Paralympics, Sochi 2014, ACSM and more!

It’s been almost a month since the ACSM 2013 meeting in Indianapolis wrapped, but it’s the gift that keeps on giving for me.

Meetings like those of the American College of Sports Medicine (ACSM), the American Medical Society for Sports Medicine (AMSSM), or the Canadian Society for Sports and Exercise Medicine (CASEM)–all partner societies with the Clinical Journal of Sports Medicine (CJSM)–are such a pleasure because a sports medicine clinician like myself can interact with clinician researchers from across the globe.


Michael Phelps better watch his back: My good friend and Paralympic Swimmer, Rayne McCann and her haul of medals

At both the ACSM meeting and the AMSSM meeting in San Diego I saw my friend and fellow CJSM editor, Connie LeBrun, M.D., from the University of Alberta.  I heard she chaired a wonderful session on the Paralympics at ACSM, one I could not attend because there was a concurrent session that took me away (such are the ‘downsides’ of these meetings–there is usually too much to fit in!)

What could I do, but beg Connie to pen a guest blog for me so I could learn more about her session at ACSM.  Little did I know, I could also live vicariously her jet-set life:  catching up with her between Indianapolis, Calgary, Russia, and all points between (I’m beginning to wonder if she’s involved in the Edward Snowden affair).  It has been hard to track her down!  But worth it.

And so I present the guest blog from my colleague, Connie Lebrun, M.D.



London 2012: Wenlock? Or Mandeville?

Can’t believe how fast the time has flown since the recent ACSM Annual Meeting in Indianapolis! A huge highlight for me, was chairing the Special Event submitted by the Olympic/Paralympic Sports Medicine Issues (OPSMI) Committee, of which I am a member. It was entitled: “London 2012: A Look Back at the Sports Medicine and Sport Science Issues of the Olympics and Paralympics.”

We had a stellar cast of speakers, beginning with David Epstein, a brilliant young “investigative journalist” for Sports Illustrated, who has won many awards for his science writing. He has produced innumerable cover stories for SI, on a variety of topical and controversial sports issues, including the piece that broke the news that Yankees third baseman Alex Rodriguez had used steroids.

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Boosting – time to be aware

Most Sports Physicians are well aware of the issue of doping in elite sport and many of the methods used by sports participants. However, some of us may well not have come across a method used by some athletes with a disability called ‘Boosting.’ With the forthcoming Paralympics just around the corner, now is the time to consider this method of doping for those of us who are involved with events later on this year in London 2012.

Some athletes with a high level spinal cord injury (T6 and above) may voluntarily induce an episode of autonomic dysreflexia (AD) prior to, or during, an event in order to enhance their performance. A variety of methods may be used by athletes, including clamping catheters, sitting on sharp objects, and using tight leg straps.

The resulting physiological response leads to a significantly raised blood pressure, with improved blood flow to working muscles. The performance enhancement that may ensue as a result of this response may be significant and lead to an improvement in VO2.

It is not always easy to determine whether or not a deliberate attempt to induce AD has taken place as AD is not uncommonly caused by a number of common triggers including urinary retention due to catheter blockage or misplacement, infections, constipation, or noxious stimuli from other sources such as pain due to a lower limb injury.

My first clinical encounter with a patient with AD was during my registrar training when I was working on a spinal cord injuries unit (SCIU) – the cause on that occasion was a blocked catheter. Recognition was swift due to the awareness of the ward nursing staff to the condition. The patient was treated with nifedipine plus a catheter replacement and bladder washout, and made a swift and uneventful recovery. I was to encounter a few more episodes of AD occurring in in-patients during the next 6 months when I was working on the SCIU.

Whilst not only banned by the International Paralympic Committee as a doping method, boosting is dangerous to the health of athletes and may lead to a hypertensive crisis, stroke and death.

The signs and symptoms of mild-to-moderate AD include piloerection, sweating above the level of the spinal cord lesion, headaches, blurred vision, bradycardia, facial flushing, nasal congestion and anxiety. Systolic blood pressure may rise to over 250mmHg.

Athletes are routinely checked prior to competition for any of these signs and symptoms, and repeated blood pressure measurements are taken if there is any suspicion of boosting or AD. If a systolic blood pressure of 180mm Hg or higher is persistently measured, then the athlete is not allowed to compete in the event and possible causes of AD are searched for.

In this month’s Thematic issue of the Clinical Journal of Sport Medicine on Paralympic Sports Medicine, our featured freely-available article by Krassioukov focuses on blood pressure control and AD in athletes, discussing the physiological mechanisms behind this doping method and what we know about the practice of boosting.

For those who may wish to raise awareness of boosting as a doping method, there is a useful presentation on AD and boosting available on the official website of the Paralympic movement, funded in part by the World Anti Doping Agency (WADA) and the IPC.

(Image of Iran v South Africa at 2008 Paralympic games available at Wikimedia Commons, and Autonomic Nervous System originally from ‘Gray’s Anatomy’ )

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