Middle-aged Couple Running on the Beach

From: WEEKLY HEALTH TIPS
By: Lisa Best MBA, Ph.D in Holistic Nutrition, CCN

In addition to a enjoying a nutritious diet, we all know that exercise is important for cardiovascular health, weight maintenance, and lymph movement throughout the body. And the most important part about exercising is picking something you like that fits your style, so you will stick with it. Just like fad diets, there are tons of fad exercise programs out there too, and it’s hard to know which ones to try.

But I must confess, interval training is my personal favorite form of exercise, not just because it’s quick and powerful, but because I can still smile while doing it.

I wrestled with writing generically about several types of exercise, but ultimately decided to turn this topic over to an expert, Dr. Al Sears, the doctor whose protocols I both recommend and have followed myself for more than 10 years.

Dr. Sears is a progressive physician in the forefront of anti-aging medicine, natural cures, and optimal heart health. He has written extensively about his formula for interval training called PACE®, which he developed after studying Olympic athletes. Many other physicians and exercise specialists have copied Dr. Sears’ programs over the years, but his was the original.

I was initially attracted to PACE® because of the short 12 minute time commitment, in contrast to the hours I’ve logged running 2-4 miles 4 or more days a week for 30 years prior to switching to intervals. I started PACE® over 10 years ago because it made sense, but I’ve stuck with it because it works.

I usually do PACE® every other day, alternating with strength training (weights) and flexibility exercises (Yoga) on the days I don’t do interval training. I’ve also encouraged nutrition consulting clients, and my whole family to try it, since the benefits are so great and the time required so minimal.

For those of us who have passed the magical half-century mark, it is especially important to minimize the loss of flexibility and strength that can often accompany aging. So I do push-ups, and squats as part of my PACE® workout in addition to sprinting or swimming to add variety. But the magical part about PACE® is you can do it with any type of movement that gets your heart rate up. The choice is yours.

Plus other major benefits I’ve noticed since I started doing interval training, is I don’t feel exhausted from my workouts anymore, and I don’t get exercise injuries. Focus is on short bursts of intense energy instead of prolonged, repetitive stress.

If you are a marathoner, tri-athlete, or one of those mud wrestlers, I’m not trying to talk you out of your sport if you love it, as long as you stay mindful of the stress you are putting on your system. I think the thrill of competition and personal sense of accomplishment are good reasons to do extreme sports short-term if you enjoy them.

But for heart health, long-term health, and long-term injury prevention, interval training is tops.

Even I was worried in the beginning that I might lose strength or stamina by cutting back my running time. So I test it intermittently by doing a 4-mile run every now and then, just to verify I can still do it.

I’ve been amazed to discover that not only can I still do it, but I also have way more energy when I do. Plus, I’ve noticed I rarely get sick anymore, so my immune system has recovered from the stress of running with interval training too.

To tell you about his plan personally, I’d like to introduce you to Dr. Al Sears, and an article he’s written on the heart healthy merits of interval training:

Man Dies after Taking Bad Advice

“Dr. Sears, my internal medicine doctor wants me to exercise for an hour a day. Sometimes I get so tired, I feel like I’m going to collapse. How could this be good for me?”

This patient recently asked me this right after I had read about a man who died while driving back from a 2,400 mile bike ride. I began thinking if that’s not enough cardio to protect your heart what will?

Many of my patients report this bad advice. That’s too bad. Traditional cardio actually makes your heart and lungs smaller. Today I’ll show you why PACE® exercise will energize your heart. You can do it in as little as twelve minutes a day.

The Problem with Long Distance Cardio

This man died of a heart attack shortly after riding his bicycle across the continent.(1) He reportedly undertook this extreme durational cardio to re-strengthen his heart.

Yet I’ve been saying for years, long duration cardio will not protect you from heart disease or heart attack. It actually makes your heart smaller and weaker.

To protect and energize your heart, you need to build your heart’s reserve capacity.

Have you ever noticed that long distance runners look thin, weak and out of shape? Watch any marathon on TV and you’ll see what I mean. To compare, watch a track and field event and see how muscular and fit the sprinters look.

The interval training the sprinters practice boosts your heart’s reserve capacity. This is what your heart needs when it gets stressed. A heart attack will hit you when your heart needs extra energy but has nowhere to go. A small heart, streamlined from years of jogging will not have the extra capacity for stressful situations.

The Secret to Heart Attack Prevention

The good news is that interval training takes as little as twelve minutes a day. You can do it on any machine at the gym. You can even run or bike outdoors. Start at a slow easy pace. Then pick up the intensity for two minutes. Afterwards, go back to a slow, easy speed. Repeat this process and increase the intensity each time you do a faster interval.

As you become better conditioned, you’ll be able to exercise in short bursts of intense intervals. After each interval, you’ll actually feel yourself start to pant. This means you’re doing it right. When you pant, you are asking your lungs for more oxygen than they can provide in the moment. This is an oxygen deficit.

This tells your body to increase your lung volume. It also builds the critical reserve capacity you need to prevent heart attacks.

Here’s an added bonus: PACE® exercise is your most reliable way to burn fat. Not only will you protect your heart and lungs, your fat will melt away.

For more information on PACE®, see Health Alerts 28, 58, 147 and 270.

To your Good Health,


Al Sears, MD


(1)Associated Press. Heart patient dies after 2,400-mile ride. www.cnn.com. May 2, 2005.

The best part about PACE® is you can start it no matter what your current level of fitness, since the idea is to slowly add intensity each time you work out. And since you are always increasing your intensity, those nasty workout plateaus are a thing of the past.

You don’t have to buy Dr. Sears’ books or workout tapes to try this concept at home, but he surely makes exercising easy for you if you want to take advantage of his expertise. 

Until next time .  .  .

female athleteKate Carr
President and CEO, Safe Kids Worldwide
Posted: 08/05/2013 9:58 pm

Sixteen-year-old Anna didn’t hesitate when I asked her about her love of soccer. “It’s my life,” she said matter-of-factly, and her reputation backed it up. Through hard work, tenacity and dedication, Anna is one of the top high school soccer players in the Washington, D.C. area with realistic aspirations of a Division I scholarship.

That’s why it’s so sad that our conversation took place when she was lying on a sports rehab table so far from the game she loves. This is her third knee surgery, which is shocking but not as uncommon as you might think among female athletes. In fact, female athletes are three times more likely to have ACL injuries than male athletes.

There are plenty of theories for this discrepancy, ranging from physical differences to hormone levels. Either way, there are stretches and exercises all athletes can do to help prevent these injuries.

I was at the rehab facility to film a video with U.S. Women’s Soccer player Ali Krieger, who you might remember from her game-winning penalty kick in the quarterfinals of 2011 World Cup in Germany. Ali, who was recovering from an ACL (knee) surgery, helped demonstrate seven exercises female athletes can do to help prevent knee injuries.

It’s a must-see for all of the athletes in your life.

Safe Kids Worldwide and Johnson & Johnson are working together to reach parents, coaches and kids with tips that can prevent the more than 1.35 million ER visits that occur as a result of a sports injury. For more information, read our research report or visit www.safekids.org

For more on fitness and exercise, click here.

For more by Kate Carr, click here.

Français : Tractions

Français : Tractions (Photo credit: Wikipedia)

 


Doctor of Physical Therapy,
PhD Candidate at the University of Southern California
May 05, 2013

Death bydeadlift!

Pungent terminology to some, but if you’re a CrossFitter, it’s pure humdrum. There have been endless articles and blogs that have advocated for or against CrossFit. Those for it wax eloquent on its perceived benefits, like improving physical strength, endurance, range of motion and even appearance. So, you’re saying when you combine a strict diet minimizing dairy products and simple carbohydrates and work out harder and with more intensity, it yields results? Shocker (and that, ladies and gentlemen, is sarcasm at its finest).

The drawbacks of CrossFit are not as apparent. Due to a lack of prospective data, there is no definitive information attributing CrossFit to injury; rather, there are simply anecdotal reports associating CrossFit with — amongst other things — shoulder, back and knee pain. However, the associations between injury potential with the particular lifts and exercises performed during a typical class are painstakingly clear. Fortunately, it can all be addressed through improved quality control, but unlike Drake, it starts from the top.

There are currently no guidelines by any nationally-recognized authority (e.g. NSCA, NATA, ACSM, NCSF) that one can use to inform themselves about CrossFit training methods. Furthermore, potentially due to the minimal qualification requirements, the coaches may not always have the skillset or knowledge base to promote (and/or individually tailor) form in order to prevent injury. This is compounded by the fact that there are inadequate guidelines to prepare novice CrossFitters and potentially insufficient individual attention due to large class sizes. As many CrossFit programs are predicated upon competition amongst the class members, performance (e.g., time and/or repetitions) also often supersedes health. In other words, if you want to be first in the WOD (workout of the day), you may have to push through pain, injury and/or fatigue. It may be the essence of competition, but with high-intensity exercise, injury is inevitable if not done with the proper form. Athletes (novice and experts alike) should thus be cognizant of choosing facilities that offer coaches who are accredited by nationally recognized authorities. With that said, here are just a few typical CrossFit exercises to be cautious of:

Deadlift

An effective lift that targets the hamstrings and back extensors. However, if fatigued, or during competition, mechanics can get sloppy, particularly characterized by the back rounding out and the bar moving too far from the body. This can result in excessive strain (and pain) to the hamstrings, as well as the back muscles, ligaments, and tendons. Having the back bent during the loading and unloading phase can potentially lead to a herniated disc. Focus on maintaining a neutral spine, all the while keeping the bar close to the body.

Power Clean

Similar to deadlifts, power cleans are an Olympic lift, yet the complex movement pattern appears to make it even harder to master. Ex-NFL strength and conditioning coach Dan Riley notes that “the inherent dangers unique to this movement can make it a potential hazard … It places the muscles, lower back, tendons and joints in a vulnerable position.” In fact, even with perfect form, the load from the power clean, particularly during the descent phase, may result in excessive forces to the knee joint. If form degrades and the back begins to arch, the body relies more on the hamstrings and back to eccentrically (muscle lengthening contraction) control the weight, potentially leading to excessive strain and injury to these structures. If performing the power clean, be sure to maintain a neutral spine, bend sufficiently at the knees, and progress very slowly until a good technique is mastered. This may help limit excessive force transmission through the body. It is also advised that those with pre-existing knee pain steer clear of this lift.

Kettlebell Swing

The force to propel the kettlebell is supposed to be derived from the hips. If the weight is too great, or one begins to fatigue, they often compensate by overstressing the upper body — neck and shoulders — during the ascent, and the back — just as in the power clean — during the descent. Furthermore, if the stance is too wide and the knees begin to fall inward, it can result in excessive load to the lateral knee joint. If the stance is too narrow, it will minimize the ability to open the hips, likely resulting in a variety of compensatory (and deleterious) movement patterns. Correct selection of stance width, and having the feet slightly externally rotated can help avoid these pitfalls.

Muscle Up

The ring muscle up is the quintessential CrossFit exercise, requiring flexibility and strength of the core and shoulders as well as mental strength and confidence to complete the task. Though it is a combination of a pull up and a dip, many individuals whom are able to perform both exercises seamlessly have great difficulty in transitioning between the two and thus completing a muscle-up. During the pull phase, one requires core strength to complete a kip pull up, else there will be compensation by the shoulders. During the push phase, the elbows have to stay tucked in close to the body, otherwise it places the shoulders in more of an open-packed position, leaving them — and the rotator cuff, in particular — vulnerable to injury. Make sure to master both ring-based pull ups and dips prior to progressing to a muscle up. It is advised that individuals with pre-existing shoulder injury or instability take particular caution.

Death by. An obvious exaggeration that in CrossFit terminology means to add a single repetition each successive minute until failure. However, the term, and this method of exercise, symbolizes the CrossFit mantra of forging elite fitness, seemingly by pushing yourself past your preconceived limit. Adherence to the CrossFit program and performance of its exercises undoubtedly generates results, but if done improperly, even though the chances of actual death may be low, the likelihood of injury appears high. I would thus be amiss to advise against CrossFit exercises and the associated diet, so rather, I take aim at the CrossFit structure that clearly fails in ensuring that their coaches place emphasis on long-term health and wellness, rather than simple performance metrics. Because frankly, it’s hard to be elite with a herniated disc.

youth-sportsby Rick Howard, MEd, CSCS,*D

Providing a safe and effective youth strength and conditioning program is only the foundation of their long-term athletic development.

The Path to Performance

All athletes have one thing in common – they either are, or were, youth. The youth strength and conditioning programs in which these athletes participate have long-term performance implications. So, whether you are a RSCC, CSCS, NSCA-CPT, sport scientist, or other allied strength and conditioning professional, here are three important youth strength and conditioning concepts:

  1. Develop physical literacy for youth by promoting a long-term approach to quality daily physical education and daily intermittent moderate-to-vigorous physical activity.
  2. Promote positive mental and psychosocial development as well as physical development with a properly designed strength and conditioning program.
  3. The Youth Resistance Training: Updated Position Statement Paper from the National Strength and Conditioning Association (2009) for guidelines on strength and conditioning programs that emphasize a long-term approach to developing strength and power.

A Model for ALL Youth

At the foundation of training youth is the philosophy that ALL children should be provided the opportunity to develop their physical, mental, and social skills. These physical, mental, and social skills must be considered simultaneously. Coaches must be aware of the nonlinear path of youth development and how this considerable variability of developmental stages has physical, mental, and social implications.

Training strategies for youth must be carefully planned based on the dynamic interrelationships of numerous variables such as number of sports being played throughout the year and during the same season, environment, ethnicity, self-efficacy, focus, etc. Strength coaches need to keep abreast of best practice and research-based program models for promoting the continuum of lifelong physical activity and sports participation for youth.

The Long-Term Athletic Development Model

The long-term athletic development (LTAD) model is a generic guide that can be used to plan the sport/activity specific plan. LTAD heightens coaches’ awareness that the focus should not be on early sport specialization but that a plan should be implemented to meet the individual needs of young athletes as they develop. LTAD is based predominantly on biological (physical) development and suggests training and competition strategies based on developmental and chronological age.

The LTAD-type program should contain developmentally-appropriate strength and conditioning as well as important elements of positive conditioning, active play, and unstructured play. Proper ratios of conditioning-to-practice and practice-to-competition are suggested and have been customized by national governing bodies to meet the needs of their sport (youth hockey and soccer, for example). Youth should participate in a wide variety of sports and activities that develop their physical, mental, and psychosocial skills– early sport specialization is discouraged.

Looking at the Individual Needs of Youth

Within a quality youth long term developmental program, differences in biological and developmental age of youth must be considered. Key measures of developmental maturation must be incorporated into the strength and conditioning program. This requires a cooperative team effort among coaches, parents, youth, physical educators, and strength and conditioning professionals to safely and efficaciously train youth along the developmental continuum.

Children will be at various points along the developmental continuum, even children of the same biological age, and those that excel at an early age need to be diversified to minimize overuse and burnout and those are considered “late bloomers” must be encouraged to continually improve. This will maximize the number of youth that are proficient in movement skills and can make their own choice to be active in sports and physical activity.

The environment in which training occurs needs to be proactive: fundamental motor skill development must be taught, coached, and assessed; positive feedback must continually and honestly be provided to youth so that skill acquisition and the positive benefits of strength and conditioning are always reinforced, and never should children be given exercise as punishment.

Strength coaches must focus on developing coaching cues for excellent lifting technique (and never sacrifice technique for increased resistance). Youth athletes must not be trained past the point of physiological benefit (e.g., making athletes vomit is not an appropriate measure of intensity).  The optimal balance of challenge and success leads to youth embracing the benefits of strength and conditioning programs (and sports programs too).

Resistance Training and LTAD

Resistance training for youth is safe and efficacious so long as important NSCA guidelines are followed. For example, participants must be able to listen to and follow directions, there must be quality supervision at all times, and exercise progressions must be developmentally appropriate. The focus of the prepubescent resistance training program is on the development of healthy habits of safe resistance training and the focus on technical performance (technique) over amount of resistance lifted.

Exercise technique is developed through body weight exercise, dowels, and light (2-3kg) medicine balls. Some youngsters that are very overweight or obese will need to use light weights before body weight, as their body weight is a significant challenge. Developmental progressions for a variety of strength and power exercises should be taught. Beginning resistance training is not sport-specific, but designed to develop health-fitness and skills-fitness attributes, which matches the philosophy of the long term development model.

What Can You Do?

NSCA-certified strength and conditioning professionals are uniquely qualified to provide properly supervised, developmentally appropriate strength and conditioning programs for youth of all ages and abilities. By following the guidelines listed in the NSCA Position Statement on youth resistance training and adapting an LTAD-type model to the specific youngster or team, you will provide a healthy, positive strength and conditioning experience that will benefit youth dually as exercise enthusiasts and athletes.

Multidisciplinary, longitudinal research is needed on LTAD, physical literacy, windows of opportunity, assessments, and dose response of strength and conditioning programs at various developmental stages. Furthermore, strength and conditioning programs should be evaluated based on whether they enhance performance for only the short-term or whether they promote long-term elite athletic development. Remember, the work you do to promote quality strength and conditioning programs for youth will have long-term performance implications.

About the Author

Rick Howard is a founding member of the NSCA Youth SIG, Immediate-Past Chair of the NSCA Youth SIG, and the Mid-Atlantic Region Coordinator for the NSCA State Provincial Director Program. Howard also serves on the NSCA Membership Committee.

A pair of ASICS stability running shoes, model...


Doctor of Physical Therapy and current PhD Candidate,
University of Southern California
Posted: 10/08/2012 11:30 am

“Yo, what type of shoes should I run in?”

Whether in a medical conference, academic setting or bar, once people know my line of research, that’s typically the first question that pops up. Often times I feel my response is a bit coy, mostly because it would take longer to answer than what people have time for. Although there’s no hard and fast answer for everyone, I personally believe it comes down to the Three Ps.

Three Ps

We’re all different — in the way we speak, the way we think, and, unsurprisingly, the way we run. Thus, when determining the optimal running shoe, it’s imperative to consider your Three Ps: pattern, passion and purpose.

(Foot) Pattern

There are three basic foot patterns: normal, overly pronated (i.e., flat-footed) and overly supinated (i.e., high-arched). Most individuals present with a normal foot type and during traditional heel-to-toe running demonstrate rapid pronation upon heel-strike. In order to slow the rate of pronation, these individuals would be best served by a stability shoe, which is characterized by a heel counter (i.e., a stiff cup around the heel), a medial wedge and a dual-density midsole.

Relative to a stability shoe, a motion control shoe is less flexible due to an increase in dual density foam and a more rigid heel counter. This type of shoe is ideal for people with flat feet, as it’s designed to help compensate for the over-pronation.

The arch of the foot is supported by a thick band of connective tissue called the plantar fascia, which becomes taught — and thus helps to absorb shock — when the foot bears weight. In people with high arches, the foot doesn’t pronate sufficiently, negating some of the shock absorption. A neutral cushioned shoe compensates for this through encouraging foot movement by maximizing flexibility (via lacking a medial wedge and presenting with a softer midsole and heel counter).

Passion

There are a multitude of different running styles that people are passionate about: heel-to-toe, pose, chi, barefoot or minimalistic, and alterations in cadence. The common denominator in all of these running forms is a manipulation in the method of foot strike. Teachers of pose, chi, and barefoot running promote forefoot strikes, while an increase in running cadence typically results in an inherent change from a heel-strike, to a mid or forefoot strike for controlled running velocities.

The method to impacting the ground is influenced by footwear. In fact, relative to traditional running shoes, when people run barefoot, or in minimalistic shoes, they naturally shift to a more anterior strike pattern (likely in order to prevent collision of the heel with the ground). It appears that shoes with reduced heel-to-toe drops may help promote this. The heel-to-toe drop is a measure of the difference in the height of the shoe from the heel to the forefoot. Traditional running shoes have drops between 8-12 mm, whereas minimalistic shoes can be as low as 0 mm.

In order to determine the optimal drop, it’s important to recognize how you impact the ground when running. Although many people believe they are forefoot strikers, it’s been shown that approximately 75 percent of runners run heel to toe, whereas 24 percent are mid-foot strikers, meaning that they strike the ground with the middle of their sole. A negligible portion of runners run forefoot. In order to prevent excessive strain to the calf and Achilles tendon, it’s recommended that heel-strike runners who yearn to run in shoes with smaller heel-to-toe drops transition to them over a period of time (with shoes with increasingly smaller drops).

Purpose

With technological advancements in the footwear industry and an associated increase in the amount of scientific research concerning footwear, we now have a greater understanding regarding the attributes of shoes that can help runners address their specific purposes. For example, a bowing-out of the knees may potentially lead to degradation of the medial meniscus (cartilage within the knee), whereas a falling in of the knees may result in lateral meniscus degradation. A lateral or medial wedge, respectively, may help to compensate for these mal-alignments. Similarly, shoes with a heel flare — an outward projection on the lateral (and sometimes posterior) aspect of the shoe — may result in an increase in pronation during the initial stance phase of running. Although it will add weight or width to the shoe, it may limit the potential of developing anteromedial compartment syndrome. Relatedly, increased cushioning under the heel may also add weight to the shoe, however, it likely will take pressure off the plantar fascia, and is thus often recommended for those with plantar fasciitis.

A recent introduction to the running market is minimalistic footwear. The Nike Free has a foam based outsole that can splay. As a result of its minimal structural support, it may help in developing the intrinsic muscles of the foot. In contrast, the Vibram FiveFingers and New Balance Minimus have rubber outsoles and appear designed to optimize the barefoot running experience. Similarly, and as mentioned above, relative to heel-strike running, shoes with reduced heel-to-toe drops that theoretically promote mid or forefoot strikes will likely result in an increased demand to the ankle and a reduced demand to the knee (and their supporting structures, respectively). The caveat of all of these shoes, however, is that they may require training to the foot and calf and/or a transitional period prior to using them exclusively for running.

So I was recently having dinner with a friend of mine at this Chinese restaurant, and his fortune read “There should only be one thing coy in the room, and that’s the fish.” So while I hope I provided a sufficient running shoe guideline, when you asked me at the bar last Friday about what type of shoes you should run in, aren’t you glad there were no fish around?

For more by Rami Hashish, DPT, click here.

Follow Rami Hashish, DPT on Twitter: www.twitter.com/runinjuryfree

Personal trainer showing a client how to exerc...

Jamie Galloway
Personal trainer, fitness coach
and lifestyle consultant
Posted: 08/28/2012 8:00 pm

Last year a new client came to me with a problem. She should have been in incredible shape — she was running 50+ miles a week, doing yoga daily and training for her first triathlon. Despite her best efforts, however, she found her performance had plateaued or even decreased. Digging deeper, I asked about her mood and sleeping habits. “The smallest things annoy me,” she said. Her sleep, diet and performance at work were all out of whack too. Her problem: overtraining.

I’ve made a career out of working out and I spend a lot of time motivating my clients to love it as much as I do. Fortunately for me, your body and brain want to help me out. When we exercise we release endorphins — the chemicals that make us feel good — into our brains. Endorphins have both pleasurable and addictive effects, and many regular exercisers feel compelled to work out more and more and even feel guilty if they miss a day’s training. Dialing your training back can be difficult and overtraining can easily creep up on you.

Put simply, overtraining is a breakdown in performance that occurs when the body is pushed beyond its capacity to recover. If you don’t allow your body adequate time to recover, then you run the risk of undoing all your hard work at the gym or on the track. To be clear, overtraining is not a problem of too much training, but of too little rest and recuperation. Gains in your strength and fitness don’t happen just because you had an incredible workout, they happen because you rested, ate and recovered afterward.

Reduced performance in the gym isn’t the only symptom of overtraining, in fact, there are too many to list in this article, but I can highlight the main ones: fatigue, decreased athletic performance, weakened immune response, sleep disturbances, irritability, reduced libido, changes in appetite. Starting to sound like fun? No, I didn’t think so.

If some of these sound familiar to you and you think you may be overtraining, all is not lost. Below are some simple things you can do to get back on (or perhaps off) track.

  1. Get more sleep, ideally eight hours a night, and especially after a heavy training session.
  2. Make sure your diet is on point, that you’re consuming enough calories and that you take the time to prepare healthy post-workout meals.
  3. Take breaks from training, you’ll be stronger and more energized when you come back to it.
  4. When you do come back, change things up. Play with different training regimes but don’t just do everything the same or you’re more than likely to end up back where you started.

Try and apply the same commitment to recovery that you apply to your workouts. Give your body the time it needs to rebound and repair and you’ll find yourself with more energy, enhanced performance and a better disposition. Less is sometimes more.

For more by Jamie Galloway, click here.

For more on fitness and exercise, click here.

Follow Jamie Galloway on Twitter: www.twitter.com/trainwithjamie


Physician; Writer; Associate Professor,
Georgetown University
Posted: 08/29/2012 8:17 am

A single rebound changed teenager Tracy Yatsko’s life. It was Jan. 10, 2005. Two minutes to go till half time in a hard-played game where she — a tenth-grade starting forward for the Tamaqua Lady Raiders of Penn Township, Penn. — left the ground momentarily while jumping for the ball, and then, on her descent, ball in hand, the collision: the back of her skull smacking into the head of the opponent who’d been guarding her. She recalls a brief visual blackout — less than a second — but she didn’t lose consciousness and even managed to get off another shot at the basket. Even so, feeling dizzy and nauseous, she opted for the bench for the rest of the game, just as a precaution.

Next day, though, the dizziness and nausea were still there. She attended school, finding that “I couldn’t concentrate, and I just wasn’t there,” but after a second night’s sleep, feeling better and hoping she’d weathered the worst of that head bump, she decided to suit up and start another game for the Lady Raiders. That was the breaking point. She made it through the game, but afterward, while changing in the locker room, she blacked out and fell to the ground. “I couldn’t hold myself,” she recalls. It was frightening, as it was now clear this was something she wasn’t just going to shake off.

From that first trip to the emergency room, says her mother, Linda McCarroll, “life was never the same.” Or, as Tracy puts it: “That’s when everything started.”

It was a concussion, and Tracy knew it, because she’d suffered one before, while still in the seventh grade. An MTBI, or Mild Traumatic Brain Injury, as it’s known in the medical literature. That earlier MTBI she did shake off — or at least the symptoms went away after 10 days or so. But “mild” can be a misleading term. Yes, there are more serious types of brain injuries, but the concussions that occur in contact sports can have effects that — despite the “mild” label — last a lifetime.

As Tracy has experienced for herself. Initially, she spent the rest of her junior year at home, literally on the couch. “I couldn’t go to the bathroom by myself. I had to cover the windows with sheets because of the light.” She has suffered constant migraines, nausea, vomiting, and had difficulty concentrating. She had to spend many days in the hospital, seeing dozens of doctors, getting all kinds of diagnostic tests. She had been on hundreds of medications, her mom says, some of them with terrible side effects. She lost many friends “because they were out having fun and I was stuck at home.”

As kids return to school and embark upon a new school sport season, stories like Tracy’s have put MTBIs — as well as other sports-related injuries — at the center of a debate that asks whether the price of getting hurt for the game is too high.

Journalists have begun focusing extensively on the toll among professional athletes, especially football players. But other experts — including the Government Accountability Office (GAO), which held a special meeting on Capitol Hill in 2010 — are concerned about the effects on younger athletes.

For student athletes, studies are producing alarming numbers. One estimates that between
2001 and 2009 more than 2.6 million children in the U.S. were treated for sports-related injuries. Of them, more than 170,000 suffered from traumatic brain injuries.

That sounds like a lot, but they’re the tip of the iceberg, says, Dr. Dawn Comstock, of the Center for Injury Research and Policy, at Nationwide Children’s Hospital in Ohio. Many injuries, she says, are never reported: “Nobody really knows how big of a burden sports-related injuries are.”

Part of the story is a lack of awareness — even now — says sports-medicine expert Dr. Clarke Holmes, of Nashville, Tenn. “Many young athletes don’t know what concussions are,” he says. Many, he says, may experience a head injury, but then believe “that if they haven’t lost consciousness then they should be okay.”

Except that they’re often not okay, a fact that may be especially important for girls to understand. Says Dr. Holmes: “There is some evidence to suggest that girls may be more likely to have concussions and that their concussions may be more severe.”

Severe is certainly what Tracy’s concussion turned out to be. Grade III. The worst. It’s been more than seven years since that fateful game and she’s still paying for it — paying for wanting to play the game she loved. Perhaps the hardest part was being told she couldn’t play sports anymore. Ever. Sports was everything to Tracy: “I was a huge athlete. I was really good in basketball and track.” So when the doctor announced her sports days were finished, “it ruined my life. That’s when the depression set in. I thought my life was over,” she said, holding back tears even now.

Indeed, many young athletes would agree that sports are what defines them. It gives them a certain social cachet and represents real achievement, as well as embodying real-life values like teamwork and competition. Sports can also be a ticket to scholarships, higher education, and exciting careers — if you’re really that good. Tracy was that good.

That’s why many athletes are reluctant to report their injury. They risk being misunderstood as weak or lacking in motivation. They fear being sidelined, losing their chance to shine, to show what they are made of. “That’s just how we grow up,” says Tracy today. “We grow up saying ‘suck it up and get back in the game.'” Remembering the winter of 2005, Tracy says she was worried that her trainer would “sit me out of the game” if she said too much. “I kept quiet, but I shouldn’t have played.”

“There is no shame in being hurt,” says Dr. Holmes. “If you hide an injury then you are not only hurting yourself, but also your team. Because you’re out there playing and you are not 100 percent, and you can let the team down. You could miss an assignment, not know a play that you should, you could be a step slow.” More importantly, he says, “You could predispose yourself to another injury, or even a second concussion.”

This is an important piece of the picture. Once a concussion has occurred, the player becomes as much as four to six times more likely to suffer a second concussion. And having a second concussion, studies have shown, can be even more traumatic, resulting in permanent brain injury from the cumulative trauma.

That’s why medical and athletic organizations are quite serious about when the appropriate time is to return to play. Guidelines vary, says Dr. Holmes, and each case should be looked at individually, but in general the athlete has to be completely symptom free for some time before being allowed back in the game. Depending on the initial symptoms, it can be as little as 20 minutes for a very mild first concussion with no loss of consciousness, to more than three months for a third concussion, according to some guidelines. Or it can be, as in Tracy’s case, never being allowed in the game again.

The guidelines, from organizations such as the American Academy of Neurology, and the Colorado Department of Education, vary. But they all agree that athletes should take time off following an injury and that premature return to play can harbor serious consequences. As serious and catastrophic as brain herniation and death.

Unfortunately, says Dr. Comstock, not many are taking heed. According to one study she authored, 40.5 percent of high school athletes with a concussion returned to play too soon. And males — true to stereotypes of being more “macho” — were more likely than females to not follow these guidelines. That study, in the journal Brain Injury, also showed that during the 2007-2008 season alone, 15.8 percent of football players who suffered a concussion and lost consciousness returned to play the same day.

But it is not just the athletes themselves who are eager to put injury aside and get back in the game. Coaches and parents are as much to blame. “I see how parents can get so involved in a game,” says Linda, “and sometimes coaches and parents can make the wrong decisions.”

She and Tracy are trying to tell their story to anyone who would listen. Tracy even testified before a congressional committee and told her story at the Brain Injury Association of Pennsylvania. “There have been a lot of coaches who’ve changed the way they’ve coached because of Tracy,” says Linda with pride in her voice. “They’ve been much more careful. They don’t put their player back into the game if there is any injury, whether it’s a head injury or it looks like they have a sprained ankle. Because of Tracy they’re really thinking twice and just admiring the message that she’s been putting out there.”

What is a concussion?

A concussion is a brain injury caused by a bump, jolt, or blow to the head. It can happen due to a fall, or after hitting another player.

Symptoms of Concussion

Early symptoms may include: Headache, Dizziness, Confusion, Nausea, Vomiting, Vision Changes, Ringing in the ears, Sensitivity to light.

Late symptoms: Memory disturbances or loss, poor concentration, irritability, chronic migraines, sleep problems, personality changes, chronic fatigue, depression.

If you think your child had a concussion:

– Seek medical help at once. The doctor can help assess the severity and help determine when it is safe to return to play.
– Keep your child out of play until a health care professional says it is okay to go back.
– Report all concussions to your child’s coach, including previous ones, or those suffered playing another sport.
– Consider baseline neuro-psychiatric testing at the beginning of the season. Repeat testing after an injury can more precisely show the degree of damage and help with rehabilitation.

A concussion can happen in any sport activity. The top offenders are contact sports. “Player-to-player contact is the number one mechanism for injury,” says Dr. Comstock.

Higher injury rates, including concussions, are found in: football, ice hockey, boys lacrosse, soccer, basketball, girls lacrosse and field hockey.

For more by Ranit Mishori, M.D., MHS, click here.

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