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.     

Liver trauma in a high school football player

Conclusions Team physicians and trainers must be alert to the mechanism of injury and symptoms of abdominal trauma. Although most liver injuries stop bleeding spontaneously and can be managed with observation, some injuries are catastrophic. Without a high index of suspicion, a subtle or unique presentation of hepatic injury may go undetected. Serum transaminases and CT scan are useful for early diagnosis of liver injury in the stable patient. Nonoperative management and early return to noncontact activity is supported by research. Additional research will be useful to establish return-to-play guidelines.     

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.     

Epidemiology of concussion in collegiate and high school football players

Despite evolutionary changes in protective equipment, head injury remains common in football. We investigated concussion in football and associated epidemiologic issues such as 1) incidence of injury, 2) common signs and symptoms, and 3) patterns in making return-to-play decisions. We received 242 of 392 surveys (62%) that were sent to high school and collegiate certified athletic trainers at the beginning of three football seasons. Of the 17,549 football players represented, 888 (5.1%) sustained at least one concussion, and 131 (14.7% of the 888) sustained a second injury during the same season. The greatest incidence of concussion was found at the high school (5.6%) and collegiate division III (5.5%) levels, suggesting that there is an association between level of play and the proportion of players injured. Players who sustained one concussion in a season were three times more likely to sustain a second concussion in the same season compared with uninjured players. Contact with artificial turf appears to be associated with a more serious concussion than contact with natural grass. Only 8.9% of all injuries involved loss of consciousness, while 86% involved a headache. Overall, 30.8% of all players sustaining a concussion returned to participation on the same day of injury.     

Catastrophic head injuries in high school and college football players

BACKGROUND: Catastrophic head injuries in football are rare but tragic events. PURPOSE: To update the profile of catastrophic head injuries in high school and college football players and to describe relevant risk factors. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: We reviewed 94 incidents of severe football head injuries reported to the National Center for Catastrophic Sports Injury Research during 13 academic years (September 1989 through June 2002). RESULTS: In the study period there were an average of 7.23 (standard deviation = 2.05) direct high school and college catastrophic head injuries in scholastic football participants per year. There were 0.67 injuries per 100 000 (95% confidence interval: 0.54, 0.81 per 100 000) high school and 0.21 injuries per 100 000 (95% confidence interval: 0.0, 0.49 per 100 000) college participants for a risk ratio of 3.28 (95% confidence interval: 0.81, 13.3). The injuries resulted in subdural hematoma in 75 athletes, subdural hematoma with diffuse brain edema in 10 athletes, diffuse brain edema in 5 athletes, and arteriovenous malformation or aneurysm in 4 athletes. Fifty-nine percent of the contacts reported that the athlete had a history of a previous head injury, of which 71% occurred within the same season as the catastrophic event. Thirty-nine percent of the athletes (21 of 54) were playing with residual neurologic symptoms from the prior head injury. There were 8 (9%) deaths as a result of the injury, 46 (51%) permanent neurologic injuries, and 36 (40%) serious injuries with full recovery. Most players sustained a major impact to the head either from tackling or being tackled. CONCLUSION: The incidence of catastrophic head injuries in football has remained low since the advent of the modern day football helmet in the early 1970s. The incidence of catastrophic head injuries in football is dramatically higher at the high school level than at the college level. Although the reason for this discrepancy is unclear, an unacceptably high percentage of high school players were playing with residual symptoms from a prior head injury. Coaches, athletes, athletic trainers, and medical personnel need to adhere to the guideline that an athlete with any neurologic symptoms from a head injury should be strongly discouraged from returning to play.     

Long-term followup of knee injuries in high school football players

Twenty-three American football participants were studied 20 years after high school competition, as well as 11 age-matched controls, to assess the development of knee osteoarthritis. No statistically significant increase in osteoarthritis could be demonstrated radiographically, subjectively, or objectively. A significant increase in knee joint osteoarthritis was found in the subgroup of football players who had sustained a knee injury.     

Injuries in intercollegiate rodeo athletes

Collegiate rodeo athletes (N = 156) in the National Intercollegiate Rodeo Association (NIRA) Southern Region, were examined for injuries during a 7 month (10 rodeo) season from 1987 to 1988. Sixty-two athletes sustained a total of 138 acute injuries resulting from 3292 exposures. One hundred twenty-seven injuries (92% of total injuries) occurred in the roughstock and steer wrestling events, and 11 injuries (8%) occurred in the roping and female events. When calculating opportunity for injury, rodeo athletes face an 89% potential for injury per season. Ninety-one of the injuries incurred were upper body injuries; 47 were lower body injuries. A 6:1 exposure to injury ratio among roughstock events exemplifies the magnitude of injury potential in this sport, affecting 25% of roughstock competitors. Contusions, strains, and concussions comprised 42%, 16%, and 11% of the total injuries, respectively, whereas fractures and dislocations comprised only 5% of the total. Twenty-three percent of the injuries occurred during the completion of an athlete's ride, with 21% of injuries attributed to equipment mishaps. Frequency of injury by performance, relation of seasonal participation and exposure to injury, orthotic care, use of conditioning programs, medication history, and need for enhanced sports medicine education in this sport are discussed.     

An outbreak of furunculosis among high school athletes

Furuncles (boils) are common among teenagers; however, few outbreaks have been documented. We investigated an outbreak of furuncles that occurred among male athletes of a Kentucky high school during the 1986 to 1987 school year. The overall attack rate was 25% (31/124). The risk of developing a furuncle increased two to three times in those who had skin injury. Athletes who sustained abrasions more than twice per week (P less than 0.01), who had a cut that required bandaging (P = 0.01), or had an unspecified injury causing a missed practice or game (P = 0.04) were at increased risk. The risk of developing furunculosis did not appear to be related to contact with formites, but rather, to contact with furuncles. Although athletes shared common areas (showers, locker rooms, practice areas, the attack rates for varsity football (36%) and varsity basketball (33%) were four times greater than for nonvarsity teams (P less than 0.01). Players who had a friend with a furuncle were more than twice as likely to also have had a furuncle (P less than 0.01). Exposure to furuncles appeared to increase the risk of furunculosis independently of reported skin injury. Control and prevention should, therefore, focus on both reducing skin injury and reducing exposure to furuncles, rather than attempting to sterilize inanimate objects.     

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.     

The epidemiology of catastrophic spine injuries in high school and college football

Athletic events have long been identified as a source of catastrophic spinal injuries. One of the most notorious sports has been American football. At both the amateur and professional level, this collision sport is associated with the highest number of direct catastrophic injuries including cervical spine trauma and quadriplegia. Although modifications in the rules of play and education of players and coaches have significantly diminished the rate of quadriplegia, there remains a need to decrease the number of catastrophic spine injuries in football. Further research related to the prevention and management of athletic cervical spine trauma is necessary.     

Incidence of injury based on sports participation in high school athletes

Objectives: Youth participation in competitive athletics has significantly increased in the past two decades. There has also been a recent rise in the number of sports injuries that physicians are seeing in young athletes. The objective of this study was to assess the likelihood of sports injuries based on several risk factors in a general sample of athletes at a suburban-area high school.

Methods: This was a cross-sectional study. An online survey was distributed to 2,200 student-athletes at a local high school with a mean age of 15.9 years. Four hundred eighty four (22%) complete responses were received. Data collected in the survey included demographics, frequency of sports participation, level of participation, types of sports played, participation in cross-training, injuries incurred, use of non-steroidal anti-inflammatory drugs, and treatment for sports injuries.

Results: Athletes played an average of 1.6 different sports. The average number of hours of participation in sports annually was 504.3 ± 371.6 hours. The average total number of sports injuries experienced by athletes in our study was 1.7 per participant. 80.8% of respondents reported having sustained at least one sports injury.

A higher total number of hours per year of sports participation and playing a contact sport were significantly associated with more reported lifetime sports injuries. Older age, playing a contact sport, and playing on a travel/club team were associated with students using NSAIDs for sports injuries. Older age, playing a contact sport, and doing cross training are also associated with having had surgery for a sports injury.

Conclusions: Although more hours of participation and playing a contact sport may lead to an increased number of injuries, this risk must be weighed against the myriad of benefits that sports provide for young athletes.     

Dieting and disordered eating in German high school athletes and non-athletes

The purpose of this study was to examine weight concerns, dieting, body dissatisfaction as well as eating behavior of German high school athletes and to compare disordered eating behavior of these athletes with regular high school students. Five hundred and seventy-six young athletes of Elite Sports Schools in the German state of Thuringia and a reference group consisting of 291 non-athletes from regular high schools completed a questionnaire regarding eating behavior and attitudes, dietary history, body image and demographics. The Eating Attitude Test was used to measure disordered eating. Athletes did not show a higher frequency of disordered eating than non-athletes. A binary logistic regression analysis revealed that gender and dietary experience, but not group (athletes vs non-athletes), were significant predictors of disordered eating. It can be concluded that dietary experience and female gender proved to be important risk factors of disordered eating. Participation in sports seems to be protective for developing serious eating problems, especially in girls. Potentially, regular monitoring of athletic performance by coaches might be a reason for this finding.     

Grade 1 or "ding" concussions in high school athletes

BACKGROUND: Recent concussion management guidelines have suggested that athletes with mild (grade 1) concussions may be returned to play if asymptomatic for 15 minutes. The purpose of this study was to assess the utility of a current concussion management guideline in classifying and managing mild concussion. HYPOTHESIS: High school athletes diagnosed with a grade 1 concussion will demonstrate measurable decline in neuropsychological functioning that persists during the 1st week of recovery. STUDY DESIGN: Prospective study designed to evaluate neuropsychological functioning both prior to and following concussion. METHODS: Forty-three high school athletes completed neuropsychological test performance and symptom ratings prior to the season and at two times during the 1st week following mild concussion. RESULTS: Thirty-six hours after injury, mildly concussed high school athletes demonstrated a decline in memory (P < 0.003) and a dramatic increase in self-reported symptoms (P < 0.00001) compared to baseline performance. CONCLUSIONS: Athletes with grade 1 concussion demonstrated memory deficits and symptoms that persisted beyond the context in which they were injured. These data suggest that current grade 1 return-to-play recommendations that allow for immediate return to play may be too liberal. Clinical Relevance: A reconsideration of current concussion grading systems appears to be warranted.     

Injuries to athletes with disabilities: identifying injury patterns

Participation in sport activities for people with disabilities continues to gain in popularity. With participation in sports, there is an inherent risk of injury. A review of current sport epidemiological studies was used and we concluded that injury patterns for this population are similar to those for athletes without disabilities. Injury data from Paralympic competitions dating back to 1976 indicate that most elite athletes with disabilities seek medical care for illness and musculo-skeletal injuries. However, there are very limited injury data regarding Winter Paralympic events or skiing injuries. For those athletes who participate in Summer Paralympic events, abrasions, strains, sprains and contusions are more common than fractures and dislocations. However, location of injuries appears to be disability and sport dependent. Lower extremity injuries are more common in ambulatory athletes (visually impaired, amputee, cerebral palsy) and upper extremity injuries are more frequent in athletes who use a wheelchair. While it appears that the majority of the injuries occurring in this population are minor in nature, inconsistencies in the definition of injury in the literature make this conclusion tenuous. When injuries are expressed as time lost in participation, 52% of injuries resulted in 7 days lost or less, 29% in 8 to 21 days lost and 19% in greater than 22 days lost. The only prospective study addressing injury rates of athletes with disabilities in a manner consistent with other sport epidemiological studies found an injury rate of 9.3 injuries per 1000 athlete-exposures (AE). This injury rate is less than American football (10.1 to 15/1000 AE) and soccer (9.8/1000 AE), and greater than basketball (7.0/1000 AE). It is unclear whether comparative statistics such as these take into consideration the number of illness and injury episodes that resulted from the disability. Further complicating epidemiological studies for athletes with disabilities is the definition of the population and samples of convenience which are frequently used. These samples are often not representative of the multiplicity of disability conditions, levels of competition and range of sport activities available. Prospective studies comparing athletes to sedentary control individuals to measure differences in injury rates, type and frequency between and within disability groups, sports and levels of competition are desperately needed to further the knowledge of injury trends and develop and establish accurate injury prevention programmes.