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.

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.

We all play an important role in life


It was disturbing to hear recently that a long time athletic trainer was dismissed for his role in a bullying scandal within an NFL team.  Disturbing, that it was going on in the first place and disturbing a colleague got caught up in it by not intervening for an associate.  We all are accountable for our actions and the atmosphere we tolerate or accept be it in a locker room, athletic training facility, office or wherever we have to accept responsibility.  The culture of sports is changing, be it the rules, the intensity, the language, the locker room atmosphere, gay & lesbian athletes becoming more visible in sports.  Even Sports Illustrated with their “swimsuit” or lack there of issue. Personally, I handed it to my wife upside down and asked she destroy it then & there, she did so gladly. It’s degrading to women and decent values.  All leads to a changing or evolving mindset.  How will you respond when and if any of this is right in front of you? Hopefully with love, compassion and a willingness to see people as a person and not some object.

Jim Mackie, M.Ed, ATC, LAT

A Championship Season

Jim Mackie, M.Ed., ATC, LAT

The Trinity Christian Academy Conquerors won their 4th State Football Championship in early December. It has been a privilege to work with an incredible group of coaches and young men this season as their Athletic Trainer. They are a most focused and dedicated group who kept their eye on the goal and the prize ahead. We were fortunate to stay relatively healthy this year though had some significant JV injuries. All are healing well and should be ready for spring practice. Thanks to a great medical team from Dr. Kevin Murphy of Heekin Orthopedic, Amy his assistant, Heartland Rehab led by Kristen and her fine staff, and two UNF Athletic Training students Kirstie & Adam. With each component we had a fine team of professionals working to get the kids in quickly, evaluated, diagnosed and with a safe return to play. Thank you and Congratulations TCA!

Momma said…. (have a chuckle) – Jim Mackie, M.Ed., ATC, LAT

We all have heard the adage, ” when Momma’s not happy, ain’t nobody happy.”
Yes, you better do what Momma says but sometimes there are all kinds of ideas for treatment of injuries and when you send the kids home you had best given good instructions and a call to that parent otherwise you may be dealing with other issues.
For example: So what am I going to do with this ankle sprain? Ankle sprains can be a bear! Just a misstep somewhere and an ankle swells like a balloon or not at all. What next? Some things to consider & questions to ask: discoloration, pain, neurological symptoms, deformed? Anything look like it shouldn’t? go to the hospital!

But Momma said, ‘Never take off your shoe or it will swell…. Well how are you going to see what’s wrong, probably good advice if it’s totally out of place. But practically speaking remove the shoe & sock, take a look at it apply some ice (20 minutes) directly to he injury.

“But I’ll get frostbite” pretty un-likely. I usually advise once you get past the first 5 minutes your numb, it’ll burn some but you will get used to it. Unless you’re really fair skinned and hyper sensitive to cold it’s usually safe to place ice next to skin and is most effective. A bucket of ice water is good too. In 40 years I’ve only had one athlete who had an allergic reaction to cold!

Apply a compression wrap starting at the toes or the swelling may pool there. Elevate the leg, foot & ankle as gravity & the bodies physiology are drawing fluids to the are to protect it.

Momma said “I should put it in warm epsom salts soak” well, heat does feel good but it will draw more fluid to the area, causing more swelling. While it might feel good at first it may just prolong healing. The same goes for rubbing on those topical products, you may gain some “analgesic relief” but it’s the massage or lymph drainage that’s best done by a professional.

X-rays, studies have shown many healthcare dollars wasted on needless x-rays which really only show the bone anyway (source may be soft tissue?) Let the MD decide.

When can I return? Mom says “I need to be out 6 weeks & not play sports anymore”? She took me off to the acute care center or family MD who sees few athletic injuries annually. While each serves their purpose and certainly no slight to some MD’s but try to refer the athlete to a sports medicine MD or professional and began some therapy as soon as possible which includes a good rehabiltation program. A guide of progression usually includes rest, frequent treatments, walking with no limp, swelling reduced, pain free, joint stability & balance, taping or bracing. Functional progression includes -straight ahead motion – walk – jog – run – sprint – slow to sharper turns – cutting agilities – strengthening, balance, & endurance – competition’

Remember that scripture tells us ‘the limping foot gains strength on the straight paths

Before I get all sorts of comments, this was written to address a common injury we as healthcare professionals face and is antidotal in nature. In all cases of injury, seek professional care. Yours in Good Health.

Santa came again this year – Jim Mackie, M.Ed, ATC, LAT

I had the opportunity over the Christmas Holidays to share in the joy of giving. Working with a charitable organization HOPE worldwide Jacksonville Chapter we received a call from a generous gentleman who gave a significant contribution to provide 51 bicycles to needy children on Jacksonville’s northside. His specific request was that they go to kids in this area as he grew up as a child here and knew the joy that came when a special treat was shared. Seeing the joy on the faces of the children as the bikes were delivered by a partner organization All My Sons Movers was a real encouragement, especially as they were delivered to an Elementary School the same time as the horrific events were taking place at another school in Connecticut. Giving is a joy and lifts the hearts of many. As we approach this new year, realize we can encourage each other daily, it’s easy to do and makes a real difference in the lives of each person we meet.

A Championship to Remember

December 2002 was a memorable time for me as a professional as the Trinity Christian Academy Football team won it’s first State Championship in Tallahassee vs. American Heritage High. Tonight, 10 years later, that team returns to TCA to be honored for their accomplishment during tonights game. Winning championships takes hard work, talent, and most of all leadership. There was a group of seniors, coaches and others who provided that leadership to successfully accomplish it’s goals. The team was a compilation of the very talented and the simply solid high school football player fulfilling their roles.

I tell others that Tim Tebow was a 9th grader who played back-up quarterback and defensive end. His brother Robby was a senior as well as Brett & Bobby Bowers (Brett attended Oklahoma), David Atlee, Bernie Hurley, Lamar Lewis (who attended FSU & Ga. Southern) and many others. One of the most encouraging things for me is to have been a small part of their lives as theuir Athletic Trainer and to see them come back over the years just to say hello and thank you. Championships bring a bond, a sense of accomplishment and a good pride.

Sadly, among that group two of the coaches have since passed away, Coach George Davis had a heart attack during the first playoff game at PK Younge and died on the field. His son also coached and two grandsons played on that team. I believe that event helped bring the team even closer. Danny Andrews, long time line coach developed Pancreatic Cancer several years later, worked through the season and passed away the following year. A third coach, Ryan Keith, now head football coach at Eagles View battles ALS with faith & courage. Championships bring fleeting rewards but life provides its ongoing challenging lessons and struggles. What we can accomplish often helps prepare us for whats ahead.

Memories are to be made and remind us of different times in our lives. They help to shape us, often define us, but challenge us to move forward to more lasting things. It will be a special time to be with these young men tonight and to see how they have grown and matured, married, built families and to just say hello again. Football teams form a special bond and it’s good to reflect on whatever times, relationships and lessons we have learned & shared.

Go Conquerors!

Emergency Responses in High School Athletics

I was recently involved in the response to a First Coast HS athlete who collapsed at half-time of a football game. This year schools in Duval County had the option of an on-site private ambulance or two JFRD Paramedics equipped with emergency equipment who would request transport as necessary. To date there have been 12 transports from the many high school football games and the system seems to be working. At the First Coast game there were present two Team Physicians provided by the Jacksonville Sports Medicine Program and the Duval County Medical Society, three Certified Athletic Trainers, one First Responder & the two JFRD Paramedics. The situation was handled professionally and the JFRD unit responded in a reasonable time. There was a good outcome and the athlete is doing well. Any situation requires post event re-evaluation as to our preparedness and how we can improve. Fortunately, this was a good outcome and for that we’re grateful. Each one of us is responsible to have a plan, practice situations and respond professionally and to the best of our training.

A season in transition

Time passes quickly, season down to final four games and the playoffs, a tradition for Trinity Christian Academy football. Fall is in the air and some cooler days ahead.

Recently attended ceremonial signing of the Florida Concussion Legislation by Gov. Rick Scott to protect our athletes with recognition of concussions and safe return to play. Present were Bob Sefcik, JSMP Executive Director, Mike Ryan, Head Athletic Trainer of the Jacksonville Jaguars, Dr’s Jen Maynard, Chair of the North Florida Regional Sports concussion Task Force and Christine DeMatis,representatives from the FHSAA and Rep. Rob Renuart, sponsor of the Bill.

The injuries mount as the bumps & bruises of the season and pounding adds up. Healing well and thankfully nothing serious to this point here in North Florida. The Athletic Trainers and Physicians are doing a fine job in providing their services to the athletes. Oh for the day when every school will have access to a Certified Atheltic Trainer. Their value is priceless in many ways.