Sickle Cell Disease/Trait And Athletics

By: Lauren Crockett, ATC

Sickle cell disease (SCD) is a very common disease seen primarily in African Americans, individuals from Spanish speaking regions in the western hemisphere, Turkey, Greece, Saudi Arabia and India.  Sickle cell disease is an inherited group of red blood cells that are hard, sticky, and shaped like a sickle, a C-shaped gardening tool.  The cells die prematurely leading to a persistent shortage of blood cells.  In addition, the shape of the cells causes them to get stuck in the blood vessels and clog.  There are multiple forms for the disease.  Sickle cell trait (SCT) differs from sickle cell disease in that the individual only inherited one gene containing the sickle cell trait and one normal gene.  Usually, those with sickle cell trait do not have severe complications except in conditions such as extreme heat or cold and high altitude.  Parents with sickle cell trait can pass the trait on to their children.

Sickle Cell Anemia

It is estimated that 1 in 500 African American births and 1 in 36,000 Hispanic births have sickle cell disease. In addition, 1 in every 12 African Americans has sickle cell trait. Because of the complications and prevalence of the disease, it is essential that athletic trainers review pre-participation physicals to determine which athletes have sickle cell disease or trait.  Athletes should not be held out of competitive sports, but they need some accommodations in order to stay healthy.  A proper warm up, changing the workout intensity, making modifications during extreme temperatures, maintaining hydration, adequate rest breaks and acclimatizing to heat are examples of ways to avoid sickel cell trait complications.  While athletes primarily have signs and symptoms including pain, fatigue and muscle weakness, more serious complications can occur such as exertional sickling.  Any athlete that is showing signs of exertional sickling should be immediately removed from practice and treated with rest, cooling, oxygen and hydration.  The signs and symptoms of exertional sickling include muscle cramping, shortness of breath, difficulty breathing, fatigue, low back pain, lower body pain, slow recovery or a “slow collapse” which is not sudden like collapse from cardiac arrest.

Altitude can greatly affect those with SCD and SCT.  Athletes training at higher altitudes should have oxygen available during training or limit the amount of training.  In 2007, Pittsburg Steelers player Ryan Clark lost 30 pounds, his spleen, and gall bladder after suffering from complications of sickle cell trait while preparing for and playing a game in Denver, Colorado.  He was not allowed to play the next time the Steelers were in Denver.

Athletes with SCD or SCT should inform their coaches of their disease so that they can be treated properly.  If there are athletic trainers at the schools, they should educate coaches on the importance of making accommodations to athletes with sickle cell trait. Coaches need to let the athletic trainers know immediately if an athlete starts showing signs and symptoms of acute illness.

References:

  1. http://www.cdc.gov/ncbddd/sicklecell/index.html
  2. Douglas JC, et al (2013) “The Inter-Association Task Force for Preventing Sudden Death in Secondary School Athletics Programs: Best-Practices Recommendations.” Journal of Athletic Training: Jul/Aug 2013, Vol. 48, No. 4, pp. 546-553.
  3. CBS News Staff. “Sickle Cell Trait Sidelines Football Player:  What is it?” http://www.cbsnews.com/news/sickle-cell-trait-sidelines-football-player-what-is-it/ January 4, 2012.
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State-Specific Differences in School Sports Preparticipation Physical Evaluation Policies

The American Academy of Pediatrics recently released their study evaluating the current preparticipation physical evaluation (PPE) administrative policies and cardiovascular screening content of all 50 states and Washington, DC. CHKD’s own Dr. Brenner was a co-author on this article published in the January 2015 issue of Pediatrics. Anyone involved in youth sports in the school systems should take a look at this research article. The link below will take you to the article.

http://www.chkd.org/uploadedFiles/Documents/Programs_and_Clinics/Pediatrics%202014-Brenner-%20State-Specific%20Differences%20in%20School%20Sports%20Preparticipation%20Physical.pdf

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Dynamic vs Static Stretching: When Should I Use It?

By: Stephanie Browning, ATC

When it comes to warming up, there is always the question of “Should I do a dynamic or static stretch?” Like most other things, there are many different opinions out there. However, there are some studies that show that dynamic warm-ups prior to activity increase the performance and decrease the risk of injury, while static stretching as a cool down helps increase flexibility and not pushing the muscle past its breaking point.

A study using thirty cadets at the US Military Academy was conducted to determine whether dynamic or static stretching had the most influence on power and agility performance. The group was broken up into three groups of ten: a group for dynamic stretching, a group for static stretching, and a group doing no stretching at all. The results concluded that the cadets that were in the dynamic stretching warm-up group showed an enhancement in the power and agility performances compared to those of the cadets that were in the static stretching and no stretching groups.

Dynamic StretchesDynamic or ballistic stretching involves a bouncing movement in which repetitive contractions of the agonist group are used to produce quick stretches of the antagonist muscle. For example, repetitive contractions of the quads are used to produce quick stretches of the hamstrings. The idea behind this type of stretching is that dynamic stretches more closely resemble the type of movements the body will be engaging in during activity and considered more functional.

Static Stretches

Static stretching involves passively stretching a muscle by placing it in a maximal position of stretch and holding it there for thirty seconds. Static stretching offers less risk of exceeding the limits of the joints because the stretch is more controlled. For sedentary or untrained athletes static stretching may be a safer start for stretching and then follow that with dynamic stretching to resemble the movements of the activity.

References:

McMillian DJ, Moore JH, Hatler BS, Taylor DC. Dynamic vs. Static-Stretching Warm Up: The Effect on Power and Agility Performance. Journal of Strength and Conditioning Research. 2006; 20(3): 492-499

Prentice, William E. Arnheim’s Principles of Athletic Training. New York: McGraw Hill, 2006, Print

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EAP: What’s Your Plan?

By: Adam Mistr, ATC

Emergency Action Plans (EAP) are an integral part to any sports medicine program.  The knowledge of what to do in an emergency situation is crucial to a smooth and successful outcome.  Every high school, collegiate, and professional athletic organization maintains an updated EAP for all of their events.  Each staff member of the sports medicine team, coaching staff, and administration should be educated on emergency procedures as it is very likely that all of them will take part in an emergent situation at some point in their career.

What does an EAP entail?

Your Emergency Action Plan contains explicit details on what to do in an emergency situation.  The EAP outlines specific roles of those involved; from securing a safe scene, to administering first aid, activating the emergency response system, to crowd control.  The plan will also provide you with the exact information to be gathered and relayed to emergency medical personnel when activating the emergency response system (i.e. calling 911).  This will include: your name, phone number, nature of injury, number of people involved/injured, and specific location.

The EAP will provide specific locations of AED(s) to be retrieved should a cardiac emergency arise.  All members of the sports medicine team (i.e. Athletic Trainers, team physicians) are trained in the proper use of the AED during a life threatening emergency.  Most athletic coaches that are CPR certified have been trained in AED use as well.

“Why use an EAP?  I know what to do.”

An emergency can be very stressful for many people and the EAP provides guidelines to help the situation go as smoothly as possible.  Everyone is not accustomed to dealing with an emergency, so when they arise you do not want the situation to become a crisis.  It is very important to remain calm during these situations.  Family members can react in many different ways when it is their son, daughter, brother, sister, parent involved in an emergency situation.  Hysterical family members or bystanders can create a distraction and impede or interfere with successful management of the situation.

Have a plan, follow the plan.

Emergencies occur every day, and not only in an athletic environment.  However, there is a high likelihood of an athletic emergency occurring at some point in your career.  Having a plan in place, and educating all of those associated with the sports medicine and athletic program, can make the emergency situation run very smoothly.  Everyone has a role in an emergency.  Knowing that role and following the guidelines of the EAP can enhance the positive outcomes of the situation.

For more information on Emergency Action Plans, you can visit the following websites:

Occupational Safety & Health Administration:

https://www.osha.gov/SLTC/etools/evacuation/eap.html

Centers for Disease Control and Prevention:

http://www.cdc.gov/niosh/docs/2004-101/emrgact/emrgact1.html

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Generalized Hypermobility

By: April Kirkner, DPT, ATC

Generalized joint hypermobility is an abnormal increase in multiple joint range of motion from the normal values of the population.  The prevalence of joint hypermobility is higher in children and is seen more in females than males.  Joint hypermobility syndrome is diagnosed when the person has musculoskeletal symptoms including pain in 4 or more joints for >3 months in addition to the hypermobility.  Generalized joint hypermobility is determined in children by use of the Beighton score.  The Beighton score is a valid measure and involves determining if 9 items (pictured and described below) are positive or negative.  If 5 of the 9 items (using both extremities) are positive then the individual has generalized joint hypermobility.

Hypermobility 1

Hypermobility 2

Hypermobility 3

Hypermobility 4

Hypermobility 5Reference:

  1. Smits-Engelsman B, Klerks M, Kirby A. Beighton score:  a valid measure for generalized hypermobility in children.  Journal of Pediatrics 2010; 158:119-123.
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