Every Picture Tells A Story: Managing Exertional Heatstroke with Rotating Ice Water Towels.

ABSTRACT: A 23-year-old woman completing her first marathon collapsed near the finish line at 4 hours 6 min with a rectal temperature of 41.8°C. She was in good health before the race with no recent illness, had completed a full training program, and was taking no medications or supplements. On the initial exam, she was unconscious with a response to painful stimulus, spontaneous breathing, rapid pulse, eyes closed, fully dilated pupils, poor muscle tone, and pale skin that was warm to touch. The medical team initiated whole-body cooling using rapidly rotating ice water towels and ice packs placed in the neck, axilla, and groin. She developed echolalia during active cooling. About 20 minutes into the cooling procedure, she "woke up," was able to answer questions coherently, and her pupils were normal size and reactive. She was discharged home with instructions to follow-up in 2 d for evaluation and blood chemistry testing.

Mass Participation and Tournament Event Management for the Team Physician: A Consensus Statement (2022 Update).

ABSTRACT: Mass participation events include endurance events (e.g., marathon, triathlon) and/or competitive tournaments (e.g., baseball, tennis, football (soccer) tournaments). Event management requires medical administrative and participant care planning. Medical management provides safety advice and care at the event that accounts for large numbers of participants, anticipated injury and illness, variable environment, repeated games or matches, and mixed age groups of varying athletic ability. This document does not pertain to the care of the spectator.

Mass Participation and Tournament Event Management for the Team Physician: A Consensus Statement (2022 Update).

ABSTRACT: Mass participation events include endurance events (e.g., marathon, triathlon) and/or competitive tournaments (e.g., baseball, tennis, football (soccer) tournaments). Event management requires medical administrative and participant care planning. Medical management provides safety advice and care at the event that accounts for large numbers of participants, anticipated injury and illness, variable environment, repeated games or matches, and mixed age groups of varying athletic ability. This document does not pertain to the care of the spectator.

Exertional calf pain at kilometer five - Finding the cause.

A 23-year-old professional distance runner with several years of exertional calf pain was diagnosed with a unique mixed type III and functional popliteal artery entrapment syndrome (PAES). Surgical reduction of the obstructing tissue allowed her to return to professional running. This case highlights the importance of including PAES in the differential for chronic intermittent lower extremity claudication and outlines the work-up required to diagnose this vascular obstruction in younger athletes.

Bias and Conflict of Interest in the Underreporting of Sexual Abuse in Competitive Sports: A Literature Review.

ABSTRACT: The prevalence of sexual abuse in competitive sports is increasing worldwide and requires a united call to action. The underreporting of such abuses gained media attention resulting from recent high-profile cases. In this article, we report the results of a systematic literature review, identifying root causes of underreporting sexual abuse in competitive sports. We identify that biases and conflicts of interest work against effective reporting of abuse by athletes at the individual, organizational, and cultural levels. We offer conflict of interest and bias mitigation approaches from the social science, law, business, research, and diagnostic error literature that may apply. Competitive sports organizations may use this analysis to identify barriers and improve the effective reporting of sexual abuse.

Implementation of Exercise Management Services Among Sports Medicine Physicians in the United States.

OBJECTIVE: Assessment of physical activity and exercise prescription has been widely supported by many organizations, yet provision of such services remains limited in the United States. We sought to uncover why such services have not been widely adopted. DESIGN: The American Medical Society for Sports Medicine organized a task force to canvas physicians and survey the American Medical Society for Sports Medicine membership. SETTING: Peer-to-peer and telecommunication discussions and web-based questionnaires. PARTICIPANTS: Sports medicine physicians in the United States. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Percentage of sports medicine physicians who provide exercise management services and mechanisms of billing for exercise management, identify barriers to such services, and identify industry collaborations for promoting physical activity through physicians. RESULTS: Three of 4 sports medicine physicians spend at least 1 min encouraging exercise with patients, using Evaluation and Management codes to bill or receive credit. Exercise counseling is often bundled within other patient care. Few health plans leverage the patient's relationship with a primary care physician to promote exercise. Most employed sports medicine physicians do not receive incentives to incorporate exercise counseling into practice, and only 1 in 6 have decision-making authority to hire an exercise professional. Major obstacles are the lack of a business model and knowledge about exercise prescription. CONCLUSION: The existing E&M codes adequately characterize the work, but physicians desire greater payment or credit for providing exercise management services. Physicians desire to do more exercise prescription, but health system bureaucracy, inadequate support, and economic disincentives are barriers to the provision of exercise management services.

A Pilot Study: Do Children Who Run Marathons Have More Osteoarthritis in the Lower Extremities as Adults.

OBJECTIVE: To compare self-reported osteoarthritis of the knee and hip in adults who ran at least 1 marathon as a child with adults who ran high-school cross country (HSCC). DESIGN: Subject self-recall retrospective survey. SETTING: Electronic survey. PARTICIPANTS: 319 adults who either ran a marathon under age 18 or ran HSCC recruited from running clubs, marathon participants, and on-line interest groups. INTERVENTIONS: Survey. MAIN OUTCOME MEASURES: Self-reported history of osteoarthritis (OA), joint pain, anterior cruciate ligament injury, still running or running marathons, and number of marathons as an adult. RESULTS: One hundred twenty-three respondents ran a marathon under age 18 (26% female) and were 40 years old (sd 16) and 196 ran HSCC (53% female) and were 36 years old (sd 13). The mean age of first marathon was 15 (sd 2.3, range 5-17); 50% ran 1% and 50% ran >1 marathon. Child marathoners reported a family history of OA in knees or hips (26%) or a joint replacement (30%) compared with 24% and 28% of HSCC runners. 10% of child marathoners and 7% of HSCC reported OA and 24% and 21% reported daily or weekly joint pain. 91% of all respondents are still running; 78% of child marathoners (mean 17, range 1-91) and 80% HSCC ran ≥1 marathons as adults (mean 10, range 1-80). CONCLUSIONS: Adults who ran marathons as children compared with adults who ran HSCC self-report similar rates of the knee and hip OA, chose to participate of their own accord, continue to run as adults, played other sports, and did not "specialize" in marathons.

ACSM Expert Consensus Statement on Exertional Heat Illness: Recognition, Management, and Return to Activity.

ABSTRACT: Exertional heat stroke is a true medical emergency with potential for organ injury and death. This consensus statement emphasizes that optimal exertional heat illness management is promoted by a synchronized chain of survival that promotes rapid recognition and management, as well as communication between care teams. Health care providers should be confident in the definitions, etiologies, and nuances of exertional heat exhaustion, exertional heat injury, and exertional heat stroke. Identifying the athlete with suspected exertional heat stroke early in the course, stopping activity (body heat generation), and providing rapid total body cooling are essential for survival, and like any critical life-threatening situation (cardiac arrest, brain stroke, sepsis), time is tissue. Recovery from exertional heat stroke is variable and outcomes are likely related to the duration of severe hyperthermia. Most exertional heat illnesses can be prevented with the recognition and modification of well-described risk factors ideally addressed through leadership, policy, and on-site health care.

Using Wet Bulb Globe Temperature and Physiological Equivalent Temperature as Predicative Models of Medical Stress in a Marathon: Analysis of 30 Years of Data From the Twin Cities Marathon.

OBJECTIVES: : Assess the relationships between wet bulb globe temperature (WBGT) and physiologic equivalent temperature (PET) at the start of a northern latitude marathon and their associations with medical stress and transfers to the emergency room (ER) when the race environment is unexpectedly warm, and participants are not acclimatized. DESIGN: : Retrospective review. SETTING: : Twin Cities Marathon from 1990 to 2019. PARTICIPANTS: : Runners competing in the Twin Cities Marathon. INDEPENDENT VARIABLES: : Start WBGT (prospectively collected) and PET (retrospectively calculated). MAIN OUTCOME MEASURES: : Marathon race starters and finishers and race day medical data (eg, medical stress, number of medical encounters, and number of ER visits). RESULTS: : The mean WBGT was 7.4°C (range -1.7°C to 22.2°C), and the meant PET was 5.2°C (range -16.7°C to 25.9°C). PET was not determined to be a significant predictor of medical stress (P = 0.71); however, a significant quadratic association between WBGT and medical stress was found (P = 0.006). WBGT (P = 0.002), but not PET (P = 0.07), was a significant predictor of the number of ER visits. CONCLUSIONS: Start WBGT was a better predictor of medical stress and ER visits than PET at the Twin Cities Marathon over a 30-year period. The start WBGT may be a better tool to predict race day environment medical safety.

Kids on the Run-Is Marathon Running Safe for Children?

This Viewpoint examines youth marathon participation through the collective perspectives of clinicians and researchers invested in optimizing health, safety, and performance in young runners.

Exertional heat stroke: an evidence based approach to clinical assessment and management.

NEW FINDINGS: What is the topic of this review? The treatment of exertional heat stress, from initial field care through the return-to-activity decision. What advances does it highlight? Clinical assessment during field care using AVPU and vital signs to gauge recovery, approaches to field cooling and end of active cooling, and shared clinical decision making for return to activity recommendations. ABSTRACT: Exertional heat stroke (EHS) is a potentially fatal condition characterized by central nervous system (CNS) dysfunction and body temperature often but not always >40°C that occurs in the context of physical work in warm or hot environments. In this paper, we review the continuum of care, from initial recognition and field care to transport and hospital care, and finally return-to-duty considerations. Morbidity and mortality can be greatly reduced if not eliminated with prompt recognition and aggressive cooling. If medical personnel are not present at point of collapse during or immediately following exercise, EHS should be the presumptive diagnosis until a formal diagnosis can be determined by qualified medical staff. EHS is a rare medical situation where initial treatment (cooling) takes precedence over transport to a medical facility, where advanced medical care may be required for severe EHS casualties. Recovery from EHS and return to activity is usually straightforward and unremarkable provided the casualty is rapidly cooled at time of collapse and adequate time is allowed for body healing. However, evidence-based data to guide return to activity following EHS are limited. Current research suggests that most individuals recover completely within a few weeks though some individuals may suffer prolonged sequalae and additional evaluation may be warranted, including heat tolerance testing (HTT). Several aspects of the care of the EHS casualty are based on best practices derived from personal experience and continued research is necessary to optimize evaluation and management.

COVID-19-Positive Testing in Minnesota High School Fall and Winter Sports: A Guide for Sports Risk.

OBJECTIVE: To assess the effectiveness of coronavirus disease 2019 (COVID-19) prevention strategies used during sports participation. DESIGN: To analyze prospective reports of student-athletes with COVID-19-positive tests to assess prevention strategies and risk factors by sports and seasons. SETTING: Minnesota high schools. PARTICIPANTS: Fall 2020 (August 24-October 30) and winter 2021 (January 2-March 12) student-athletes. ASSESSMENT OF RISK FACTORS: Sports, indoor location, mask use, physical distancing, and season. MAIN OUTCOME MEASURES: COVID-19-positive test rates. METHODS: Self-selected schools voluntarily reported, in 2-week intervals, the number of student-athletes with COVID-19-positive tests in each sport and the number of athletes participating in each sport during the fall and winter sports seasons. The positive testing rates per 100 000 athletes were calculated for participants in each sport and compared by sports type and risk variables. RESULTS: The high school age community-positive testing rate was 1298 per 100 000 students in the fall and 2396 in the winter. The student-athlete positive testing rate was 1500 per 100 000 athletes during the fall and 2800 during the winter (χ2 = 1.98, df = 1, P = 0.350). Positive tests per 100 000 athletes ranged from 197 (girls alpine skiing) to 4151 (wrestling). The incidence rates comparing indoor with outdoor sports (P = 0.001) and close-contact with physically distanced sports (P = 0.023) were significantly different, but the incidence rates comparing indoor masked with unmasked sports (P = ns) were not different. CONCLUSION: Athletes competing in outdoor individual sports have less risk of a COVID-19-positive test compared with age-matched individuals in the community and indoor sports participants either wearing or not wearing masks during competition. Unmasked athletes in close proximity have the highest positive test rates, and unenforced masking is not associated with lower positive testing rates. More study is needed to understand mask effectiveness.

COVID Vaccination in Athletes and Updated Interim Guidance on the Preparticipation Physical Examination During the SARS-Cov-2 Pandemic.

ABSTRACT: The American Medical Society for Sports Medicine (AMSSM) convened an expert panel to address the current evidence, knowledge gaps, and recommendations surrounding the COVID vaccination in athletes during the SARS-CoV-2 pandemic. The group held a series of meetings beginning in July 2021 and reviewed the available literature while using an iterative process and expert consensus to finalize this guidance statement. This document is intended to provide clinicians with suggestions on how to incorporate the COVID vaccination during the preparticipation physical examination for athletes in all levels of training and competition. The statement is not intended to address treatment, infection control principles, safety, ethical discussion, or public health issues related to SARS-CoV-2. The AMSSM task force acknowledges the clinical uncertainty, evolving public health objectives, and the limited data currently available to create this guidance statement.

Running-related injuries in middle school cross-country runners: Prevalence and characteristics of common injuries.

BACKGROUND: Understanding the prevalence and factors associated with running-related injuries in middle school runners may guide injury prevention. OBJECTIVE: To determine the prevalence of running-related injuries and describe factors related to a history of injury. DESIGN: Retrospective cross-sectional study. SETTING: Survey distributed online to middle school runners. METHODS: Participants completed a web-based survey regarding prior running-related injuries, training, sleep, diet, and sport participation. MAIN OUTCOME MEASUREMENTS: Prevalence and characteristics differentiating girls and boys with and without running-related injury history adjusted for age. PARTICIPANTS: Youth runners (total: 2113, average age, 13.2 years; boys: n = 1255, girls: n = 858). RESULTS: Running-related injuries were more prevalent in girls (56% vs. 50%, p = .01). Ankle sprain was the most common injury (girls: 22.5%, boys: 21.6%), followed by patellofemoral pain (20.4% vs. 7.8%) and shin splints (13.6% vs. 5.9%); both were more prevalent in girls (p < .001). Boys more frequently reported plantar fasciitis (5.6% vs. 3.3%, p = .01), iliotibial band syndrome (4.1% vs. 1.4%, p = .001) and Osgood-Schlatter disease (3.8% vs. 1.2%, p = .001). Runners with history of running-related injuries were older, ran greater average weekly mileage, ran faster, had fewer average hours of sleep on weekends, skipped more meals, missed breakfast, and consumed less milk (all p < .05). Girls with history of running-related injuries reported higher dietary restraint scores, later age of menarche, more menstrual cycle disturbances, and higher likelihood of following vegetarian diets and an eating disorder diagnosis (all p < .05). Runners with no history of running-related injuries were more likely to have participated in ≥2 years of soccer or basketball (p < .001). CONCLUSIONS: Most middle school runners reported a history of running-related injuries and certain injuries differing by gender. Modifiable factors with the greatest association with running-related injuries included training volume, dietary restraint, skipping meals, and less sleep. Sport sampling, including participation in ball sports, may reduce running-related injury risk in this population.

Mental Health Aspects of Voluntary and Involuntary Sport Retirement.

ABSTRACT: Sports participation is an important factor in the mental health of athletes. A change in sports participation affects athlete mental health, in addition to other components of the athlete's life, including overall health and fitness, future career plans, current and future financial status, and available social network. Athletes should be encouraged to develop balanced lives that involve rewarding activities outside their sport. Clinicians should evaluate the mental health of athletes leaving sport for any reason, develop protocols to address any concerns, and assist with postsport career and life planning.

COVID Vaccination in Athletes & Updated Interim Guidance on the Preparticipation Physical Examination during the SARS-CoV-2 Pandemic.

ABSTRACT: The American Medical Society for Sports Medicine (AMSSM) convened an expert panel to address the current evidence, knowledge gaps, and recommendations surrounding the COVID vaccination in athletes during the SARS-CoV-2 pandemic. The group held a series of meetings beginning in July 2021 and reviewed the available literature while using an iterative process and expert consensus to finalize this guidance statement. This document is intended to provide clinicians with suggestions on how to incorporate the COVID vaccination during the preparticipation physical examination for athletes in all levels of training and competition. The statement is not intended to address treatment, infection control principles, safety, ethical discussion, or public health issues related to SARS-CoV-2. The AMSSM task force acknowledges the clinical uncertainty, evolving public health objectives, and the limited data currently available to create this guidance statement.