LeBron and Exercise-Associated Muscle Cramping

June 7, 2014 by 1 Comment

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Does this count as “Old School”? LeBron James, in his first incarnation as a Cleveland Cavalier (photo: Dave Hogg, Wikimedia)

Game 2 of the NBA finals is this weekend, and I’m sure the Miami Heat (despite their nickname) are hoping the air conditioning works.  In truth, I think most of us are hoping that we witness a straight up basketball affair determined more by athletic skill and less by Exercise-Associated Muscle Cramping (EAMC).

If you need a primer to know what I’m talking about, here’s a brief rundown of Game 1 and LeBron’s EAMC. 

‘Most of us’?  I truly have no horse in this race (speaking of that….I most definitely am rooting for California Chrome to bring home the Triple Crown later today), but outside of Texas, it seems that most of the country may be leaning toward the Heat.  At least that’s what ‘Big Data’ would suggest:  check out this great, data-driven map from the New York Times showing the breakdown of team allegiances across the United States.

Truly though, aside perhaps from a pocket deep in the heart of Texas (who may want victory, no matter what!), I think most fans of the NBA would rather see the outcome of the games determined by the players and not by a lack of AC.

As a team physician, like many of you, I have had–along with my Athletic Trainers–to deal with plenty of muscle cramping in my career.  Here in the States, I find it occurs most often in the very beginning of football season:  during August pre-season, or the early September games that may be played in temperatures approaching 90 degrees.  It seems the combination of relative deconditioning, environmental conditions, and plain foolishness (my adolescent athletes frequently forget to stay hydrated, despite constant reminders to do the same)  gives rise to any number of trips on to the field to assist a player downed with quad or abdominal cramps.  At some levels of the game, to circumvent that inability to maintain adequate oral hydration during a game, teams will turn to pre-game intravenous hydration, as has been discussed in literature published in this journal and blog.

Then again, perhaps there are other issues altogether different than these potential risk factors that give risk to EAMC. Despite the high incidence, the etiology of EAMC continues to be debated.

Yes, I am a believer in the powers of pickle juice, but EAMC remains a puzzle to me and others.  And so I turned to the CJSM website  this morning for guidance and found a great 2013 study:  Collagen genes and exercise-associated muscle cramping, from a group of South African authors.  I especially appreciated this article for its contribution to my basic science knowledge:  I learned so much about the biology behind EAMC.  I encourage you all, clinicians and non-clinicians, to check it out.

The authors begin the paper with an excellent overview of various hypotheses of EAMC, ranging from electrolyte depletion to altered neuromuscular control. They then explored the literature that points to the possibility that EAMC may be associated with a genetic predisposition to musculoskeletal soft tissue injury. Specifically, their research hypothesis was that “variants within collagen genes that code for components of the musculoskeletal system would increase susceptibility to EAMC.”  To test this, the authors conducted a ‘retrospective case-control genetic association study’. Read more of this post

Filed under Basic Sciences in SEM, Elite sport, Exercise Medicine Tagged with , ,

Tommy John Surgery

April 28, 2014 by

It’s the season for Tommy John surgery.

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Former LA Dodgers pitcher, Tommy John, whose name will forever be linked with the successful elbow surgery he had.

Major League Baseball (MLB) began its season earlier this month…….Wait!  In truth, it began its season last month:  the Opening Series of the season took place in Australia on March 22! I thought it was a nice, antipodean, cross-cultural touch that MLB played the first game of 2014 at the Sydney Cricket Grounds (the LA Dodgers faced the Arizona Diamondbacks)…..

With the return of baseball comes an all too common injury:  UCL tears, partial and complete.  This season, it seems there is a veritable epidemic:  14 pitchers scheduled to have this surgery already (in comparison, from 2000 to 2011 there was an average of 16 MLB pitchers per year undergoing the procedure).

What was once a career-ending injury has been transformed into a season-ending one because of one man, Dr. Frank Jobe.  Dr. Jobe, as readers will know, passed away earlier this year.  Many in the sports world noted his incomparable legacy as the ‘savior of pitchers elbows’  He was a great doctor, and a decent man.

He devised the surgical approach to ‘ulnar collateral ligament reconstruction,’ and his first patient was the pitcher Tommy John, who went on to pitch 164 games in his career after the surgery (such success is arguably a major reason his name has ‘branded’ the procedure).

I’m not the only one thinking of Tommy John, Dr. Frank Jobe, and pitching-related elbow pain.  Sue Basile, a reader of this blog, reached out to me and asked if she could write a guest post on the topic.  Sue received her BS in  Biomedical Engineering from Columbia University, her MS in Biomedical Engineering/Biomechanics from the University of Tennessee, and is working on her PhD in Kinesiology/Biomechanics at Georgia State University.  Here are her thoughts on prevention of the injury that can lead to Tommy John surgery:

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Stemming the Tommy John Tide begins in Little League – Sue Basile
Ivan Nova may soon find himself on a list that no pitcher wants to be on – the one of those undergoing Tommy John surgery.   Despite it still being the first month of the season, the elbow count is already high, with the Yankee pitcher potentially joining promising players like the Mets’ Matt Moore and the Braves’ Cory Gearrin  in having their season cut entirely too short.  Read more of this post

Filed under Elite sport, General Interest, Injury Prevention, Youth Sport Tagged with , ,

The Marathon

April 21, 2014 by

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.

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The 2014 Boston Marathon is happening…..now!

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!!!!!!!

Filed under Elite sport, General Interest Tagged with ,

Gender Issues in Sport

April 15, 2014 by 2 Comments

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.

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Caster Semenya, 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 Semenya, 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

Filed under CJSM Polls, Doping in Sport, Elite sport, Ethics and probity in SEM, Female Athletes, Women in Sport Tagged with

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