Obesity in a high school football player.

When a physician disqualifies an athlete based on theoretical deleterious effects, he is doing so based on the perception that the risk of participation is sufficient to override the athlete's desire to participate (4). If sports participation is very important to the athlete, the sports physician should determine what interventions might reduce the risk of participation. Rather than look for reasons for disqualification, the team physician should look for ways for the athlete to participate more safely and reduce the risk of injury. (If the risk of participation is too high, the athlete should be disqualified.) In this case an aggressive shoulder rehabilitation program and prompt follow-up of his asthma and anemia would have been helpful to this athlete's participation in football. In general, team physicians should weigh all the potential risks and benefits in each case and involve the athlete and the family when these difficult playability issues arise. The team physician should be mindful of potential conflicts of interests and should be careful to avoid imposing his or her own values on the athlete. In this case, the disqualification of this athlete based on obesity was not in his best interest. Whether the potential conflicts in decision making played a role in the decision in this case will never be known. Weighing the facts as presented, I believe the athlete's interests would have been better served by allowing him to play after completing a shoulder rehabilitation program.     

Case presentation: painless arm swelling in a high school football player.

Paget-Schroetter syndrome, more commonly called "effort thrombosis," has been well documented in the literature but is considered an uncommon cause of morbidity in the athletic population. We describe a case of axillary-subclavian vein thrombosis ("effort thrombosis") that presented as painless arm swelling in a high school football player. This case reviews the presentation, diagnosis, and management of this difficult problem in a young athlete.     

Jejunal rupture in a football player

An 18-year-old football player sustained a jejunal rupture when he was struck in the abdomen during a high school football game. Such abdominal injuries in contact sports are rare; however, it is imperative that team physicians, trainers, and coaches be aware of such injuries.     

Myasthenia gravis in a collegiate football player

A 17-yr-old Division I-AA collegiate offensive lineman developed unilateral ptosis shortly after minor head trauma during a scrimmage. The subsequent temporal profile of the ptosis, a history of a similar event lasting a short period of time 2 yr earlier, and the results of his clinical and electrophysiologic examinations established a diagnosis of very mild, generalized, antibody-negative myasthenia gravis (MG). His desire to continue playing football posed several additional management problems for which there was no published guidance. We started him on alternate-day, high-dose prednisone therapy with potassium and calcium supplementation, and allowed him to partake in conditioning but no contact. Except for residual decreased exercise tolerance, he improved symptomatically and experienced no serious adverse effects from the illness or the treatment during his first season, despite imperfect drug compliance. His MG eventually came under excellent symptomatic control, allowing initiation of a slow taper of the prednisone before his second season. Shortly thereafter, he abruptly stopped the prednisone without seeking medical advice. He continued to experience mild left ptosis and a mild decrease in intense exercise tolerance. He decided to forego his senior season of collegiate football after a bout of severe mechanical low-back pain incurred during spring football practice and limited his athletic activity thereafter to recreational sports.     

Cervical disc herniation in a football player.

A case of cervical disc herniation occurring in close association with playing football is reported. The handling of neck injuries in football players is outlined.     

Seizure disorder in a professional American football player

Conclusions This 27-year-old previously healthy professional football player developed a tonic-clonic seizure and delirium due to acute hyponatremia. This appears to be the first case of hyponatremia in an American football player. Hyponatremia was due to acute water intoxication; sodium losses through sweat and emesis may have partially contributed. There may have also been some contribution from renal dysfunction and diuresis due to his supplement use. Proper education regarding appropriate type and volume of fluid consumption, additional dietary salt intake, general nutrition, and close monitoring of body weight should prevent this disorder. The CT scan and chest radiograph findings appear to have been artifacts, but complicated the treatment of this patient. Because of these radiographic findings and the history of chronic excessive water consumption, the patient was treated as having chronic hyponatremia. In retrospect, he should have been treated as having acute hyponatremia with water restriction, and possibly diuretics or IV 3% saline.     

Obesity in a high school football candidate: a case presentation.

A 14-yr-old male presented for medical clearance to play fall football for his high school team. He had stayed out of the prior spring football practice sessions after a shoulder injury on the first day of practice, but indicated no other positive responses to the standard medical questionnaire. He was severely overweight with height of 180 cm, weight 133.4 kg, and his estimated body fat was 36%. His examination was otherwise not revealing. He demonstrated poor aerobic fitness, exercise-induced bronchospasm, residual left shoulder weakness, and a dyslipoproteinemia on further medical evaluation. He was disqualified on an empirical basis, the attending physician making the clinical decision that it would be of greater harm than good for this adolescent to participate. However, there is little data and no established guidelines for this type of situation. The overweight football athlete is a challenge to the sports medicine team, both in managing the condition and in determining athletic eligibility.     

Heat injury prevention practices in high school football.

OBJECTIVE: To survey high school American football programs regarding current prevention measures for reducing heat injuries during the football season. DESIGN: Web-based survey of 27 questions based on consensus statement guidelines by the American College of Sports Medicine on reducing heat injury risk in youth football. SETTING: National (United States) and community-based. PARTICIPANTS: High school programs receiving survey distribution from their state athletic association and the National Federation of State High School Associations. MAIN OUTCOME MEASURES: Responses (percentage and incidence) to questions on preseason acclimatization procedures, practice modification protocols, preparticipation risk factors, hydration management strategies, rest period strategies, heat injury education and policies, and preparation for heat-related emergency care. RESULTS: A total of 540 high school football programs from 26 states completed the survey. The reported number of preseason heat injuries per program (1.38+/-2.08) was greater (P<0.001) compared to during the regular season (0.98+/-1.84). Programs modified equipment configurations during preseason (no helmets or pads, 31.3%; just helmets, 57.0%; helmets and shoulder pads only, 33.5%) or altered the practice schedule when there was excessive heat. Hydration management, education, and preparation for dealing with an acute heat injury varied among programs. CONCLUSIONS: Greater implementation of effective prevention measures to reduce the incidence of heat-related injury and death in high school American football is needed. Strategies should focus on modifying practices appropriately on a day-to-day basis to minimize heat strain and optimize hydration, identifying and educating at-risk individuals during the preparticipation period, and developing an emergency action plan for effectively managing heat injuries.     

Risk factors for injury in high school football players

BACKGROUND: Many studies have reported the frequency and types of injuries in high school football players. However, few have assessed the relationship between player characteristics and risk of injury. PURPOSE: To describe the epidemiologic characteristics of and risk factors for injury in high school football players and to determine whether players' characteristics could be used to predict subsequent injury. STUDY DESIGN: Prospective cohort study. METHODS: This study was part of a 2-year prospective investigation (1998 to 1999) of risk factors for injury in 717 (343 in the 1998 season and 374 in the 1999 season) high school football players in the Oklahoma City, Oklahoma, School District. Player characteristics (playing experience, position, injury history) and physical parameters (body mass index, weight, height, grip strength) were measured at the beginning of each season. Logistic regression analysis was used to determine whether any of the baseline variables were associated with the odds of subsequent injury. RESULTS: The physical characteristics of players, such as body mass index and strength, were not associated with risk of injury. More playing experience and a history of injury in the previous season were significantly related to increased risk. Linemen were at the highest risk of injury, particularly knee injuries and season-ending injuries. CONCLUSIONS: Future research should focus on decreasing the risk of injury to linemen.     

Incidence of injury in Texas high school football.

This study was undertaken to determine the incidence of injury in high school football based on evaluation of 100 high schools in the State of Texas during a single football season (1989). Certified athletic trainers were the initial medical professionals providing on-site diagnosis and treatment of all injuries. An injury was defined as: 1) an incident causing an athlete to miss all or part of a single practice or game; 2) any incident treated by a physician; and 3) all head injuries reported to the athletic trainer. Data were collected that allowed calculation of the time of exposure to injury per athlete in the sample. There was 75.5% participation in the study by the certified athletic trainers in the 100 schools. A total of 4399 athletes in varsity football programs participated in the study. There were 2228 injuries, as defined in the study, during the period of study, giving an incidence of injury of 0.506 injury per athlete per year. Severe injuries--those requiring hospitalization--were found in 137 cases, for an incidence rate of 0.031 injury per athlete per year. The incidence of reportable defined injury was calculated to be 0.003 injury per hour of exposure per student athlete. The knee was found to be the most commonly injured anatomic site; the ankle ranked second.