by Bob Calvin, MS, RD, CSSD, LD/N, CSCS and Denise Barry, RD
Performance Nutritionists – Athletes Performance

Mild traumatic brain injuries, or as they are more commonly known concussions, have been a hot topic lately within the sporting world. According to the Brain Injury Research Institute, headed by one of the leading researchers in the field, Dr. Julian Bailes, “approximately 1.6-3.8 million sports and recreation related concussions are estimated to occur annually in the United States” (1). As we are coming to learn this is a very serious matter that cannot be taken lightly.

When the brain undergoes a concussive impact or force, neurons, the main functional cells of the brain, are damaged. The neuron’s axon, or tail, undergoes swelling and detachment from soma, or cell body. Leakage of calcium and other chemical messengers into the synaptic space can then occur through damage in the axon’s membrane. This leakage can lead to disruptions in cellular metabolism, glucose utilization, neuron communication and ultimately apoptosis, or cell death (2).

This all sounds very grave, so you might be asking yourself, is there anything that can be done to protect against / minimize damage, or accelerate the healing process? According to the research, the answer may be yes, and may very well lie within that fish oil capsule you have sitting in your medicine cabinet.

Supplementing with omega-3 fatty acids post traumatic brain injury, particularly DHA (the most abundant omega-3 found in the neuronal membrane) has been shown to produce neuroprotective effects in rats. These essential omega-3 fats appear to enhance phospholipid production (the primary constituent of the cellular membrane), nerve growth and circulation, while at the same time combating chronic inflammation (2).

Do not let this information limit your omega-3 supplementation to post injury, as there is also compelling preliminary research in the rat model for supplementing prior to a potential injury. In a recent paper, Mills and colleagues showed that DHA supplementation prior to a traumatic brain injury in rats significantly reduced axonal injury and apoptosis while improving memory function when compared to controls (3).

This preliminary research in the animal model is quite convincing, nevertheless, more studies need to done on the human population to really determine the need and dosing for omega-3s. Currently, the most frequently recommended dose of supplemental omega-3 for overall health is 1-3 total grams of EPA/DHA per day (2). Now go take your fish oil!

References:
Gail Hayes. CDC Announces Updated Information to help Physicians Recognize and Manage Concussions Early. Available at: http://www.cdc.gov/media/pressrel/2007/r070607.htm?s_cid=mediarel_r070607. Accessed October 26, 2009.

Bailes, JE, Mills, JD. Docosahexaenoic acid (DHA) Reduces Traumatic Axonal Injury in a Rodent Head Injury Model. Journal of Neurotrauma.

Mills JD, Hadley K, Bailes JE. Dietary supplementation with the omega-3 fatty acid docosahexaenoic acid in traumatic brain injury. Neurosurgery. 2011 Feb;68(2):474-81; discussion 481.

A few months ago I wrote about the head injuries in athletes and the concerns for children who play contact sports. The Wall Street Journal (8/31/10) reported on a study published in the journal Pediatrics in which concussions more than doubled between 1997 and 2007 in children playing sports despite participation declining. My concern was not that children are playing contact sports, but rather that the sporting aspect of adolescence and maturity is very important to the youngsters’ development. What I was attempting to identify is that many parents and children do not understand all the potential dangers associated with sports-related head injuries.

Following my post, new research suggests that athletes who have had multiple head injuries may be prone to developing a disabling neurological disease similar to ALS, otherwise known as Lou Gehrig’s disease. The study was published in the September issue of the Journal of Neuropathology and Experimental Neurology. The research, which came out of Boston University School of Medicine and the Veterans Administration Hospital in Bedford has pinpointed evidence of a new disease that mimics ALS in two former National Football League players previously thought to have died of ALS. These findings may mean that athletes previously diagnosed with ALS might actually have had the related syndrome. Clearly, more research is needed.

So what does this mean for our children who are out on the field playing the sport of their favorite athletes? Although sports can cause serious injury to the brain if and when head to head or head to body contact is made, children are more susceptible than adults to injury and its consequences. A child’s skull and brain continue to develop throughout adolescence and damage to this vital organ could be irreversible. The brain is a dynamic tissue and damage may not be noticeable until later in life.

Neurologists are still learning not only how the brain works, but how it matures. Chronic trauma to the brain could possibly lead to chronic progressive disabling neurological disorders, such as ALS, later in their lives.

Be careful what you teach and/or encourage your child to do as they engage in sports. Help them understand the value and vulnerability of their brain, and their entire body for that matter. Help them be aware of the subtle sign of brain injury in themselves and their teammates. If a player does not “feel right,” pay attention and seek medical help. Teach these youngsters to treat their brain with respect as they will need their brain functioning at its full capacity for the rest of their lives.

About Helene Pavlov:

Dr. Helene Pavlov is a Board-Certified Radiologist specializing in Orthopaedic Radiology since 1976. She was elected to be a Fellow of the American College of Radiology (FACR) in 1989 and an Allied Specialty member of the American Academy of Orthopedic Surgeons in 1989. She has published over 100 investigative original research articles, 62 book chapters and review articles and has displayed over 36 exhibits at national radiologic and orthopaedic scientific assemblies. Dr. Pavlov is the first author of 3 textbooks: Atlas of Knee Menisci: Arthrographic Pathologic Correlation – 1983; The Running Athlete Roentgenograms and Remedies – 1987; and Orthopaedic Guide to Plain Film Imaging – 1999. She is well known in both the radiologic and orthopaedic communities for having co-authored two monthly columns in the orthopaedic literature entitled “Radiology for the Orthopaedic Surgeon-What is your diagnosis?” from 1982-1996 and also ” Legislative Update” detailing the current changes in the healthcare/provider laws and regulations from 1988-1996.

Dr. Pavlov serves on the Expert Panel Task Force on Appropriateness Criterion for Musculoskeletal Imaging since 1994 and is a past delegate to the New York State Chapter of the American College of Radiology.

She is an invited lecturer and presenter, including instructional course faculty, at local, national, and international scientific specialty meetings and is a recognized authority of sports medicine radiology and imaging of athletic injuries. She is funded for several clinical research projects by corporate grants.

Dr. Pavlov has been recognized as one of “The Best Doctors in New York” as reported in New York Magazine and Castle Connelly in 2000 and 2001. Dr. Pavlov has been listed in the Consumer’s Research Council of America: “Guide to America’s Top Radiologists First Edition 2002-2003″; and also in Castle Connelly’s: “Best Doctors in Metro Area 2000-2005″.

By Ralph Cornwell, Ph.D., a.b.d.

In a tradition that dates back centuries, physicians take the Hippocratic Oath before they practice medicine. In the original interpretation of the oath, a doctor would swear to “prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone.”

This code of moral conduct offers up valuable lessons to strength coaches and athletic trainers who work with the “patient” in their world: the athlete.

Strength coaches are charged primarily with the duty of preparing athletes for the rigors of their chosen sport. Referring back to the Hippocratic Oath, one could argue that increasing the performance of an athlete should become the second priority for strength coaches because a great athlete standing on the sidelines injured does no one any good.

The top priority for strength coaches instead should be a training regimen targeted first at protecting their athletes from harm as their “patients” are tuned for competition. Strength coaches who help athletes achieve their goals while maintaining their overall good health ensure that these athletes are prepared for any and all possibilities they may face in competition. And just as amazingly, those coaches who have shifted their priorities have realized that performance is not diminished but rather enhanced by a more completely trained athlete.

Of course, it goes without saying that the chance of injury is always a possibility during sports competitions. Simply being in the wrong place at the wrong time can cause an injury despite the best of precautions. Strength-training professionals, however, who take their cue from that vital part of the Hippocratic Oath can step to the forefront to strengthen any perceived weak links in the human chain.

If strength coaches look first to protect their athletes from potential harm and prepare properly and diligently the most vulnerable region of athletes’ bodies, one could also argue then that the number of serious sports injuries could be reduced or minimized.

And what would be the most vulnerable region of the body that if traumatized could lead to a serious, possibly life-threatening injury? Without question, the neck (cervical spine).

 The neck supports the head, which encases the hierarchy of human beings’ functions, the brain. The trapezius–either of the two large muscles that run from the base of the back of the skull to the middle of the back–makes it possible for persons to raise their heads and shoulders. In essence, all these muscles act as the foundation to support the driving force at the top of the body—back to the brain. If the foundation is strong, then the head is better supported and the brain better protected.

Given the critical role these muscles play, one would think the neck and trapezius would be at the top of strength coaches’ regimens for their athletes. But maybe not. For instance, in a recent survey of over 200 college and university strength coaches that asked about their neck/trapezius training regimens, the results revealed this muscle region as low or no priority. This could be explained by the fact that many coaches are simply unaware of the importance of training the neck and the trapezius muscles on which the neck relies to dissipate forces.

Survey questions ranged from “does your weight room have a four-way neck machine” and “do you do any direct stimulation to strengthen the neck” to simply “how important is training the neck in your program.” The results overwhelmingly pointed back to little emphasis and interest. If strength coaches knew of the vital role the neck plays in sports performance, as well as the importance of increasing neck strength, then these results may have been very different.

Muscle regions other than the neck/trapezius area were emphasized in most strength-training programs. Does this sound familiar when examining many of the nation’s strength training programs: bench press for the upper body; squats and leg presses for the lower body; and some abdominal and lower back work. This is a complete regimen, as many would suggest, if the strength coach’s only priority is the performance of the athlete rather than protection of that individual.

But actually by training the neck and trapezius muscles, strength coaches can enhance both protection and performance of their athletes. A stronger neck increases the strength of an athlete, who then functions as a complete working unit. For example, consider that the trapezius muscles run from the base of the back of the skull all the way to thoracic vertebrae 12. Overlooking such a critical and major muscle group certainly would not enhance an athlete’s overall performance.

By neglecting the neck/trapezius area in training regimens, what could that lead to in the lives of athletes? While orthopedic surgeons can repair many soft-tissue and bone-related injuries that can allow athletes to compete again, the neck and cervical spine, however, are not areas of the body where successful surgical outcomes are likely, even with the advances in modern medicine.

If an athlete is fortunate enough not to sustain a catastrophic neck injury, there is still the very real danger of a brain concussion. For example, the Centers for Disease Control recently reported that approximately 300,000 sports-related concussions occur annually in the United States. (A concussion is an immediate and transient impairment in the brain’s ability to function properly.)

Concussions are not only a significant finding among professional and collegiate athletes, but they are occurring more often than necessary among younger players. For example, high-school football players suffer concussions more often than their collegiate and professional counterparts. Additionally, concussions are not gender specific. Studies have revealed that female athletes suffer concussions more often and with less impact than male athletes.

Moreover, researchers today are discovering that subconcussive forces over time can have a cumulative effect on athletes and can be just as debilitating as those who have suffered full concussions. Recent studies on brain trauma suggest that repetitive blows to the head over time—subconcussive forces—might cause a form of dementia known as chronic traumatic encephalopathy (CTE), a progressive, degenerative brain disease.

Consider, for example, the medical condition known as “dementia pugilistica.” Once thought to afflict only boxers, dementia pugilistica is now at the forefront of brain research being done at several major universities. Subconcussive injuries are particularly dangerous because an athlete may not show any symptoms after receiving such blows—not until much later.

The problem with bruises to the brain is that they cannot be seen like the ugly, black and blue torn hamstring. But these hurtful injuries to the brain do exist, and with alarming frequency among a variety of athletes. To minimize these injuries, let’s revisit again the neck/trapezius area and how these muscles play a critical role.

Neck muscles act as springs and shock absorbers; bigger, stronger necks can better absorb with less deformation. Recalling the laws of physics, consider the neck as a cylinder. The larger the circumference of the cylinder, the more load it can support without buckling.

As training the neck area increases strength there, the soft tissue thickens and the neck becomes stiffer. Using physics again to explain the necessity for stiffness, view the neck as a coiled spring. The thicker the coils, the greater the stiffness. A smaller, less stiff spring is easier to compress from an axial-loading standpoint. A stiffer spring—“stronger neck”—deflects greater frontal or side impact forces.

All variables being equal, if a given cylinder increases its diameter by two inches—say from six inches to eight inches–the deformation decreases 43 percent. Common sense, simple logic or even strong speculation would suggest that a bigger, stronger neck would give an athlete a better chance of avoiding serious injury when having to absorb impact forces during collisions.

And female athletes should not avoid training the neck area, as many think they will get a “fat neck” from such conditioning. Biologically, females do not achieve the hypertrophy that males do, but they can benefit greatly from the strength gained in this region of the body.

Training the neck area in four directions—flexion, extention, and left and right lateral flexion—followed by a shoulder shrug exercise offers the most effective direct stimulus to this region of the body. Neck machines are great devices to help with this training, but if strength coaches cannot afford these machines, they should educate themselves on the protocol of manual neck resistance, along with a barbell or dumbbell shrug.

Relating back to the original premise, if strength coaches truly believe their first priority is to protect the athlete and prevent injury and that the neck and cervical spine are at risk during competition, why would they not train this region of athletes’ bodies religiously? If strength coaches train all the agonist and antagonist muscle groups but neglect the neck and trapezius area are they truly preparing their athletes effectively for the rigors of their sport? Well-informed strength and conditioning professionals would see the logic in this premise and would want to help their athletes in any way they could.

Strength coaches need to find 30 minutes twice a week to train the neck and trapezius area. With effective time management and efficiencies, a strength and conditioning program could meet this objective. In setting up a strength training facility, would it not make sense also that for every station, say, for squatting, there would also be a station for protecting the brain and turning the head?

As these questions tumble forth, again the Hippocratic Oath comes back into play—“to prescribe regimens for the good of my patients.” Maybe the essence of that document created long ago can have relevance in more ways than one to strength coaches everywhere today.

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Ralph Cornwell is a Ph.D. candidate in health promotion/human performance at Virginia Polytechnic Institute and State University, with additional course work in sports psychology. An honors society member, he currently is conducting a case study on neck injuries and the prevention of or leasing of concussive forces. He has more than 17 years experience as a strength and conditioning coach, consultant and lecturer. Having derived his training philosophy from Dan Riley while at the Washington Redskins, Cornwell has worked with high-school, collegiate and professional athletes–including those in the National Football League, Major League Baseball and Major League Soccer—as well as women’s soccer and lacrosse players, NFL Europe athletes, European and Russian basketball players, and several international players from Africa and Australia. He has been the head strength and conditioning coach at Radford University, the University of North Carolina at Greensboro, and North Carolina Agricultural and Technical State University, and assistant coach at the United States Military Academy at West Point. Cornwell points to the fact that he never had an injury in a weight room where he was the head coach. At age 45, he still trains as hard as any of his athletes.

By Joe Hughes

Baseball is no longer just a spring sport.  Players are now participating in this sport year round.  Upon completion of the regular season and play-offs athletes continue to play the game during the summer and into the fall.    This is most evident in high school and youth baseball programs.  Coaches, parents and players are under the misconception that players need to play year round to continue to develop their baseball skills and fundamentals.   Players are encouraged to participate in travel leagues and summer and fall completion.  In addition to game activity a majority of players still participate in hitting and pitching lessons.  This continuous activity increases your chances of injury, mental burnout, physical fatigue which will all lead to decrease performance and career ending injuries.

The four major risk factors resulting in shoulder injuries in youth baseball are 1) year round baseball 2) overuse, playing in more than one league or coaches not monitoring pitching volume, 3)   the radar gun resulting in players trying to throw as hard as they can and 4) showcases where players go out and throw hard to show off for a college coach or a maybe a pro scout when they are not in shape to throw or arm is fatigued from a long season.

VOLUME, VOLUME AND VOLUME IS THE SINGLE FACTOR WHICH CONTRIBUTES TO FATIUE, OVERUSE AND INJURIES IN BASEBALL.   Bottom line most coaches do not monitor their pitchers throwing volume or percentage of type of pitches they throw (fastball, sliders, change-ups, split, curve) during the course of the season.  This in combination with athletes not participating in a sound strength and conditioning program with an aggressive shoulder and elbow injury prevention program increases the chances of shoulder or elbow related injuries or surgery.

Take a Break from the game.  Utilize the off-season to allow for rest and recovery and physically prepare your body to improve performance and reduce the risk of injury.  Still dedicate time to continue to improve your skills but your priority should be rest and a sound strength and conditioning program.  Remember the big picture…..making it to the next level and career longevity…know when to GIVE THE GAME A BREAK!

The exact reason for pain is unknown, but it may be due to repetitive microtrauma, which leads to chondromalacia of the patella and or trochlear groove. Inappropriate patellofemoral articular balance from malalignment, patellofemoral incongruency, or dynamic imbalance, such as a weak vastus medialis oblique, may predispose one to chondromalacia. In addition, mechanical imbalalance of the foot and ankle, such as hyperpronation of the foot during foot strike may predispose the patella to maltrackingand subsequent symptoms.

TREATMENT

Initial treatment is conservative and emphasizes reduction of activity with quadriceps and hamstring flexibility and strengthening. If a lower extremity imbalance exist, shoe orthodic inlays with a medial heel wedge and arch support may be needed. Long arc exercises, such as forceful knee extensions from a hyperflexed position, will aggravate the condition and should be avoided. Quadriceps strengthening includes quadriceps setting, straight leg raises, and short arc extensions avoiding the terminal 30˚ of extension because of the high patellofemoral contact pressures. Iso-kinetic exercises that impose high loads on the patellofemoral joint should be avoided.