Tuesday, March 16, 2010

Tommy John” Elbow Reconstruction 95% Successful with Grown Teen Pitchers, Study Says

A new study presented today at the American Orthopaedic Society for Sports Medicine’s (AOSSM) Specialty Day in New Orleans, (March 13), found that 95 percent of skeletally mature high school pitchers were satisfied with their “Tommy John” elbow reconstruction surgery. Almost as many, (94.7 percent) returned to competitive baseball.

“Tommy John” surgery is a procedure where a damaged elbow ligament (ulnar collateral ligament or UCL) is replaced with a tendon from elsewhere in the body. The surgery is named for Hall of Fame pitcher Tommy John, who was the first person to have the surgery in 1974. John returned to the major leagues and went on to win 164 games after the surgery. Prior to this historic surgery, a UCL injury was a career-ending injury.

“High school kids have been a grey zone for this surgery,” said Michael J. Angel, MD, of Premier Orthopaedics of Westchester and Rockland. “Obviously, surgeons would avoid surgery on young patients whose growth plates had not closed. But this study can give surgeons the confidence to recommend this surgery to teenage skeletally mature athletes. It also gives the teen and their parents assurance that the surgery should go well.”

In the study, 20 high school baseball pitchers between 16 – 18 years old had the UCL surgery, 19 out of 20 reported being satisfied with the surgery (17 were very satisfied, 2 were somewhat satisfied). Eighteen of the 19 satisfied patients (94.7 percent) reported that they returned to competitive baseball. Of the 19 players, three reported that their highest level of competition was in the minor leagues, another 13 went on to play intercollegiate baseball and three returned to high school baseball.

Overuse injuries account for nearly 50 percent of all sports injuries in middle school and high school students, according to the National Center for Sports Safety. For high school athletes whose growth plates have closed, this study shows that the “Tommy John” UCL reconstruction is a successful option for teenage baseball pitchers who need it.

While the trend of young athletes to specialize in one sport remains controversial, sports medicine has developed innovative surgeries to repair and reconstruct overuse injuries that can result from specialization. However, the bigger problem is prevention of injury. AOSSM and several other sports medicine organizations, including the American Academy of Orthopaedic Surgeons, American Medical Society for Sports Medicine, American Academy of Pediatrics, National Athletic Trainers’ Association, National Strength and Conditioning Association and SAFE Kids USA have teamed together to help prevent overuse injuries in youth athletes. The STOP (Sports Trauma and Overuse Prevention) Sports Injuries campaign includes cutting edge information on sport specific injury prevention techniques for athletes, parents, coaches and healthcare providers. For more details, visit www.STOPSportsInjuries.org.

Wednesday, March 3, 2010

Soccer reduces risk of falls and bone fractures

An extensive research project has studied the effects of soccer on muscle strength, postural balance, bone mineral density and reflex response to a sudden push in the back among adult women and men. Five scientific articles are now being published in Scandinavian Journal of Medicine & Science in Sports showing that regular participation in soccer increases both bone mass and bone density, causes a significant improvement in standing postural balance and improves muscle strength. Together, these effects reduce the risk of falls and bone fractures.

The observed improvements in bone mineral density, strength and postural balance due to recreational soccer are of particularly interest for a large group of women but also for elderly men, says project leader Associate Professor Peter Krustrup, Department of Exercise and Sport Sciences, and continue "It is well known that the risk of falls and fractures increases with age as a result of weaker bones, poorer balance and attenuated ability to trigger rapid muscle force, but the present results suggest that soccer - and possibly other ball games - is an effective training method to reduce bone weakening that comes with increasing age".

Better bones from soccer than from running

A 14-week study in which women aged 20-47 years trained soccer twice a week showed marked increases in bone density in the left and right tibia. Furthermore, soccer training showed an elevated mass of the calf muscle, greater muscle strength, and an improved balance. A 16-months training intervention for the same subject group showed that prolonged soccer training for untrained premenopausal women elevates whole-body bone mineral density. The women who participated in the study had never played soccer before, implying that all can benefit from soccer. Interestingly the short- and long-term training effects on bone mineral density were greater for the soccer players than for a similar group of runners and an inactive control group.

- "During soccer training and games, the players perform many sprints, turns, kicks and tackles. This combination of actions help achieve a variable bone impact that appears to provide a better stimulus to bone mineralisation than running", explains project leader Peter Krustrup.

Little training required

Small-sided soccer games for 1 hour two to three times a week during 12 weeks for untrained men aged 20-40 years resulted in significant increases in muscle mass and leg bone mass, whereas no effects occurred for the inactive control group. The postural balance was improved as well. In a follow-up study on long-term effects of soccer for men, it was demonstrated that 64 weeks of training have an additional effect on both muscle mass and leg bone mineral density. These effects were observed despite the fact that the training volume was reduced significantly. After the first 12 weeks the training frequency was only 1.3 times per week, indicating that a relatively small amount of training can nevertheless affect bone strength in the longer term.

70-year-old men as fit as 30-year-olds

The research group has also examined muscle function and postural balance in a group of 65-75 year old men who have played recreational soccer most of their lives and compared the values with a group of men at the same age without specific training and a group of 30-year-old untrained men.

- "The research shows that 70-year-old men, who have played soccer most of their lives on a recreational basis, have just as good a balance and rapid muscle strength as untrained 30-year-olds and much better balance and muscle strength than their peers" says Peter Krustrup.

As an example, the untrained older men had more than twice as many falls in a one-leg balance test, compared to the soccer-trained older men and untrained young men.

About the project

Led by Professors Peter Krustrup and Jens Bangsbo from Department of Exercise and Sports Sciences, University of Copenhagen, 50 researchers from seven countries have studied the physical, psychological and social aspects of soccer and the results are remarkable. A number of scientific articles from the project are published on 2 March 2010 later this month the Scandinavian Journal of Medicine and Science in Sports will publish a special edition issue entitled "Football for Health" containing 14 scientific articles from the soccer project. The research project has received funding from FIFA - Medical Assessment and Research Centre (F-MARC), The Danish Ministry of Culture, TrygFonden, United Federation of Danish Workers (3F), The Danish Football Association, Team Denmark and The Danish Sports Confederation.

Further research plans:
The researchers have specific plans to examine the effect of soccer on other patient groups such as people with diabetes II and cancer. The research group is also planning follow-up studies of the long-term effects of soccer on preliminary stages of osteoporosis, on high blood pressure for middle-aged men and women as well as the cardiac and musculoskeletal health effects of youth soccer. A planned collaboration with an international network of researchers from, among others, England, Italy, Portugal, Switzerland, Germany, Norway, Sweden, USA, Kenya and Iran will examine the cardiovascular and musculoskeletal effects of soccer and other ball games such as basketball, handball, volleyball and floorball on inactive and overweight children and inactive elderly people.

Tuesday, March 2, 2010

Common Marathon, Half-Marathon Training Mistakes

Half marathons and marathons can be over in a matter of hours, but runners, both newbies and elite, often spend months training for the 13.1- and 26.2-mile races. Robert Chapman, director of the Human Performance Laboratory in Indiana University's School of Health, Physical Education and Recreation, and coach of Brook Team Indiana Elite, discusses four common mistakes runners make when preparing for these major races.

Mistake #1: Discounting the importance of the weekly long run

For the half-marathon and marathon, the weekly long run is one of the most important components of training. The adaptations that take place physiologically and psychologically during the long run are critical in helping the runner complete the race distance, as well as helping the runner achieve a goal time. Key adaptations that take place with the weekly long run:

* Increased storage of muscle glycogen. Glycogen is the primary storage form of carbohydrates in the body, and the amount of glycogen the body can store is limited. In a typical person, there is enough glycogen present to fuel about two to three hours of moderate exercise. When glycogen stores get low or run out, the runner "hits the wall" and will struggle to finish the event. However, glycogen stores can increase as a result of training, and stores improve significantly as a result of including long runs each week.

* Improved psychological ability to handle the race distance. With each weekly long run, there is an improvement in the runner's ability to mentally tolerate exercising for long periods of time.

* Improved ability to absorb and tolerate the "pounding" the legs will take during the race. Feet, joints, tendons and muscles are all gradually strengthened over time from the overloading they receive from the weekly long run. Many runners who fail to finish a marathon do so because of leg pain and discomfort, resulting from the weight-bearing pounding over 26 miles.

* Chapman recommends a long run once each week, starting early in training at about 20 percent of overall weekly volume. From there, athletes in the half-marathon should aim for a minimum long run distance of 8-10 miles, ideally completed at least twice before their race. Marathoners should aim for a minimum long run distance of 15 miles, completed at least twice before the race, with at least two long runs of around 20 miles being ideal.

Mistake #2: Selecting a race without considering the weather or lifestyle considerations for training.

Most marathons are held in the spring or fall because of the milder temperatures in the Northern Hemisphere. Most experts recommend a training buildup of 10-16 weeks for most experienced runners prior to a marathon, perhaps a few weeks less for a half marathon.

For athletes who select a spring race, this will mean completing a large portion of their training during the thick of winter -- where cold temperatures, snow and ice, and limited daylight hours can all have a dramatic effect on the quality of training and motivation for completion. Runners with work and family commitments, who have to train in early morning or evening hours, may find preparation for a spring marathon challenging. For athletes who select a fall marathon or half marathon, the bulk of the training load will come during the heat and humidity of summer. For most runners, training in extreme heat is more challenging than training in cold weather, where additional clothing can be worn. While it may be considerably easier to get runs in during early morning or late evening hours, summer is typically full of family vacations and weekend outings that can make sticking with a rigid training routine more difficult.

In the end, when deciding on a marathon or half marathon, each runner should take a look not just at the time of the year of the race, but the logistics of how well they will be able to complete their training in the three to four months prior to the event.

Mistake #3: Failing to "practice" the race day routine.

After weeks and weeks of training, many runners end up failing to finish or meet their goals -- often due to some simple, small detail that was overlooked regarding race day routine. Here are some examples:

* Not being used to running in the early morning, when most races start.
* Logistics such as bus departure for the race start, parking, proximity of race to hotel.
* Breakfast decisions, such as what and when to eat.
* Clothing, shoes, socks -- will they cause chafing or blistering?
* Uncertainty about the sports drink provided by the race and whether it upsets runners' stomaches.
* Shoe choice -- newer or older pair.

Many of these questions can be worked out during weekly long runs, such as clothing and breakfast choices. Runners also can contact race organizers for details about sports drinks and then try out the drinks during training. The weekly long run is not just an important component for training adaptations. It is also a great "dry run" for the race.

Mistake #4: Starting the race too fast.

Three athletes who Chapman coaches qualified for the U.S. Olympic Marathon Trials and another won the Columbus Marathon in her debut at the distance. In all four cases, the athletes executed a "negative split" strategy -- where the second half of the race was faster than the first.

Based on the paces completed in training, runners should have a strong idea of what pace they are capable of executing for the race distance, with slight modifications based on changing race day conditions such as weather. Once that pace is determined, Chapman recommends a conservative approach, especially if the goal is simply to finish the race. Even if a runner has a goal time in mind, a conservative, negative split approach will often lead to best performances, typically without the late race discomfort that normally accompanies a more aggressive pacing approach.

Starting out at a conservative pace can often be a challenge with the excitement of the race start, the bands and music, and even fireworks that are present when the gun fires. However, the most common recipe for disaster in a marathon is going out too fast.