The curious case of turf toe

Toe injuries are not often associated with the need to remove an athlete from a contest. Turf toe is a painful foot injury that has pushed athletes to the sideline for extended recovery periods.

The human foot is divided into three basic sections: the hindfoot (heel), the midfoot (arch), and the forefoot (toes).  Turf toe affects the forefoot.

Turf toe involves the first metatarsalphalangeal joint.  This joint is the connection between the great toe and the bone that anchors it to the foot.  Like other sprains, it consists of damage to the connective tissues that stabilize the moving parts.

The mechanism of injury consists of the sudden, extreme dorsiflexion (upward bending) of the great toe.  The force results in stretching and tearing ligaments beyond their normal range of motion.  Cartilage can also be injured in more severe trauma.

Inflammation follows with swelling and pain.  Initial treatment includes rest, ice, compression and elevation.

This type of injury usually involves an activity on a firm surface.  Turf toe is most common in football.  The recent popularity of artificial turf over natural turf is part of the reason for the rise in cases.  A force applied to the calf muscle while the knee is flexed is another cause of turf toe.

“The injury is primarily mechanical in nature and so is the treatment.  Putting the foot in a more rigid shoe or an orthotic device will avoid further injury,” said Dr. Joseph DiFrancesca, a Norwich podiatrist who treats many athletes with turf toe.  He also believes that careful selection of athletic shoes with a rigid shank will reduce injury rates.

The healing process for turf toe can take several weeks.  Unfortunately, an early return to activity without sufficient healing can lead to a chronic debilitating injury

Professional athletes and depression

There are many terms used to describe professional athletes.  Some of these include famous, rich, leader and superstar.  One word not commonly applied in this context is “depressed.”

Depression is an illness that affects approximately 15 million American adults each year.  Like many other illnesses, depression has no boundaries in regard to gender, profession or socioeconomic status.

Previously thought to be an illness of adults, depression is often overlooked in children and young adults.

There is no single factor that causes depression. Stress, sleep deprivation, genetics and hormonal fluctuations are among the influences that cause an alteration in brain chemistry ultimately resulting in depression.

Depression often impacts other illnesses.  It can significantly worsen diabetes, stroke and heart disease.

 In athletes, head injury can play a big role in precipitating a bout of depression.  Athletes typically enjoy the benefits of being popular among peers, access to higher education and being in excellent general health.  Unfortunately, many of these advantages can be fleeting.

Eric Hipple, a former NFL quarterback, currently works as an outreach specialist at the University of Michigan Depression Center.  In his book, "Real Men Do Cry," he chronicles his personal experience with depression, bankruptcy and the death of his 15-year-old son from suicide.  “Depression is often brought on by transition and athletes face transition on a regular basis.  Being cut from a team often results in loss of friends, income, support mechanism and daily structure,” said Hipple.

Hipple advises parents to monitor stress levels, be aware of a family history of depression and look for early signs of depression.  Some early warnings are changes in appetite and sleep pattern, poor concentration in class, lack of motivation and overwhelming sadness.

Depression is a treatable illness but identifying and admitting to it early are crucial for a full recovery.

All sports supplements are not created equal

A visit to any athletic training room reveals a variety of tools used to heal the wounds of battle including whirlpools, various adhesives and pads. A recent addition is an area occupied by strength and conditioning specialists. It is in this area of the locker room where discussions of injury prevention predominate.

Improving human performance involves multiple disciplines. Developing a powerful muscular system relies on a variety of fitness activities.

Aerobic or cardiac fitness uses activities like running, biking and swimming. These are designed to build stamina and allow the human body to utilize oxygen efficiently.

Weight lifting and stretch bands are categorized as resistive fitness. These movements are designed to increase power and strength.

Fueling the human body involves a variety of nutrients. The basic components are fat, protein and carbohydrate. It is often the refinement of the nutrition regimen when the picture becomes cloudy.

The use of nutritional supplements that promise to magically transform the human body are often a problem for strength and conditioning specialists responsible for the health of athletes.

Supplements are not subjected to mandatory regulation like drugs.

The National Science Foundation (NSF) is an independent federal agency that provides certification for supplements. The NSF seal of approval means that the contents have met stringent standards and no substances banned by sports leagues are present.

“When athletes inquire about what supplements they can take I tell them to keep it simple and only use those that are NSF approved,” said Mike Wickland, the New York Yankees minor league strength and conditioning coordinator.

Wickland’s advice regarding supplements is certainly applicable for all athletes and he firmly believes that food is the best source of nutrition. “After a workout or a game, I recommend a peanut butter and jelly sandwich with chocolate milk,” advises Wickland.

Be prepared before hitting a sports fantasy camp

A professional pianist slides into second base, fracturing his right hand a week before a scheduled performance with Aerosmith, an orthopedic surgeon breaks his ankle rounding third and a homemaker dislocates her finger trying to barehand a ground ball. These are all examples of injuries seen in the growing business of fantasy baseball camps.

Adult fantasy sports camps allow participants to swing, shoot, putt, ski or bat with their sports idols. As the variety of camps and participation has grown, so has the number and type of injuries.

“I advise campers to start out slow and gradually build up as the camp progresses,” said Greg Spratt, a certified athletic trainer with the New York Yankees who has worked with many baseball fantasy campers over the years. “Unfortunately, many try to go all-out on day one and often end their camp experience in the training room. There is no fantasy disabled list.”

Spratt provides incoming campers with a program that includes stretching, running, hitting and throwing drills. He advises that the program begin 12 weeks prior to the big week.

Preparation for a sports fantasy camp will only involve a small percentage of athletes but the lessons are easily applied to any athlete preparing for a competitive season.

Some important tips include:

• Physical exam. Make an appointment for an annual physical exam with your physician before heading to the gym. This should include a cardiac stress test if necessary.
• Lose weight. Spring is a good time to get rid of any extra pounds put on over the winter. It will also put less stress on muscles and tendons.
• Stretch. The most common injuries in sports camps are torn muscles, particularly the hamstrings. Adequate warm-up cannot be over-emphasized.
• Sport-specific movement. Incorporate activities that involve swinging, throwing and jumping similar to the actual sport.

Sports fantasy camps usually require a significant financial investment. That investment will pay off greatly if it includes getting into better shape.

The viability of sports medicine academies

Recently, a high school classmate who has become a successful orthopedic surgeon approached me about becoming involved in establishing a sports medicine academy within our alma mater.

The concept of sports medicine academies has arisen from the increased number of people participating in athletic activities and subsequent sports-related injuries. Several recent surveys project a growing need for health care professionals with a background in sports medicine.

Sports medicine is generally associated with professional and collegiate sports teams. Interestingly, although highly publicized, these high profile injuries make up a relatively small percentage of the sports injuries evaluated each year.

Medical studies continue to demonstrate that many chronic illnesses can be more effectively treated with a regimen that includes regular exercise. Among these are vascular diseases, diabetes, obesity and dementia.

Health professions involved in sports are physicians, athletic trainers, physical therapists, psychologists, nurses, exercise physiologists and conditioning specialists. The goal of sports medicine academies is to provide fundamental education with transferrable skills that allow students to enter any of these areas of study.

In addition to a basic liberal arts high school course load, students are required to study anatomy, physiology, biology, biostatistics, sports conditioning and marketing. All students are also required to work in a variety of sports medicine settings to gain clinical and practical experience.

Although sports medicine is often associated with the treatment and prevention of athletic injuries, one of the most exciting areas of sports medicine involves the study and improvement of human performance.

Making the human body more efficient is one key to improving health and avoiding disease. A foundation in sports medicine may provide the necessary skills for future health care professionals.

When heading for the hills, practice avalanche safety

Seventeen people have lost their lives this year in accidents related to avalanches. Although uncommon in the northeast, many winter sports enthusiasts will soon be heading west for the spring season.

An avalanche consists of large volumes of snow sliding down a mountain at high velocity. These sudden events result in destruction of roads, homes and lives. Trees, boulders and debris often become part of the descending flow.

Snow and ice will accumulate in layers as the winter season proceeds.

As the adherence of these layers weakens, the chances of an avalanche will increase.

Many factors play a role in loosening these layers. Natural causes include rapid warming, sudden precipitation and falling rocks. Artificial influences consist of skiers, snow boarders and snowmobile riders who may disrupt the snowpack. Animals may cause stress just by walking over a weakened area. Explosive use will certainly cause an avalanche in a vulnerable zone.

Avalanche risk can be calculated based on prevailing conditions and location. They are most commonly seen on back country ski trails that are not frequently used. Warnings are posted when the chances of an avalanche are high. Sometimes they will be intentionally triggered as a way of avoiding an unsuspected downfall.

Safety equipment and measures have proven to be effective:

• Pay close attention to warning signs and closed trails. Closing trails are not arbitrary decisions and there is most likely a reasonable degree of danger.

• An avalanche beacon will emit a signal to allow others to quickly find a victim and begin digging out.

• The avalanche balloon is a device that is designed to keep a person above the rising snow when deployed.

When planning to escape the unseasonable warmth of the northeast for a northwestern adventure, remember to invest in specialized safety equipment along with common sense.

Digging deeper into exercise immunology

One of the most exciting fields of research in human physiology involves the effects of physical training on the immunologic response.

Immunology is the study of the ability to fight off attack from infection and certain forms of cancer. It consists of a response that utilizes white blood cells that isolate and destroy an offending agent.

Among the more common triggers of the immunologic response is the influenza virus. It also has a negative effect on the ability of athletes to attain their peak performance.

Pertinent findings regarding the effect of exercise on the immunologic response include:

• Studies performed on marathon runners reveal that intense exercise lasting longer than 60 minutes has an adverse effect on the ability to summon immune cells. This results in more frequent upper respiratory infections. Moderate regular exercise is associated with an improved response.

• There is a natural decline in the ability to mount a response to infection with age. Physically conditioned elderly subjects had a superior response to infection versus a sedentary group.

• Mental stress has also been shown to have an adverse effect on the immunologic response. Athletes who meditated for one hour a day for 8 weeks had an enhanced response to infection.

• Diet plays a big role in immunologic function. Athletes who were undernourished or involved in rapid weight loss were more susceptible to infection. This particularly applies to combat sport athletes and other athletes who must achieve a weight level.

• Adequate sleep is crucial to efficient immunological function.

After a very thorough review of the current literature in a recent lecture at the University of Connecticut, Professor Neil Walsh from Bangor University in the UK discussed the importance of hygiene.

Ironically, in addition to following solid training principles, it may be merely proper hand washing and covering the mouth and nose when sneezing that can lead to victory.

Cardiac arrest during marathons are rare, but possible

Millions of Americans participate in long-distance running events. The marathon distance (26.2 miles) and the half-marathon (13.1 miles) have become increasingly popular. It is because of the extreme physical demands of these competitions that the occasional report of sudden death during an event is not surprising.

The human heart consists of four chambers that contract and expand in sequence to pump blood throughout the vascular system. In order to do this, the heart has a carefully synchronized electrical network that must fire signals in a rhythmic manner.

The muscular heart chambers have thick walls that allow for the maximum volume of blood to be ejected with each beat. Aerobic training reduces the amount of effort necessary for the heart to function.

A recent study looked at the incidence and outcomes of cardiac arrest associated with marathon and half-marathon events from January 2000 to May 2010. The number of participants steadily grew from 1 million in 2000 to 2 million in 2010.

Of the 11 million people studied over the 10-year span, only 59 suffered cardiac arrest during a race. Cardiac arrest was most common in males who participated in full marathons as opposed to half-marathons. Men were also most likely to die from the arrest and are clearly more susceptible to exertional cardiac arrest.

Surprisingly, the most common cause of arrest was not due to blockage of coronary arteries but an oversized left ventricle. The increased size (hypertrophy) eventually blocks the outflow of blood from the heart.

Cardiac hypertrophy is most common in younger athletes and associated with poor outcome.

The rate of cardiac arrest should in no way discourage participation in long-distance athletic events. Instead, it should alert athletes to the need for proper pre-participation physical examinations.

Giants' Mark Herzlich overcomes bone cancer

Inspirational comeback stories abound in the world of sports. This year’s NFL season is no exception, such as the come-from-behind, underdog victories by the Denver Broncos, led by Tim Tebow.

One story that bears noting is the return of Mark Herzlich to the sport many thought was part of his past and not his future.

Herzlich, a 24-year-old linebacker for the New York Giants, was diagnosed with Ewing’s sarcoma, a form of bone cancer, while playing for Boston College. His treatment included chemotherapy, radiation therapy and excision of the tumor that involved the largest bone in the human body, the femur. A titanium rod reinforced the bone shaft.

A two-year course of physical therapy and intense training followed. After being invited to try out for the New York Giants, he accomplished something many thought was impossible: He made the team.

Ewing’s sarcoma is a malignant tumor that typically is seen in children and young adults. It generally appears in the long bones of the body.

The most common presenting symptom is intense bone pain. Unfortunately, in approximately one-third of patients, the tumor already has spread to the lungs and other bones at the time of diagnosis.

Treatment of Ewing’s sarcoma includes aggressive chemotherapy and radiation therapy that is focused on the tumor site. Surgical excision of the tumor follows.

Dr. Dinesh Kapur, an oncologist and director of cancer services at The William W. Backus Hospital, isn’t surprised by Herzlich’s recovery.

“Early detection, combined with the multimodality approach of chemotherapy, radiation and surgery, has dramatically improved survival from Ewing’s sarcoma,” Kapur said.

Herzlich’s return to the highest level of professional sports not only required a combination of modern medical therapies, but an unwavering spirit and commitment to succeed.

Celtics player saved from aortic aneurysm

Amidst the confusion of ending the NBA lockout and hurriedly beginning a shortened season, a young life was saved.

Jeff Green, a 25-year-old forward, had signed a one-year, $9 million contract to play for the Boston Celtics. During a routine preseason physical examination, he was diagnosed with an aortic aneurysm. Instead of heading over to the practice court, Green was headed to the operating room.

The aorta is the largest artery in the human body. It provides the main passageway for richly oxygenated blood to vital organs. The aorta is divided into two main sections:

• The thoracic aorta leads blood from the heart and downward through the chest cavity.
• The abdominal aorta continues into the abdomen feeding branches to the kidneys, liver, spleen and intestines.

An aneurysm is an abnormal enlargement of a blood vessel. It results from a weakening of the supporting tissue that provides a firm lining in an artery. Under constant pressure, the weakened area will enlarge and cause the artery to dilate and eventually rupture. This results in profuse life-threatening hemorrhage.

Aortic aneurysms can be repaired by cutting out the affected section of aorta and replacing it with a synthetic segment. Another approach is an endovascular repair. In this procedure, a new lining is inserted in the weakened area via a catheter through an artery in the groin.

Aneurysms are typically associated with high blood pressure, elevated cholesterol levels, obesity and smoking. All of these potential causes are not typically associated with professional athletes.

Green’s aneurysm will be repaired and he is expected to return to the NBA next season.

Jeff Green’s circumstance should serve as a reminder of the importance to have annual physicals performed by a physician even if you are young and in excellent health.