Day two will focus on Emergency Prepardness with some new wrinkles on tourniquets, wound packing, as well as head, spine & neck issues and heat illness. We are again planning to bring in some of the leading national experts in these areas and it should again be an outstanding program. We look to see your there so please save the date.

That time of year again

It’s that time again and it just seemed like yesterday we were starting summer practice. High school football playoffs are off and rolling and we end another year of sports which moves so fast. Seniors for the most part, face the end of their playing careers, others continue to dream. Time for the aches and pains neglected to rest and heal. Recovery is playing a more important role with elite athletes these days. Cryotherapy tanks are being used to heal tissue and intermittent extremity pumps are being utilized by more and more to gain an edge. Will they last, and real evidence be produced or will they be another trend or fad? Time will tell and time moves on, standing still for none. Time to put the equipment away and prepare for the future or as i’ve been fortunate to do… advance in the playoffs towards another possible state football championship. Living the dream.

Your ACL and Graft tissue

Recently, I was able to participate in the annual JSMP Symposium & Concussion Update entitled “Head, Shoulders, Knees & Toes,” a comprehensive overview of a number of conditions.  Some interesting takeaways included, Jacksonville Jaguar Head Team Physician Dr. Kevin Kaplan  discussing ACL repairs that those patients under age 25 face a 25% failure rate when using a allograft (cadaver tissue). Those older than age 25 do best with a allograft if they are in low demand activities.  One’s patella tendon graft (autograft) is the best for a repair for those under age 25, followed by the Quadriceps tendon, Hamstring tendon or other graft selection.  A caution as well, although patients may feel great at about 2 months post op the graft is at its weakest and really takes up to 10 – 18 months to return to full vascularization and strength.  Return to play is best determined by a variety of functional tests as well as strength measurements.  Stay healthy!

Let’s all take a breath

IMG_1969With the recent admission by the NFL there exists a link between CTE from head injuries & football, emotions have run high.  One owner calling the link “absurd” to a coach saying you’re a “fool” if your don’t let your kid play football, it hits all spectrums.  Yes, there are many good reasons to play sports, particularly football such as it builds teamwork, character, relationships, teaches good life lessons,  and so much more.  On the other hand, from a safety perspective, could there be some change in the culture and maintain a “gladiator / true warrior mentality” of toughness, strength and competition?  One unfortunate aspect is coaches, parents and players rewarding or encouraging the violence in sport, living out their desires in a fantasy manner.  Another aspect is teasing the concussed, calling them “soft” or challenging if they really have a concussion. This only brings suspicions, doubt, depression, as well as other negative consequences and delays change.

The answer to the question raised is yes, changes need to be made and are coming.  Coaches would actually have to spend time teaching fundamentals, proper tackling techniques and re-inforcing “see what you hit” and not lowering the head or targeting.  Less contact in practice would help as well, overall reducing the injury rate and keeping players fresher through the long season.  A good place to start implementing change is with spring practice as coaches use the hitting portions to separate the weak from the strong.  Using spring to actually coach and teach whole probably bring about better execution.  During the fall practices with the younger or middle school kids I believe it would show we see higher rates of concussion and fractures as they are younger an less mature.  I once had a coach in late October still running Oklahoma drills, when questioned he responded “we still need to see who can hit.”

There will be resistance but can’t we work to find a balance?  Winning is great and I’ve been fortunate to be a part of some great championship teams but I also empathize with the pain when kids are injured as well.

Let’s work together to keep football (and all sports) in their proper perspective in life while growing and developing aspects to keep them all safe and enjoyable.  Come on now, take a breath and think about it.

AT Month

It’s National Athletic Training Month, a time to celebrate the work that so many do in so many diverse practice settings.  One new recognition is the way we identify ourselves, for example AT in the secondary school setting.  Hopefully it will help us all and better solidify the name Athletic Trainer, a name we have often struggled with. Personally, I’m happy with the term Athletic Trainer so let’s move on.

The significance of the NFL finally agreeing there is a link between football and the degenerative brain disease chronic traumatic encephalopathy (CTE) will bring change.  The challenge is to make the sport of football (and others too) safer as well as change the culture of the sport without diminishing it’s benefits.

Recently, I attended the SEATA annual meeting and one of the highlights of many is the relationships we share and multiple learning opportunities.  It was also my last as an elected officer and yes it was a little emotional.  My time of service in this fashion was most meaningful and certainly will find opportunities to contribute in some fashion in the future.  It’s a privilege to serve in any manner in our profession and if we want to be a part of the change we need to participate.  Become engaged in your profession and you will be the beneficiary.

Looking forward to the 6th annual First Coast Sports Injury Symposium and Concussion Update.  www.jsmp.us for program and registration.  Hope to see you there.

Keep them safe.

Always Learning

Winter is here and sports are in full swing. It’s also time for professional meetings and educational clinical symposiums. As a professional, time is always a challenge but I encourage each of us to take the time to keep learning. We can never “know it all” and certainly benefit from research, journals, symposium lectures and one to one sharing of ideas as to what is working. Personally, I’m looking forward to visiting with colleagues, get beyond the pleasantries (which are appreciated) and have some good learning conversations as well. So much is learned outside the conference room and through interpersonal discussions. It’ challenging but rewarding. In the words of Albert Einstein, “Intellectual growth should commence at birth and cease only at death.”

Have a great time learning. All the best, stay healthy and happy, and don’t take yourself so seriously.

Hidden Dangers of Drugs in Sports

Sports Illustrated recently had a feature article on the dangers of heroin use by young athletes entitled “Smack Epidemic”.  Painkillers like OxyContin and other prescription drugs become easy outs but the cost is high.  Heroin is cheaper and accessible. According to the CDC, heroin overdose deaths rose from 2000 to 2010 but tripled in the following three years.  It cuts across all demographics and young athletes have become a prime target. According to the U.S. Substance Abuse and Mental Health Services Administration, a full 80% of all users arrive at heroin after abusing opiod painkillers such as OxyContin, Percocet and Vicodin.  According to a study by the University of Michigan, by the time high school athletes are seniors approximately 11% will have used a narcotic pain reliever for nonmusical purposes.  Bottom line this should raise red flags for parents, athletes, coaches, medical professionals and others as to their potential  dangers.  Take care in monitoring what medication are and are not being prescribed as well as the consistent use of any medications to placate pain.  Prevention and many eyes are a key.

Jim Mackie, M.Ed., ATC, LAT

Are you prepared?

As we’re less than 30 days away from the beginning of a new football season as well as with cross country and volleyball.  Athletic Trainers have been busy as well, reviewing and updating emergency action plans, ordering equipment, attending educational sessions and supplies, getting  little break where they can and so much more.  It’s a time to prepare so athletes can perform their best and do it safely.  Training to prevent injuries as well as learning new techniques and best practices.  One of the biggest changes coming may be the treatment of a potential spine injured athlete and their on field removal. This requires up front communication with staff and EmS personnel so everyone is trained, familiar with, has rehearsed and practiced these new procedures.  So get a little rest but keep preparing as it is upon us soon. See you on the field.