The Marathon

It’s Patriots Day, a very special holiday celebrated in New England but revered throughout the world as Marathon Monday:  the running of the Boston Marathon.


The 2014 Boston Marathon is happening…!

There are few people today who won’t be remembering the events of the 2013 running. My hope, and strong sense, is that the 2014 version of the BAA Marathon will be known for great competition only, with Lelisa Desisa hoping to defend his title in the men’s event and Rita Jeptoo hoping for the same thing on the women’s side.  Right now, it looks to be a near perfect day for both the runners and spectators, with the only worry that afternoon temperatures may trend a little on the warm side.

We are, as sports medicine providers, used to dealing with the possibility of hypo- or hyperthermia in such events, dealing with hyponatremia and exercise-associated collapse….I commend to you a number of excellent studies we have published over the last decade about such medical events.  The illustrious Tim Noakes has written about fluid replacement in marathon running, Bill Roberts has published original research on risk factors for developing hyponatremia during marathon running, and last year Lawrence Hart wrote about marathon-related cardiac arrest. We all need to be up-to-date about such issues; they represent the typical challenges we will face in the medical tent at such events.

Last year the running of the Boston Marathon reminded us that we must also be prepared for mass casualty at such events.  The New England Journal of Medicine published a short piece by the medical providers on the scene, The Boston Marathon and Mass Casualty Events, which I encourage you to read.  Preparing for the worst, hoping for the best:  a mantra that can serve us well in medical coverage as well as life in general.

I know several of the doctors who are on the course and at the finish line this morning, and I know they are prepared for all eventualities.  But I hope the only trauma they have to deal with might be from a fall on the course, a twisted ankle…….

Here’s to the safety of the runners, the spectators, and the staff of today’s great sporting event!!!!!!!

Gender Issues in Sport

I was taken by an editorial that I read in the New York Times this weekend:  The Trouble With Too Much T.  If you didn’t have the chance to see it yourself already, by all means click on the link and read this piece.


Caster Semanya, South African Olympian

The authors, Katrina Karkazis and Rebecca Jordan-Young, give a broad overview of how current sports governing bodies determine if an athlete is ‘really’ female.  Of note, Karkazis and Jordan-Young are also the principal authors of  The American Journal of Bioethics critique of the current gender-testing policies of the IOC, IAAF and other governing  bodies.

They lead with the well-known story of Caster Semanya, the South African woman who, in 2009, was barred from international competition and was compelled to undergo testing after the Berlin World Championships (she has subsequently been reinstated, and in the 2012 London Olympics was the flag-bearer for the S. African team and earned a silver medal in the 800m).  After the uproar that ensued over the Semanya case, the previously mentioned sports governing bodies instituted new gender-testing policies and interventions to redress the ‘problem.’

The new policies, as described in the editorial, are arguably no improvement and, it seems, a step in the wrong direction.

In the editorial, the authors tell the story of four female athletes with endogenously high levels of testosterone (‘T’) who all went through a battery of tests: physical examination (including genital inspections), blood tests, MRI, and psychosexual histories.  They then underwent surgery:  gonadectomy and (inexplicably) clitoral surgery.  They were required to do this to lower their levels of T, and they all subsequently were allowed to return to competition.

The essence of the current gender policies is 1) an identification of abnormally high levels of endogenous T; 2) a ‘therapeutic proposal’ which would be offered to athletes who test ‘too high’ and which include medications and/or surgery; 3) a disqualification from elite sport for women who elect not to have their T altered with said ‘therapeutic proposal.’

We’ve discussed some aspects of this issue in a previous blog post, our review of David Epstein’s sublime book ‘The Sports Gene.’ Epstein devotes an entire chapter (‘Why Men Have Nipples’) to female athleticism, and the powerful role that testosterone can often play in elite performance.  After reading this editorial, I thought it was time to write another post and poll the readership about aspects of this issue.

I can sympathize with the need to screen for use of exogenous testosterone, the systemic abuse of which led to most of the superior performances produced by East German athletes in the 1970′s.   Read more of this post

NOT Sports Medicine


The 2014 Boston Marathon will be run in a little more than a week (Monday April 21). We look back on the events of last year while we look forward to a safe running in 2014. Good luck to all the clinicians and staff who will be taking care of a record number of runners!


Boston Strong!

Originally posted on Clinical Journal of Sport Medicine Blog:

I don’t think any of us in sports medicine got into the field expecting to be involved in an event like that which transpired in Boston yesterday .

Map of Boston Bombings

Like many people around the world, I became riveted to TV, internet newsfeeds, and Social Media yesterday as I tried to make sense of what was occurring in Boston:  at 2:50 p.m., a little over four hours after the start of the Boston Marathon, two bombs exploded near the finish line, creating a chaotic scene resulting at this moment in three deaths and over 100 casualties.  A scene of sporting joy and celebration had been turned into mayhem.

In the days ahead and as the investigation into this event unfolds, we will likely learn ‘who’ was behind this and for what supposed purpose.   It is my hope that ‘they’ become a footnote in history, and that instead…

View original 570 more words


#AMSSM14 is the tag to follow on Twitter the next few days if you want to stay on top of what is topical in the world of sports medicine.  The American Medical Society for Sports Medicine (AMSSM) is having its 2014 annual meeting in New Orleans these next several days.  #AMSSM14 began Friday and is continuing through Wednesday.  It’s already been a rich experience, one we’ve been looking forward to for a while.


Happy conference attendees, Drs. Jane Sando and Natalie Stork.

Among the speakers who have already graced the podium:  David Epstein, a journalist and author of The Sports Gene, gave a great keynote speech Sunday on some of the factors that go into the ‘making’ of an elite athlete.  He presented a compelling argument for avoiding early sport specialization, allowing the youth athlete to sample and perhaps find the sport that ‘fits’ his or her unique physical attributes.  The talk was the perfect prelude to the afternoon’s sessions, ‘From Best Practices to Burnout,’ a series of lectures on how sports medicine clinicians might best guide youth athletes and families as they work their way through the North American sport system.

Dr. John DiFiori, the outgoing AMSSM president and lead author on the statement on youth sport specialization and burnout we published in January, spoke at length about the findings of that systematic review.  In case you missed the lecture and/or are elsewhere than New Orleans this weekend, take a look at our ’5 Questions with CJSM’ interview with Dr. DiFiori.  Dr. Tracy Ray discussed ‘Patient Centered Care’ of the collegiate athlete that I particularly enjoyed.   The focus was the InterAssociation Consensus Statement on Best Practices for Sports Medicine Management for Secondary Schools and Colleges.

I already have my eye on a series of ‘point/counterpoint’ discussions tomorrow morning:  contact sport: should it be embraced or avoided? Spondylolysis:  to brace or not to brace? And vitamin D:  to screen and treat or not?  I’ll be there and I’ll be sure to be tweeting the high points of those sessions.

I think it’s a testament to the quality of the sessions that I am sitting in a large auditorium at 5 pm on a weekend day here in New Orleans…..and it’s nearly full!  Great to see folks want to hear about positive and negative likelihood ratios rather than enjoying the temptations of Bourbon street…..well, at least for an hour more perhaps!

Follow us on @cjsmonline, follow the AMSSM on @TheAMSSM, and follow the hashtag #AMSSM14 for all the info coming hot off the press from this conference!!

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