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Ethics, In the News, Sports, Stanford News, Women's Health

Arguing against sex testing in athletes

Arguing against sex testing in athletes

Testosterone does not a man – nor a woman – make. So argues Stanford medical anthropologist Katrina Karkazis, PhD, in a New York Times op-ed today. She cites evidence against the scientific and ethical soundness of sex-testing policies used since 2011 by sports governing organizations including the International Olympic Committee, the Fédération Internationale de Football Association and the International Association of Athletics Federations.

From the piece:

Rather than trying to decide whether an athlete is “really” female, as decades of mandatory sex tests did, the current policy targets women whose bodies produce more testosterone than is typical. If a female athlete’s T level is deemed too high, a medical team selected by the sport’s governing bodies develops a “therapeutic proposal.” This involves either surgery or drugs to lower the hormone level. If doctors can lower the athlete’s testosterone to what the governing bodies consider an appropriate level, she may return to competition. If she refuses to cooperate with the investigation or the medical procedures, she is placed under a permanent ban from elite women’s sports.

Sports authorities argue that screening for high T levels is needed to keep women’s athletics fair, reasoning that testosterone improves performance. Elite male athletes generally outperform women, and this difference has been attributed to men’s higher testosterone levels. Ergo, women with naturally high testosterone are thought to have an unfair advantage over other women.

But these assumptions do not match the science. A new study in Clinical Endocrinology fits with other emerging research on the relationship between natural testosterone and performance, especially in elite athletes, which shows that T levels can’t predict who will run faster, lift more weight or fight harder to win. The study, of a sample of 693 elite athletes, revealed a significant overlap in testosterone levels among men and women: 16.5 percent of the elite male athletes had testosterone in the so-called female range; nearly 14 percent of the women were above the “female” range.

Karkazis concludes, “Barring female athletes with high testosterone levels from competition is a solution to a problem that doesn’t exist. Worse, it is pushing young women into a choice they shouldn’t have to make: either to accept medically unnecessary interventions with harmful side effects or to give up their future in sports.”

Previously: Is the International Olympic Committee’s policy governing sex verification fair?, Researchers challenge proposed testosterone testing in select female Olympic athletes and Gender ambiguity gets attention

Health and Fitness, Public Health, Research, Sports

Lingering effects of injuries sideline many former college athletes later in life

Lingering effects of injuries sideline many former college athletes later in life

basketball playerWhile playing sports in college, it wasn’t uncommon to see medical trainers tape up teammates’ bruised ribs or administer cortisone shots so that athletes wouldn’t have to sit out a game. I always felt fortunate that I suffered only a series of sprained ankles, but concern for my health grew after reading about new research showing that many college athletes are inactive later in late due to the long-term consequences of past injuries.

The study, which appears in the American Journal of Sports Medicine, examined more than 230 men and women who were former Division I athletes and 225 who didn’t play high-level sports in college. Individuals ranged from 40-65 years old. As reported in a recent Health Day story, the Indiana University researchers’ findings showed:

Former Division I athletes were more than twice as likely to have physical problems that limited their daily activities and exercise. Sixty-seven percent of these former athletes said they had suffered a major injury and 50 percent said they had chronic injuries during college, compared with 28 percent and 26 percent, respectively, among non-athletes.

The study also found that 70 percent of athletes said they had practiced or played with an injury, compared with 33 percent of non-athletes. Forty percent of athletes were diagnosed with osteoarthritis after college, compared with 24 percent of non-athletes.

Previous joint injuries may increase the risk of developing osteoarthritis, the study authors said.

The former college athletes also had higher levels of depression, fatigue and poor sleep than non-athletes, according to the study, which was published recently in the American Journal of Sports Medicine.

Previously: Is repetitive heading in soccer a health hazard?, Study shows men, rather than women, may be more prone to ACL injuries and Researchers call for improvements to health screenings for female college athletes
Photo by K.M. Klemencic

Orthopedics, Sports, Videos

Using motion-capture technology to identify movements that alter tissue in dancers

Using motion-capture technology to identify movements that alter tissue in dancers

In a marvelous duet between humans and technology, the late choreographer Merce Cunningham used motion-capture sensors on dancers’ bodies to record movement and project the electronic dance as visual design for his 1999 work BIPED. Now, computer scientist Nadia Magnenat-Thalmann, PhD, of the University of Geneva in Switzerland has used sensors to capture what happens to dancers’ internal tissues during the movements they perform day after day. She presented her animations at a recent American Association for the Advancement of Science conference.

As New Scientist recently reported:

[Magnenat-Thalmann's] team carried out MRIs – but also asked six ballet dancers to perform typical dance moves while wearing a motion-capture suit. This allowed them to animate the underlying bone image with each dancer’s movements.

The result is a moving three-dimensional model of the ballerina’s skeleton – that mimics her actual movements. Algorithms then calculate how much stress is placed on each part of the body, drawing attention to areas that are likely to cause trouble in the future.

The findings could help doctors address joint problems and cartilage deformation among dancers. (And perhaps, one hopes, save a few from needing altogether-too-common hip replacements?)

Previously: Is repetitive heading in soccer a health hazard?Measuring the physical effects of yoga for seniorsWalking-and-texting impairs posture – and walking, and texting and Researchers look at brain activity to study falling

Pain, Sports, Videos

Do athletes feel pain differently than the rest of us?

Do athletes feel pain differently than the rest of us?

With five days left in the 2014 Winter Olympics, here’s an interesting question to ponder: Do athletes feel pain differently than the average person? As this recently posted ASAPScience video explains, athletes seem to have a higher pain tolerance, and researchers are still trying to determine if this is because of genetics, training or environment.

Previously: Stanford researchers address the complexities of chronic pain, Retraining the brain to stop the painExploring the mystery of pain and More progress in the quest for a “painometer

Parenting, Public Safety, Research, Sports

Is repetitive heading in soccer a health hazard?

Is repetitive heading in soccer a health hazard?

soccer_headerIn the 20 years that I played soccer as a child and young adult, I used my head countless times to challenge and control the ball as it sailed through the air. During practices, coaches gave instructions on which part of the head to use in making contact and redirecting the ball so that the impact was less painful. They also trained me and my teammates on the body mechanics of receiving the ball to maintain possession. But there was never a discussion on the potential health affects of repetitively heading the ball.

So I was interested to read about a paper (subscription required) recently published in Brain Injury wherein researchers raise concerns about long-term consequences of repetitive heading. In the study, Canadian researchers analyzed nearly 50 papers that examining the incidence of concussion in soccer. Among their findings:

  • Overall, concussions accounted for 5.8 per cent to 8.6 per cent of total injuries sustained during games.
  • In particular, girls’ soccer accounted for 8.2 per cent of sports-related concussions, the second highest sport after football.
  • Research papers that looked at the mechanism of injury found 41.1 per cent of concussions resulted from contact by an elbow, arm or hand to the head.
  • Another study showed 62.7 per cent of varsity soccer players had suffered symptoms of a concussion during their playing careers, yet only 19.2 per cent realized it.
  • Studies on the long-term effects of heading found greater memory, planning and perceptual deficits in forwards and defenders, players who execute more headers.
  • One study found professional players reporting the highest prevalence of heading during their careers did poorest in tests of verbal and visual memory as well as attention.

Considering that an estimated 265 million(.pdf) people worldwide play soccer, researchers say these findings show more research on the long-term consequences of repetitive heading is greatly needed.

Previously: Kids and concussions: What to keep in mind, Measuring vs. reporting concussions in cheerleading, Can a single concussion cause lasting brain damage? and A conversation with Daniel Garza about football and concussions
Photo by Gordon Marino

Health and Fitness, Research, Sports, Stanford News

Study reveals initial findings on health of most extreme runners

Study reveals initial findings on health of most extreme runners

Running_guyThose of us who feel accomplished after jogging a 5K may wonder what drives more serious runners – marathoners, and even ultramarathoners, who run races longer than 26.2 miles. A pair of physicians believes that learning more about these extreme athletes could benefit the rest of us.

Eswar Krishnan, MD, an assistant professor of medicine at Stanford, and Martin Hoffman, MD, of UC Davis, plan to collect data on 1,200 ultrarunners for the next 20 years. They launched the Ultrarunners Longitudinal Tracking Study with a web-based questionnaire in November 2011, and baseline findings of the study were published online today in PLOS ONE.

In a news release, Krishnan explains the value of studying extreme exercise:

“It will help us to understand how much exercise is optimal, how much recreational activity is appropriate and beneficial, and if there is a reason not to push your body beyond a certain point,” he said.

Initial results show, not unexpectedly, that ultrarunners are healthier than the overall U.S. population. Most of their visits to health-care professionals were for exercise-related injuries, which were more common in younger, less-experienced runners. Injuries were mainly to the knees and lower extremities. Notably, ultrarunners reported a lower incidence of stress fractures than other runners, but stress fractures were more common in the foot, perhaps due to running on uneven terrain. These runners also had higher-than-average rates of asthma and allergies, possibly because they spend so much time outdoors.

Identifying what inspires ultrarunners may have broader applications:

The psychological profiles of ultrarunners are of particular interest to the researchers and will be a focus of the upcoming questionnaire. Krishnan and Hoffman are collaborating with several sports psychologists to study what drives these runners to such an extreme level of competition. “Understanding what motivates ultrarunners could be useful for encouraging others to meet minimum levels of exercise to enhance health,” Hoffman said.

Previously: Is extreme distance running healthy or harmful?, A closer look at ‘runner’s high’ and Untrained marathoners may risk temporary heart damage
Photo by Robeter

In the News, Research, Sleep, Sports, Stanford News

Expert argues that for athletes, “sleep could mean the difference between winning and losing”

Expert argues that for athletes, "sleep could mean the difference between winning and losing"

Boston CelticsGoodnight Butler Bulldogs, goodnight Boston Celtics. A recent article in the Boston Globe spotlights ways coaches of elite basketball teams are turning to scientific research on sleep to improve players’ performance on the court.

As outlined in the piece, Brad Stevens enlisted the help of Stanford Sleep Disorders Clinic and Research Laboratory researcher Cheri Mah to help his Bulldogs play their best during a challenging travel schedule when he was their head coach. Charles Czeisler, MD, PhD, chief of the division of sleep medicine at Brigham and Women’s Hospital and director of sleep medicine at Harvard Medical School, has advised the Celtics on planning sleep for optimal results. And sleep influences more than stamina, coordination and muscular power: Czeisler points out that lack of sleep can lead to delayed reaction times, loss of control over emotions, and impaired consolidation of memories – all of which matter when playing ball.

From the article:

The optimal amount of sleep for an average person varies, but Mah and Czeisler each said it is around eight hours — though NBA players might need at least nine.

Many NBA players take pregame naps — Miami’s LeBron James and the Lakers’ Kobe Bryant swear by them — and Mah and Czeisler said that naps are a good power boost that can last for a few hours, but naps and caffeine can’t replace a night of proper sleep.

“It won’t turn a couch potato into an NBA player,” Czeisler said, “but if you’re looking for a potential advantage, sleep could mean the difference between winning and losing.”

Previously: Ask Stanford Med: Cheri Mah responds to questions on sleep and athletic performanceA slam dunk for sleep: Study shows benefits of slumber on athletic performance and Want to be like Mike? Take a nap on game day
Photo by ASSOCIATED PRESS

In the News, Neuroscience, Sports

Traumatic brain injuries: An issue both on the battlefield and the playing field

Traumatic brain injuries: An issue both on the battlefield and the playing field

Last week I had the distinct honor of caring for a wounded veteran who suffered a traumatic brain injury (TBI) while handling munitions. He was literally using his hands to move large mortars when one of them unexpectedly discharged. The explosion left him blind and with significant facial injuries, including a big hole in the base of his skull. The procedure included the concerted efforts of three different surgical specialties designed to reconstruct the bones of his face and skull, to provide symmetry, and improve facial function and protect his brain. Like a true solider, he recovered quickly, and returned to the Palo Alto Veterans Hospital to continue on his path down rehabilitation road.

America’s soldiers aren’t the only ones suffering from TBI. Brain injuries are one of the largest growing ailments faced by our civilian community

Sadly, I’ve told this story before, with the many other soldiers I’ve cared for. Over the last decade of intense war, nearly 260,000 American military service members have suffered a traumatic brain injury. The U.S. Department of Veterans Affairs (VA) and Department of Defense (DOD) have worked tirelessly to identify and treat our nation’s troops, and it’s helping. There are concussion restoration centers in Afghanistan, and neurologists, neurosurgeons and psychiatrists serving in the warzone; and every VA location around the country has, or is in the process of setting up, a mental health center of excellence. Troops who suffer from TBI in combat are quickly evaluated, identified and treated. It’s often said the only good thing that comes out of war is the advancement of medicine, and from these past ten years we have begun to understand the impacts of brain injury.

America’s soldiers aren’t the only ones suffering from TBI. Brain injuries, such as traumatic brain injury, stroke, or damage caused by brain tumors, are one of the largest growing ailments faced by our civilian community. Parents know this better than anyone else: Kids hit their heads – and they do so frequently. Whether it’s sports or just kids being kids, the rate of brain injury is on the rise. Surprisingly, after football, girls’ soccer is the next leading cause of concussions.

Tonight on PBS, Frontline will release a long-awaited documentary detailing the impact of concussions as they relate to American’s most popular sport, football. (The program will air locally on KQED at 9 PM.) The investigation into the National Football League aside, “League of Denial” is poised to expose the long-term effects of repetitive and severe head injuries, an awareness that America needs now. The early onset dementia, increased rate of suicide, and depression are all being examined as potential consequences of brain injury – and football is a big source of injuries. I expect that the game will evolve, and new rules will be implemented to improve safety – but the changes have to come from fans, supporters, and players.

And what about the American public? Where are the concussion restoration centers for the 1.7 million Americans who suffered a concussion this year alone? Well, the short answer is: They’re likely coming. As the recent announcement by the president of the $100 million BRAIN Initiative indicates, concussions are an important issue to us as a nation. And with the growing frequency of neurologic illnesses like Alzheimer’s, Parkinson’s, dementia and brain injury, now’s the time for us to figure out how to prevent, diagnose, and treat them.

Anand Veeravagu, MD, (@AnandMed) is a senior neurosurgery resident at Stanford and a former White House fellow/special assistant to Secretary of Defense Hagel.  Anand’s interests include complex spinal deformity, advanced brain tumor molecular imaging, and patient centered outcomes analysis.

Previously: NIH announces focus of funding for BRAIN initiative, Developing a computer model to better diagnose brain damage, concussionsStanford researchers working to combat concussions in footballMental and emotional costs of a concussionA conversation with Daniel Garza about football and concussionsDeceased athletes’ brains reveal the effects of head injuries and When can athletes return to play? Stanford researchers provide guidance

Ask Stanford Med, Sleep, Sports, Stanford News

Ask Stanford Med: Cheri Mah responds to questions on sleep and athletic performance

Ask Stanford Med: Cheri Mah responds to questions on sleep and athletic performance

US Open TennisWhether you’re a student-athlete superstar or the mayor of your local gym, chances are your performance on the field, court or treadmill could be influenced by the way you sleep. So for this installment of Ask Stanford Med, we’ve asked Cheri Mah, a researcher with the Stanford Sleep Disorders Clinic and Research Laboratory, to respond to questions on sleep and athletic performance. Below are her answers, along with some tips to help you get the most out of your nightly slumber. We hope this will help you consider which of your own sleep practices are working, and what you might want to reconsider.

Michelle asks: Can you give a summary of your  research to date showing that sleep might help athletes? And what kind of studies are you working on now?

For past few years, William Dement, MD, PhD, and I have been studying the impact of sleep extension on the athletic performance in elite athletes. My interest in specifically studying sleep duration and sleep quality in athletes stems from a study in 2002. By chance, several Stanford swimmers were in our study, and although we weren’t investigating athletic performance, they mentioned that they had set several personal records in their last swim meet!

Over subsequent years, we’ve examined the impact of sleep extension across many sports at Stanford including basketball, football, tennis, and swimming to compare similarities and differences across sports. Our findings from men’s basketball published in 2011 indicate that several weeks of sleep extension improves reaction time, mood, levels of daytime sleepiness, and specific indicators of athletic performance including free throws, 3 point field goals, and sprint time. These findings suggest that sleep duration is likely an important component of peak performance.

Additionally, our study suggests that significantly reducing an accumulated sleep debt from chronic sleep loss may require more than one night or weekend of recovery sleep. Although sleep is frequently overlooked and often the first to be sacrificed, sleep duration and sleep quality should be important daily considerations for athletes aiming to perform at their best.

Currently, we’re continuing our research on sleep extension and examining the impact on different aspects of performance in various sports. We’re  also investigating the habitual sleep habits and patterns of elite athletes. Since each sport has it’s own unique culture and training, we’re  interested in examining the similarities as well as differences across sports among the Stanford student-athlete population.

Emily asks: What sort of sleep-related work have you done with Stanford athletes over the years? What kind of feedback have you gotten from the students?

Aside from research,  I’ve worked over the years with various teams and athletes at Stanford to help improve and optimize their sleep and recovery.

For many athletes, it’s their first time diving deep into the impact of sleep on performance – they had never before focused on their sleep as an important component of their daily training beyond being told to “get a good night of sleep” before a game or competition. Many of the athletes I work with are surprised at the difference sleep can have on their training, performance, and even schoolwork! For many, it’s their first experience having a strategic approach to optimizing sleep and tracking their progress through a season. It’s often only in hindsight – after they’ve significantly reduced their sleep debt over several weeks – that many athletes realize they were operating at a sub-optimal level. Additionally, athletes often realize after extending their sleep that they need more hours of sleep than they previously thought to perform at their best. Some athletes have gone on to play at the professional level and have even been advocates of the importance of sleep on sports performance.

Several coaches have been quite interested in improving sleep and recovery in their team. They’re often aware that their athletes aren’t  properly rested and thus have been interested in both educating their athletes and implementing strategies to improve their team’s recovery. Some coaches have also consulted me on their travel schedules to minimize jet lag and optimize performance on the road.

Dr. Dement and I are also part of the Stanford Performance Enhancement Alliance, which serves Stanford athletes through a multidisciplinary approach to sports performance.

Continue Reading »

Cardiovascular Medicine, Orthopedics, Sports, Stanford News

Following treatment for thoracic outlet syndrome, Stanford athlete dives back to life

Following treatment for thoracic outlet syndrome, Stanford athlete dives back to life

diver2

Those of us who spend hours on a keyboard each day – especially ones that torque our wrists and thumbs out of their natural stance – may have already experienced the pain and stiffness that can come from asking our body parts to do the same thing over and over again. And such is the case for athletes, as well.

When Taylor Sishc arrived at Stanford as an All-American high school diver, with years of devoted practice responsible for that achievement, he found himself with a similar repetitive use injury. He had severe weakness in his left arm, and the trick – as with many medical challenges – was to figure exactly what was going on and how to fix it.

As a member of Stanford’s elite diving team, Sishc had access to expert coaches, trainers, therapists and doctors, including vascular surgeon Jason Lee, MD. As I wrote in an Inside Stanford Medicine article:

Lee, an associate professor of surgery at the School of Medicine, had his suspicions about what the problem was: Sishc might have thoracic outlet syndrome, a condition often seen in athletes but also found in people who use their arms in a repetitive motion, which can lead to the compression of nerves or blood vessels, or both, in the thoracic outlet — an area bounded by the base of the neck and the first rib.

Diagnosis of thoracic outlet syndrome, also known as TOS, is not straightforward. “There’s no one blood test or radiographic test or physical exam finding that gives you that ‘aha’ moment,” Lee said. “It’s a combination of positive and negative tests.”

Sishc had been a gymnast since childhood and a serious competitive diver since he was 13. By the time he reached Stanford, he had been lifting his arms over his head in a similar motion for years — exactly the kind of long-term overuse that creates thoracic outlet syndrome…

My story details how Lee’s hunch was correct and how the therapies Sishc received slowly but surely got him back on the diving board in championship form.

Previously: ‘Snorkel’ stents create lifeline to organs in method of treating complex abdominal aortic aneurysms
Photo by Todd Holland

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