How to Save a Young Athlete’s Life: Pre-screen with an ECG

The Case for Using an ECG to Screen for Cardiac Disorders.

Does Pre-Screening Help Prevent Loss?

Each time a young athlete dies of a cardiac-related incident after athletic exertion, the debate over athletic pre-participation screening is reignited. The loss of a seemingly healthy young athlete to sudden cardiac death (SCD) is a jarring event that leaves people questioning what could have been done to prevent the tragedy. Cardiomyopathy leading to ventricular arrhythmia and SCD is actually the second leading cause of athlete death behind trauma. While SCD is rare, the statistics cause concern: almost 80 percent of athletes who die of a cardiac-related incident showed no symptoms prior to their death, and over 90 percent of SCDs in young athletes occur during or shortly after exercise. The NCAA estimates that nearly a dozen college student-athletes in the U.S. suffer sudden cardiac arrest each year.

The Gap in Current U.S. Recommendations

Current American Heart Association (AHA) standards do not recommend routine pre-participation screening for athletes, citing expense, burden to the healthcare system and false positive results. Rather, the AHA suggests use of a screening tool that includes 12 questions about personal and family medical history and a physical exam to identify aspects of an athlete’s health that could signal a cardiovascular problem.
But what about athletes who are not aware of, or do not have access to, extensive family history or who are reluctant to report these potential health issues for fear of being excluded from participation in their sport?
In 2005, the European Society of Cardiology recommended universal screening, and this position has been endorsed by the International Olympic Committee. Israel also requires ECGs as part of athletes’ pre-participation physicals (PPE).
These pro-screening policies are largely a result of a population-based study conducted in Italy which examined the athletic and nonathletic populations between the ages of 12 and 35 years. The annual incidence of SCD in athletes decreased by 89 percent between 1979 and 2004; whereas the incidence of SCD among the nonathletic population did not change significantly. Most of the reduced mortality rate was due to fewer cases of sudden death from cardiomyopathies.
Recent research supports the viability of screening with ECGs, despite concerns about cost and false positive results. A study commissioned by the NCAA screened 2,471 athletes from 14 NCAA Division 1 universities who had not previously received an ECG screening. Seven athletes were diagnosed with serious cardiac disorders, all of whom had abnormal ECGs, but only two of those athletes had an abnormal history or physical exam.

A Trend Toward Cardiovascular Screening in the U.S.

A recent survey of head athletic trainers in NCAA Division 1 football programs found that 35 of the 116 schools were already incorporating non-invasive cardiovascular screening (NICS) in their PPEs.
As the trend in the U.S. moves toward a more proactive approach to screening, and with mounting evidence pointing to the value of screening athletes with ECGs, perhaps athletic trainers and programs should consider partnering with contracted medical staff, or better yet should invest in an onsite ECG, like the ones found on Sports Health to have ECG testing readily available. After all, it could mean the difference between life and death for a young athlete.

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Danielle Masursky, PhD
Janice Riley, RN, CRA

Bibliography

Corrado D, Basso C, Pavei A, Michieli P, Schiavon M, Thiene G.Trends in sudden cardiovascular death in young competitive athletes after implementation of a preparticipation screening program. JAMA. 2006 Oct 4;296(13):1593-601.
Coris EE, Sahebzamani F, Curtis A, Jennings J, Walz SM, Nugent D, Reese E, Zwygart KK, Konin JG, Pescasio M, & Drezner JA. Preparticipation cardiovascular screening among National Collegiate Athletic Association Division I Institutions. British Journal of Sports Medicine.2013; 47(3):182-4.
American Medical Society for Sports Medicine. NCAA-Funded Study Supports Screening NCAA Athletes for Sudden Cardiac Death Risk. [Press Release, April 21, 2013]. Retrieved from http://www.amssm.org.
American Heart Association: Pre-participation Cardiovascular Screening of Young Competitive Athletes: Policy Guidance (June 2012) Retrieved from http://newsroom.heart.org.

BOSS Hydration System Review

This blog was written by Phil Hossler, ATC. Phil has been an athletic trainer on the scholastic, collegiate and Olympic levels. He has authored 4 books and numerous articles and served as an officer in state and regional athletic training associations for 20 years. He is a member of four halls of fame including the National Athletic Trainers’ Association’s.

As a certified athletic trainer and director of several large sporting events, properly and adequately hydrating participants is one of my standard safety concerns. There are multiple solutions available to provide hydration depending upon budget and number of participants. These options range from bottles and coolers to cups, hoses and drinking stations.


In reviewing products, I was intrigued by the BOSS Drinking System. About two decades ago, I actually thought along these lines and developed a lid with a hand pump idea. I was glad to see BOSS refine this idea to one of battery power. The product seems to be well conceived with a lid that does not have to be exclusively used on ONLY their coolers but can be used on any screw on 7- or 10-gallon cooler.


Often the large 10-gallon coolers can be too heavy for many high school age athletes to transport so the inclusion of a cart by BOSS was a nice touch. The BOSS system provides a four hose assembly with auto shut-off capabilities so that when not in use the nozzle can shut off to conserve battery power. The power is provided by a 12-volt DC rechargeable battery.


There are, however, some possible negative points that I would like to explore. There are several vendors that carry the BOSS system. I found Sports Health to be the most detailed and offer the greatest variety of combinations. If I had the chance I would like to actually use the BOSS system, but my school budget will not permit me to do such an experiment.


So, my following thoughts are based on experience and product review but not on actual use:

1. It appears that the cart may not be substantial enough to last long with the weight of a 10-gallloon cooler. It appears to be aluminum and the arm holding the actual cooler should be longer to reduce the axial load at the fulcrum point.
2. Sports Health does a nice job, actually better than www.outdoorboss.com does explaining the different options available.

Learn more about BOSS Drinking Stations

Concussion Book & Documentary a Must-Read for Anyone Involved in Sports

Head Games- You need to know the rules to this game

This blog was written by Phil Hossler, ATC. Phil has been an athletic trainer on the scholastic, collegiate and Olympic levels. He has authored 4 books and numerous articles and served as an officer in state and regional athletic training associations for 20 years. He is a member of four halls of fame including the National Athletic Trainers’ Association’s.

To say that head injuries, specifically concussions, are more in the spotlight now than ever before, would be understating the obvious. With a number of retired National Football League (NFL) players coming forth since 2006, the subtle, yet substantial, effects of diagnosed concussions and “sub-concussive” head trauma have gained national attention.

One the leader of this heightened awareness is Christopher Nowinski from Boston. Chris is a Harvard graduate, former Harvard football and former WWE professional wrestler. Looking back now, Chris realizes how many and how serious some of his “dings” throughout his career(s) actually were. His book, Head Games details the National Football League’s dealings and misdealings in the area of player safety as it relates to head trauma. The combination of the text and now film is perhaps the finest, most detailed and comprehensive regaling of the underbelly of this country’s most beloved sport. These are must reading and viewing by anyone associated with sports, not just football.

The award-winning documentary is a feature length by an acclaimed director. It combines actual stories from players, surviving loved ones and some of this nation’s finest brain trauma experts. Dr. Ann McKee, MD, Dr. Robert Cantu, MD and Dr. Robert Stern, PhD - who are now known internationally for their work and examination of deceased brain tissue changes of former athletes from a variety of sports and age groups.

As someone who played 4 years of high school and 4 years of college football, I identified with the stories. On one occasion I was knocked unconscious in college practice. It took me considerable time to remember the play I was carrying the ball on. I am glad now that I did not act upon the invitation letter to attend an NFL non-drafted player tryout.

The film is an outstanding tutorial; it is not a condemnation of sports. It supports the inherent value of sports, overcoming obstacles, teamwork and life values. But all these objectives must be tempered with safety, rule changes, age-specific alterations and increased scrutiny of participants’ health. Several former professional athletes now must live their lives filled with mental and physical shortcomings. Several deceased athletes that we all loved to watch display their talents are believed to have succumbed to dementia, Alzheimer’s or depression.

Chris’s involvement and narration on the documentary expertly delves into boxing, college football, girls’ soccer as well as professional ice hockey and football. These experts detail the need to decrease or eliminate the “military mentality of organized war with rules” that sports have so often become. Dr. Cantu, father of the first grading protocol for concussions, says that with the rise in sports participation every high school that offers a sports program should have a certified athletic trainer on staff. If not, then schools should not offer sports that give rise to concussive trauma. He goes on to state that the number of practices that allow head trauma should be reduced to reduce the incidences of “sub-concussive” head trauma. He points out that the NFL typically has only one practice day a week with contact.

This five star detailing of accounts, history and real stories make the text and documentary film a requirement for every high school and college athletic department’s must read/view list.

Learn more about how to purchase Head Games

Athletic Trainer Helps Save High School Referee with AED

Watch the video of the Athletic Trainer reunited with the referee who's life she helped save on Thursday, February 7th during an exciting overtime Girls' Basketball game at Eastchester High School in NY. Neil Berniker, teacher, coach and high school referee in the Bronx, suddenly collapsed and hit the floor while officiating the game. Jason Karol, the school's Athletic Director, along with Ellen Bastoni, the school's Certified Athletic Trainer, came to his rescue.

"As soon as I ran over, I saw he wasn't breathing and I yelled to call 911," Karol said. "I told the [athletic] trainer to get the AED because he was gasping for air but he wasn't breathing." Karol, a first year athletic director, began CPR until Bastoni returned with the LIFEPAK 500 AED (Automated External Defibrillator).

Once the AED was connected to the referee, it advised a shock. Incredibly, through the efforts of Karol, Bastoni and a parent bystander, Berniker was successfully revived in front of the 200 people watching solemnly from the stands. "We saw his eyes open and he started breathing again," Karol said. "He was confused and I just held his hand until the EMT's got there. He didn't know what happened."

Once EMT's arrived, Berniker was put on oxygen and transported to the intensive care unit. It was reported that he is recovering well, and that he was up and walking and making jokes by the next day.

Eastchester has 23 AEDs located strategically throughout their buildings. Interestingly, the week before the referee collapsed during the basketball game, the placement of the AEDs was reviewed and the one used to save Berniker's life was placed in a more accessible location in the gym so that it could be utilized after normal school hours.

Sports Health is a leading provider of AEDs to schools and athletic organizations across the country. The AED Program at Eastchester High School was implemented with the help of a School Health/Sports Health Representative. If you would like more information, please contact us and one of our knowledgeable representatives will get in touch with you.

Request an AED Consultation and Download "The 10 Common Mistakes Made By School AED Programs">>

Video courtesy of Lohud.com

About Sickle Cell Disease and Athletes

Sickle cell trait needs to be identified in athletes

Sickle cell disease (SCD) is a condition in which  red blood cells can develop a “C” shape similar to the old farm tool called a sickle that was used to harvest grains. The danger of the “C” shape blood  cells is that they die early which causes a shortage  of red blood cells. Due to their non-round shape they can also become stuck and clog smaller blood vessels resulting in pain and other complications.  Tissue that does not receive a normal blood flow eventually becomes damaged. This is what causes the complications of sickle cell disease. Read more: http://www.nhlbi.nih.gov/health/health-topics/topics/sca/

Disease (SCD) or Trait (SCT)?

SCD is a genetic condition that is present at birth having been inherited from one or both of their parents. Persons who have inherited one sickle cell gene and one normal gene have SCT. This means the person won’t have the disease, but will be a trait “carrier” and can pass it onto their children. Sickle cell trait is not a type of sickle cell disease. People with sickle cell trait are generally healthy. Persons with SCD can pass either SCD or sickle cell trait (SCT) onto their children.

SCT affects 1 in 12 African Americans in this country. Estimates are that 3 million people in the United States have SCT and many are unaware of the condition. SCT is also frequently found in people living in or have families in South and Central Americans, Caribbean, India, Arabia and Mediterranean counties such as Turkey Greece and Italy.

Chances of Inheriting SCD or SCT

• Both parents have SCT = 50% chance of SCT in their children; no symptoms in children of SCD; but they can pass SCT onto their children
  
• Both parents have SCT=25% chance of SCD in their children; 25% of no SCD in their children
  
• One parent has SCT= 50% chance of SCT; 50% chance of no SCT
  

How do you know?

A simple blood test is used to detect SCT. For several decades now blood testing for sickle cell and other blood conditions has been standard on newborns. Families with inherited SCD and SCT tendencies should see a genetic counselor (contact your family physician or local hospital) to investigate the number of relatives on the husband’s and wife’s side of the family who are carriers before deciding on having children of their own.

Knowledge of medical problems possibly associated with sickle cell trait and their appropriate management is good clinical practice for athletic programs so check with the school physician and/or the athlete's physician.

How Improving Listening Skills Can Improve Athletic Healthcare

Being is a good listener is half of being a good speaker. Americans spend 80% of their waking hours communicating. We spend 45% of the time listening, but we only listen at about 25% of our ability to do so.

Student-athletes need to understand their assignments, know the techniques of the sport and to listen to -  not just hear - instructions. The following guidelines will help student-athletes and student trainers become more effective communicators by improving their listening skills:

• In order to listen you have to stop talking.
• Listen actively. You can hear someone without really listening to them. 
• Don’t get ahead of the person talking. 
• Wait. Don’t jump to conclusions. 
• Listen to them without turning their story into your story.
• Don’t finish other people’s sentences. Be patient and do not interrupt. 
• Become a student of human behavior. Observe their nonverbal language. 
• When appropriate, summarize to show you were actually listening. 

When tending injured athletes, care providers must pay attention to details that affect decisions. Asking and listening are key evaluative tools used by all health care providers. Injured athletes need to feel comfortable and reassured by the person who is caring for them. Powerful body language, positive facial expression, eye contact and professional verbal skills are trademarks of successful people in all walks of life. This is especially true in the emotional, fast paced world of athletic healthcare.

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Successful Verbal and Non-Verbal Communication Key to Success in Athletics

Communication is the key to successfully accomplishing any task in athletics. From the catcher’s signals with the pitcher to the coach’s pep talk before the game, effectively conveying your message is crucial. Successful leaders throughout history have been effective communicators.

People use as many as 40,000 words in a normal day. Each day we typically spend 45% of our day listening, 30% speaking, 16% reading and 9% writing. Unfortunately, most of our training is just the opposite - with most of our time being taught how to write and very little time spent teaching how to be an effective listener. Effective communication is made easier by finding what you have in common. Focus on the common goals, not the common obstacles.

Your appearance is how someone initially molds their opinion of you. First impressions are lasting ones and are often formed with the first three minutes.

Your body language conveys a powerful message. Learn to stand and sit tall. When speaking, stand firmly on both feet and make eye contact with the person, but don’t stare or will make them uncomfortable. Don’t clench your fist or tap your fingers. Take a breath; relax and speak slowly and deliberately. Avoid quick snappy answers that you later take back.

Most of what you say goes without saying; actions and body language speak louder than words.

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Dancer's Foot Information and Treatment Suggestions

Dancer's Foot

Sesamoid bones are one of nature’s most amazing anatomical creations. Sesamoid bones are unique in that they are “floaters” - not connected to another bone - and they are embedded in a tendon or muscle. They provide a smooth surface over which tendons can slide to increase mechanical (muscle) power. The leverage advantage produced by the exact location of this bone gives us leg power (patella bone) as well as foot movement. The sesamoids in the forefoot (directly under the first toe joint) assist with weight bearing and help elevate the bones of the great toe.

Like other bones, sesamoids can break and tendons surrounding the sesamoids can become irritated or inflamed. This is called sesamoiditis. When the patella is dislocated or the Q angle (angle between thigh bone and larger shin bone) is excessive, the patella may not glide smoothly each time the leg is flexed or extended. If the underside of the patella loses its smoothness a condition called chondromalacia may develop.

On the underside of great toe there are two sesamoid bones. The great (big) toe is critical to walking, dancing and running. These two sesamoid bones improve the angle and effectiveness of the toe-off portion of the gait cycle. When injured there may be no swelling and bruising with pain localized directly under the joint of the big toe. If this pain appears quickly you should seek physician care for an x-ray. If you experience pain bending/straightening the big toe even when non-weight bearing, suspect sesamoiditis.

The American Academy of Orthpaedic Surgeons offers the following guidance for sesamoiditis:

• Stop the activity causing the pain.
• Take aspirin or ibuprofen to relieve the pain.
• Rest and ice the sole of your feet. Do not apply ice directly to the skin, but use an ice pack or wrap the ice in a towel.
• Wear soft-soled, low-heeled shoes. Stiff-soled shoes like clogs may also be comfortable.
• Use a felt cushioning pad to relieve stress.
• Return to activity gradually, and continue to wear a cushioning pad of dense foam rubber under the sesamoids to support them. Avoid activities that put your weight on the balls of the feet. 
• Tape the great toe so that it remains bent slightly downward (plantar flexion).
• Your doctor may recommend an injection of a steroid medication to reduce swelling.
• If symptoms persist, you may need to wear a removable short leg fracture brace for 4 to 6 weeks.

There are specific pads for sesamoiditis in the foot that are intended to re-distribute body weight off of the bones upon weight bearing. Find these pads on the Sports Health’s web site >>

Easily Improve Your Fitness Level Using a Pedometer and These Walking Tips

Walking for Health

In our current fast paced world, we still can’t find enough time to do that one thing that we need: mild to moderate exercise repeated often. For the majority of Americans we do not need military-like fitness goals, we just need to do something actively and do it often.

Examples of lifestyle changes are common, well known and yet still underutilized, such as park the car in the last row at the mall instead of the closest row, stop the elevator one floor early and walk the stairs to your floor and walk yourself (or your dog) for that 15-30 minutes every night after dinner.

For many of us, we have grown accustomed to measuring, assessing and defining our lives and for this crowd using a pedometer is perfect. A pedometer is a device that senses your movements to tally up the number of steps you take. It can be worn, clipped, tucked or carried. Pedometers can be simple (clip it on your belt and start walking) or advanced (determine your stride length, weight, pulsating rhythm as you walk, calories burned and can be downloaded onto your computer). Choose a pedometer that has a display you can easily read in different lights, can be worn comfortably and has the features you want.

Prices range from $10 to over $100. If you are new to the walking idea and the keeping track of your “motion minutes”, start simple and move up when needed. Once you are ready to get started, try wearing it around your normal day for about 2-4 days just to see how many steps you take in a typical day. You can now begin to add steps by scheduling that 10, 20,30 minute walk and add them onto your total. If you want to measure distance instead of steps, find that local track or measured distance by car, walk the ¼ mile and see how many steps or strides it took you, multiply by 4 and there you have your mile number. Remember this is an estimate, but after all, we are in this to be in motion not measure in exact feet or yards!

According to the staff at the Mayo Clinic, you should

• Set long-term step goals. Think about your overall fitness and activity goals. Your short-term goals are the building blocks to these long-term goals. A long-term goal may be walking 10,000 steps a day, or about five miles (eight kilometers), several times a week as part of your new daily routine. You may also want to set a goal of walking faster as your fitness level improves. Keep in mind that the Department of Health and Human Services recommends that, in general, healthy adults get at least 150 minutes a week of moderate aerobic activity or 75 minutes a week of vigorous aerobic activity.
• Track your progress. To see how you're doing, monitor your progress over time. Your pedometer may or may not have a memory function to track your steps on a weekly or monthly basis. You can choose to use that feature or record your steps in a log of your own making. Or upload the information digitally to your computer or mobile device. Tracking your progress can help you see whether you're meeting your goals and when it may be time to set fresh goals.
• Check with your physician before beginning, especially if you have been sedentary for a while, have any orthopedic problems or have any medical issues that are being monitored.

To read more about different pedometers, shop Sports Health pedometers online >>