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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

Neuroscience, Pediatrics, Sports, Stanford News

Kids and concussions: What to keep in mind

Kids and concussions: What to keep in mind

Back to school means to back to sports for many, and it’s a good time for parents and coaches to be thinking about – and watching out for – concussions. In a recent Q&A from Lucile Packard Children’s Hospital, two experts offer ways to reduce the effects of a concussion, provide guidance on when an affected player can get back on the field, and remind readers about sex differences in symptoms. Stanford’s Paul Fisher, MD, chief of pediatric neurology at Packard Children’s, says:

Girls and boys tend to report different symptoms of a concussion and may also describe the same symptoms differently. Boys often report symptoms that are fairly severe – confusion, bad headaches, forgetting – while girls may report milder symptoms, such as drowsiness, malaise, or noise sensitivity. But that doesn’t mean a girl’s concussion is any less severe.

A big problem here is that when a girl reports milder symptoms to a male coach – and a lot of coaches in girls’ sports are male – her concussion could be missed if the coach isn’t alert to the differences in how boys and girls report symptoms.

Previously: Study shows concussion recovery may take longer for female, younger athletes, Report finds brain injuries rising among high school football players, Can high-tech helmets safeguard young athletes against concussions?, Study suggests teens are more vulnerable to effects of sport-related concussions, Should parents worry about their kids playing football? and A conversation with Daniel Garza about football and concussions

Ask Stanford Med, Sleep, Sports, Stanford News

Last day to submit questions on sleep and athletic performance to Stanford expert

CARTERAs a reminder, today is the final day to submit questions for our Ask Stanford Med installment spotlighting sleep and athletic performance. Questions related to research on the subject and to sleep patterns or exercise habits can be submitted to Cheri Mah either by sending a tweet with the hashtag #AskSUMed or by posting a comment here. We’ll accept questions until 5 p.m. Pacific time.

In our earlier post, we included details on Mah’s research:

Sleep and sports are the focus of Mah’s work, dating back to a 2002 study during which collegiate swimmers reported they had beaten personal swim records after getting extra hours of sleep as part of their participation in the trial. A light bulb went off in Mah’s head, who decided then to investigate whether sleep extension could have an impact on physical performance. Since then she has researched the effects of sleep on numerous groups of athletes, including elite college-level basketball players (as detailed in a 2011 study), and she has two soon-to-be-published papers measuring the impact of sleep on Stanford football players and on NFL players. Over the last several years, Mah has also worked with many of the Stanford sports teams and coaches to integrate optimal sleep and travel scheduling into their seasons, and she consults on sleep issues with professional hockey, football and basketball teams.

Previously: Ask Stanford Med: Cheri Mah taking questions on sleep and athletic performanceStanford expert: Students shouldn’t sacrifice sleepA slam dunk for sleep: Study shows benefits of slumber on athletic performanceCould game time affect a baseball player’s at-bat success? and Want to be like Mike? Take a nap on game day
Photo by ASSOCIATED PRESS

In the News, Orthopedics, Research, Sports

Barefoot running: the conversation continues

Barefoot running: the conversation continues

footprint

Running au naturel could feel freeing or painful, and runners and sports medicine specialists argue both ways about going bare…foot. As previously reported on Scope, sans-shoe or reduced-shoe running has been shown to promote landing further forward on the foot, which may prevent injury, but the practice could introduce other physical problems if adopted into a routine too quickly.

At this year’s British Science Festival in Newcastle, U.K., an overview of research suggested that runners who wish to begin running barefoot should introduce the practice slowly into their routine. A BBC News article on the conference proceedings reports that experts differ on recommendations for running footwear, but they agree that more research needs to be conducted.

From the article:

[Mick Wilkinson, PhD, an exercise physiologist from Northumbria University] was one of the first people to run the Great North Run completely barefoot, which he did in 2011. But he believes that those using thin-soled shoes which claim to emulate barefoot running may be missing out on the potential benefits from running without footwear.

“Studies in the late 80s suggest there needs to be a sense of friction before the impact avoidance behaviour is triggered. So if you put anything between you and the ground, even if it’s only 4mm thick, people tolerate extremely high vertical loads, without doing anything about it,” Dr Wilkinson explained.

Other researchers suggest that thinner-soled shoes still encourage front-foot striking and the associated benefits. According to Mark Burnley, PhD, a senior lecturer in exercise physiology at the University of Kent, barefoot running “will save you money on shoes, but is not some injury-eliminating/performance-enhancing panacea.”

Previously: Seeking to reduce stress on the body, some runners are reversing their strideIs barefoot running better for the body? and “Barefoot” running craze still going strong
Photo by Gordon Tarpley

Ask Stanford Med, Sleep, Sports, Stanford News

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

football kidIt’s football season and back-to-school time, which means evening routines in households across the country may be changing to accommodate homework, practice, dinner, and perhaps Monday Night Football-watching. For athletes of all ages and stripes, conversations may also be focused on optimizing performance and reducing the risk of injury, with such topics as conditioning technique and nutrition getting playing time in the discussions. But one thing that may not be getting enough attention is sleep, and its role in sports.

To boost the conversation of sleep’s part in athletic performance, we’ve asked Cheri Mah, a researcher with the Stanford Sleep Disorders Clinic and Research Laboratory, to respond to your questions on the topic. Sleep and sports are the focus of Mah’s work, dating back to a 2002 study during which collegiate swimmers reported they had beaten personal swim records after getting extra hours of sleep as part of their participation in the trial. A light bulb went off in Mah’s head, who decided then to investigate whether sleep extension could have an impact on physical performance. Since then she has researched the effects of sleep on numerous groups of athletes, including elite college-level basketball players (as detailed in a 2011 study), and she has two soon-to-be-published papers measuring the impact of sleep on Stanford football players and on NFL players. Over the last several years, Mah has also worked with many of the Stanford sports teams and coaches to integrate optimal sleep and travel scheduling into their seasons, and she consults on sleep issues with professional hockey, football and basketball teams.

Questions can be submitted to Mah by either sending a tweet that includes the hashtag #AskSUMed or posting your question in the comments section below. We’ll collect questions until Tuesday, September 17 at 5 p.m.

When submitting questions, please abide by the following ground rules:

  • Stay on topic
  • Be respectful to the person answering your questions
  • Be respectful to one another in submitting questions
  • Do not monopolize the conversation or post the same question repeatedly
  • Kindly ignore disrespectful or off topic comments
  • Know that Twitter handles and/or names may be used in the responses
  • Mah will respond to a selection of the questions submitted, but not all of them, in a future entry on Scope.

Finally – and you may have already guessed this – an answer to any question submitted as part of this feature is meant to offer medical information, not medical advice. These answers are not a basis for any action or inaction, and they’re also not meant to replace the evaluation and determination of your doctor, who will address your specific medical needs and can make a diagnosis and give you the appropriate care.

Previously: Stanford expert: Students shouldn’t sacrifice sleep, A slam dunk for sleep: Study shows benefits of slumber on athletic performance, Could game time affect a baseball player’s at-bat success? and Want to be like Mike? Take a nap on game day
Photo by Nick Weiler

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