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Tobagganing Injuries

The snow has fallen and the kids are eager to get out and try the new toboggan. Everyone has fond memories of their childhood of flying down the hill. Unfortunately many of us also have memories of severe or potentially severe injuries while out there having fun. I encourage you to go out and test those hill but I recommend that you follow these following tips.

1/ Dress appropriately for the day. Dress in layers and cover all exposed parts. As cold as it might be the temperature is increased by the wind chill factor that increases the faster you go. Wear waterproof boots, pants and jacket. Avoid contacting frostbite.

2/ Make sure all scarves are tucked in and not loose. Avoid hats with tails that can get caught around your neck. Hoods with drawstrings can also be a danger. All these things can get caught around your neck and cause strangulation.

3/ All kids should wear a bike or hockey helmet when tobogganing

4/ Always go feet first and not head first

5/ Standard toboggans are the safest. Flying saucers or magic carpets can spin and cause the person to go down the hill backwards and not see potential hazards.

6/ Never toboggan with a dog. The dog can run in front of the toboggan and be injured.

7/ Make sure there is always a long safe run off to the hill you are going down. Be especially cautious if it seems you might run off into a road.

8/ Always toboggan on hills that are totally unobstructed by trees or other hard objects.

9/ Watch out for icey conditions which may cause you to go much faster and out of control than usual.

10/ Always climb back up the hill to the side well out of the way of other tobogganers going down the hill. Also watch out for people climbing up before you start down the hill. Tobogganing is one of the great Canadian winter activities. One of the pleasures of growing up in a winter climate is zooming down the hill on that sled. Let us all enjoy this great activity but let us do it safely and enjoy the post toboggan traditional hot chocolate.


 

New Years Column 1997

As has been my tradition I am writing my New Years Column. Many events have occurred over the last year, but perhaps the most significant is the release of a report by the Surgeon General of the United States. This is the same group who released the report that smoking is indeed hazardous to your health in 1964. This has been the single most important document that has curtailed the use of cigarette smoking in North America. The report released this year titled ""Physical Activity and Health"" is a huge step for a group and with as much impact as the Surgeon General. The report was stimulated with the facts that over 60% of the population was not physically active and over 25% were not active at all. Physical activity declines dramatically during adolescence. These dangerous trends were something that has to be dealt with immediately.

The benefits of physical activity has been talked about for years, but it is only in the past couple of decades where there is now scientific proof that regular physical activity may be the best thing you can do to both improve the quality and longevity of your life. The following are the major conclusions of this landmark report.

1/ People of all ages, both male or female, benefit from regular physical activity.

2/ Significant health benefits can be obtained by including a moderate amount of physical activity(eg. 30 minutes of brisk walking or raking leaves, 15 minutes of running, or 45 minutes of playing volleyball) on most, if not all days of the week. through a modest increase in daily activity, most Americans can improve their health and quality of life.

3/ Additional health benefits can be gained through greater amounts of physical activity.

People who can maintain a regular regimen of activity that is of longer duration of more vigorous intensity are likely to derive a greater benefit

4/ Physical activity reduces the risk of premature mortality in general, and of coronary heart disease, hypertension, colon cancer, and diabetes mellitus in particular. Physical activity also improves mental health, and is important in the health of muscles, bones and joints.

5/Nearly half of American youths 12-21 years of age are not involved in regular vigorous activity. Moreover the level activity greatly diminishes after this age group.

6/ Daily enrollment in physical education classes has declined among high school students from 42% in1991 to 25% in 1995.

7/ Research on understanding and promoting physical activity as at an early stage, but some interventions to promote physical activity through schools, worksites and health care settings have been evaluated and proven to be successful. There are not many thing s that I believe greater in than regular physical activity.

The message is finally getting to the masses. It has now become important enough for the Surgeon General to release this report. We must concentrate on our youth and promote and educate a healthy lifestyle that they can continue in their life hand in hand with the other good values that we strive to educate them on.

If we follow these guidelines we will all lead individually a more heathy, happy and productive life. Have a Happy New Year and may your resolution be to become physically active or increase your level of physical activity. The resolution may be even sweeter if you can encourage a friend or relative to increase their activity, or the ultimate to lobby your school board to include daily regular physical activity in the curriculum.



 

Diabetes In Athletest

The site of Bobby Clarke's toothless grin is etched on many of our minds. This great player had just led his Flyers to the Stanley Cup. What many of us did not know was what Bobby had to endure as an athlete. Bobby Clarke was a diabetic. Diabetes is a disease which in its worst state starts in late childhood or early adolescence. The bodies ability to control the sugar levels in the blood is compromised. When you eat there is an increase in the sugar level in the blood. The body reads this and controls the sugar level. Insulin is released from the pancreas which moderates the sugar level and maintains it at an appropriate level. The problem in diabetics is that the pancreas stops functioning to release insulin in response to an increased sugar level in the blood. This can be a problem when you exercise when the sugar level can go too low in the blood as you uses the sugar in your blood for energy.

The good news is that even if you have diabetes there is no reason why you can not participate in sport. In fact regular exercise can be one of the best things you can do to maintain or level the amount of insulin you need to take. Not only that regular exercise can be very beneficial in preventing or limiting the side effects that comes with having diabetes especially the effects on the blood vessels which is the most life threatening complication in diabetes. Therefore regular exercise may not only increase longevity in diabetics but may greatly increase the quality of life. The best exercise for diabetics is regular controlled exercise such as running or swimming. If done on a regular basis especially at similar times of the day this allows the diabetic to have greater control over their diet and insulin dose they need to take.

This does not preclude them from playing a sport that is less controlled such as hockey but those sports have a greater risk. There is an increased risk of too low a sugar during exercise and an increased risk of too high a sugar during periods of poor control in between periods of intense exercise. We know that very tight control of the sugars level in the body of a diabetic is crucial in reducing the serious side effects of having diabetes. Therefore the athlete must monitor very closely their blood sugar levels sefveral times per day. This is even harder but more important due to the demands of their sport and travel/tournament schedule. Diabetics who exercise(and all should) must work closely with their doctor to titrate the appropriate diet and insulin dose to match their level of physical activity.

They must learn to look for the signs of too little of too much sugar in their blood. One of the major complications in Diabetics is foot problems. A combination of a poor blood supply to the feet and a loss of sensation to the feet makes them much more prone to injury. Once injured the diabetic has to be very careful because the diabetic is more prone to infection and slow healing. It is therefore paramount that the diabetes is meticulous with their foot care. Proper shoes and socks as well as regular maintenance is crucial. Once a diabetic develops eye or kidney problems, vigorous exercise may aggravate these conditions and your doctor should be consulted. So far I have talked about the more serious form of diabetes that develops in childhood.

A less severe form of diabetes occurs in adults. It is usually less severe and can be usually controlled with diet, weight and regular exercise. Nonetheless it still is a problem. The good news is that this can be prevented. The best way to reduce your risk of developing adult onset diabetes is with regular exercise. In a recent study there was an decreased risk of 50% if the individual exercised for greater than 40 minutes per week of light exercise. This was especially important in those that were of higher risk such as being overweight. Diabetes is very common in our society. Not only is exercise possible but it may be one of the best things a diabetic can do to help control their sugar levels and prevent the side effect of this potentially devastating disease.


 

Infections

The Sports Headlines last week reported that Jeff Brown almost died. This was not the front page news headlines, this was the Sports headlines. if it was not for the quick work of our Toronto Maple Leaf training staff it might have been the end of Jeff Brown. I had received a call in the morning stating that Jeff Brown had a deep cut on his leg a couple of weeks ago. The therapists thought that it looked a bit red but otherwise Jeff felt okay. He went on the ice and skated through practice and did several media interviews after. It soon became apparent to the therapists that Jeff was not looking that well. They immediately brought him up to my office. Jeff was acquired in a trade earlier in the week while the team was on the road. Therefore I had not met Jeff Brown but it was immediately obvious that he did not look well. Dr. Ogilvie-Harris and I sent him down to the hospital and we all know the end to this story. He is now doing well and will return to play shortly.

Whenever the skin surface is broken there is a risk of infection. The skin provides a barrier to microbes that cause infection and when that seal is broken these microbes can invade the system causing an infection. When the body is injured there is usually bleeding and local swelling. This provides a warm moist environment which is a perfect home for an infection to develop. The microbes can invade from outside the body through the opening in the skin or they can come from inside the body. If you had for example a strep throat the streptococcus in your throat can travel in the blood to the injured area causing the infection. Fortunately, most injuries do not become infected and ones that do are only a small localized infection. In Jeff Browns case the infection spread into the blood causing a thing called sepsis.

It is then that you become very sick and you can die if this is not treated properly. This happens incredibly fast as it did in Jeff's case where he is playing hockey at an elite level and two hours later he is in a hospital bed receiving treatment. We have also heard of the Lucian Bouchard flesh eating disease which although rare progresses very rapidly. In his case they had to amputate his leg to stop the infection from killing him. The other scenario which we see in sports is a local skin infection around a joint that spreads into the joint. These although not life threatening have to be treated very aggressively to avoid any damage to the joint. I have seen these most commonly in the elbow caused by an infected bursa(fluid sac) behind the elbow and from a similar infected bursa around the knee. As in most illness the best way to treat an infection is to prevent an infection. It is important for all athletes to be up to date in their tetanus vaccination.

All wounds should be thoroughly cleansed. There are certain wounds that are more prone to becoming infected. Wounds that are very deep or long should be treated more carefully and the athlete should be put on antibiotics to prevent an infection. Some wounds should be left open and not closed in to let any possible infection out. An example of this is a wound caused by a human bite. Human bite wounds can be very serious and lead to an infection very quickly. Wounds that need suturing must be done within six hours to limit the risk of becoming infected. Infections from wounds can be quite serious and thankfully almost never get to the state that Jeff Brown was in , it is always important to remember proper wound care to prevent any kind of infection that at the very minimum cause increased pain but at the worst lead to a loss of a limb or even death.



 

Olympic Psych
The winter Olympics are starting this week. Athletes have trained hard over the last four years in preperation for this event. This is the marquee event in sport that will make or break an athletes career. There are many great athletes competing over the next two weeks but it is the athlete that can rise above the rest in the Olympics that will reap the benefits. The pressures on the atletes is great.Not only have they sacrificed everything in their life to be the best, they are carying the hopes of their country on their shoulders. Not only is there the glory of being the best in the world at the largest venue in the world, there may be huge financial implications if they perform at this event. In todays world money is a real factor. An Olympic medal may be a significant part of financial security for the rest of their lives if they can somehow win a medal at the Olympics.

At this point in time all the training has been completed. All injuries have been treated. All the nutritional expertise has been taken into account. All equipment has been finely tuned. All outside distractions have been eliminated. There is only one thing left. The athlete and the event. The athlete has performed millions of times their event prior to coming to Japan. It is now a matter of the Mind. Sport Psychology has become an important tool for these athletes. With all the outside pressures it is important to train the mind as well. The body is prepared but it is eventually the mind that controls the performance. We have seen many athletes that simply can not perform at these big events while we have seen other athletes that somehow are able to rise to the occasion with their best performance ever.

The most important thing is to have positive thoughts. If you do not think will be your best, you won't. If you do not think you can win, you won't. If you do not think you are good enough, you aren't, If you think you will fail, you will. BUT if you think you will win, you might. If you think will do your best, you will. You must focus on past successes and best performances. On the flight over to Nagano the men's hockey team will watch our World Championship victory last year followed by the 1972 Russia-Canada series victory. The player's intinery has Canada listed on the final day in the gold medal game which of coarse we will be in and will win. There is only one objective for all involved-WIN GOLD. Other athletes must perform a set routine. The figure skaters must perform a routine that is timed down to every second. The ski aerialists must perform jumps that require perfect timing. These athletes must work on visualization.

Before their event these athletes go through every bit of their routine over and over in their head forming an imprint in their brain so when they are actually competing their body follows that imprint without any hesitation. It is important for athletes to get properly psyched. If an athlete can not get psyched up for the Olympics then they should not be there. The more common problem is for the athlete to get over psyched, tense and nervous. Techniques are used to avoid getting too psyched for an event. This drains the athletes energy. Athletes perform the best when they are in a calm relaxed state where they feel totally in control. Their bodies and minds working in perfect harmony. The last important technique for the athletes to learn is to re-frame events in case something does not go according to plan. A lot of athletes plan for events and their performance is predicated on everything going according to a plan from their preparation to their event. Unfortunately, things do happen to alter the plan. A skate lace breaks, a bus leaves late, an opponent does not perform as expected. All these things can throw an athlete off their game, but the athlete must be mentally prepared to adapt to changing conditions so they can be their best no matter what happens. Canada is known to have some of the best Sport Psychologists in the world so you know our athletes will be prepared as any. WIN GOLD CANADA!!!!



 

Gut Check
We have all heard of the proverbial ""GUT CHECK"" in sports. The big game is on the line and the winner is the one that is most composed, but the real gut check is problems that athletes have in the stomach that may affect their performance or enjoyment of their activity. Although regular exercise is one of the best things for improving digestion, regular bowels and preventing constipation, there are other things that can go wrong. Gastrointestinal problems in sport is most common and most visible in running long distances such as marathons. There have been several famous runner's who have continued to run a race with diarrhea dripping down their leg, or vomiting several times in front of millions of viewers on TV. It is not uncommon to see a runner with a bag of pills to help them in case they run into these problems.

In fact a survey of triathletes said that almost 70% experienced some kind of gastrointestinal problems with their training. Most of these were minor and a nuisance but others were more severe. The most common complaints were to the upper gastrointestinal tract. The complaints here were of bloating, loss of appetite and heartburn. The most common complaint of heartburn can be relieved by exercising more than 1 hour after eating, avoiding jarring type activities such as running or aerobics or if necessary taking antacid medication before exercise. Vomiting can occur at various stages of exercise. Pre competition jitters can cause vomiting. Glen Hall, the goalie for the Chicago Blackhawks was famous for vomiting before every game. There are now several players in the NHL who perform this same ritual.

In sprint events, athletes often vomit after exercising to exhaustion. This is probably due to a rapid build up of lactic acid. In endurance events athletes may vomit later in the competition from one or a combination of factors. These are dehydration, consuming drinks which have high osmolartity, and by an increase again of lactic acid. There are very few runners who never experience some lower gastrointestinal problems with running. If you run long enough and often enough you will eventually end up ion the bushes with a case of ""runner's trots."" There are many theories of what might cause this problem. The most likely is simply the mechanical jarring of the intestines as you run that stimulates the intestine to contract more rapidly and faster movement of the stools through the bowels.

Some think that when you run blood is diverted away from the intestines to the exercising muscles. This leads to dysfunction of the bowels due to not enough blood supply. If you have an infection in your bowels, running may cause your bowels to react to the infection with the increased trauma where they might otherwise be more quiescent. Food allergies or intolerances especially lactose intolerance can cause problems for athletes as well. The treatment for this problem depends on the cause. An infection must be treated. Dietary problems must be addressed and possibly an elimination diet is needed to determine what the offending food group is. It is best to exercise several hours after eating to allow things to digest.

Try and go to the washroom before exercise and avoid things like coffee and surgery foods which stimulate the gut. The time of day of exercise might have to be changed if there is a particular pattern like early in the morning which causes more of a problem. Exercise can cause more severe problems such as blood in the stools. Some of this may be normal but it may also signify a more serious problem. Exercise can cause all of these problems, Fortunately most are not serious and can be easily dealt with. If a problem persists or gets worse, you should not assume that all of your problems are due to the exercise, but it could be something more serious. See your doctor for a real ""GUT CHECK"" at that time.



 

Wendyl's Slapshot

Wendyl Clark is perhaps the most popular player to play for the Toronto Maple Leafs in the past couple of decades. The prototype player that could play a physical game while scoring goals at the same time. For years he was the bright spot in many under performing teams in Toronto. When the Leafs played in the conference final in 1994 Wendyl was one of the strongest players scoring many key goals and always a threat when on the ice. In the days of the slapshot reining supreme Wendyl was famous for having one of the most fearsome wrist shots in the league. Hoe ironic that his present injury which has kept him from playing the last couple of months is called ""Slapshot Gut"" The groin injury is often considered an occupational hazard of a hockey player. Most of these are typical stains of the groin tendon.

What we are seeing more and more of is a more complex injury where the groin is injured and it extends up into the lower abdominal area. Last season Mathieu Schneider had this injury and eventually had to have surgery to allow him to get back to play. There are many players in the NHL who have suffered from this injury and several of them had to have surgery. The NHL group of physicians are now doing research to help us understand this injury and how to better treat or more importantly prevent it. The cause of the now becoming famous ""slapshot gut"" is a tearing of the abdominal muscles as they enter the pelvis area. This is the same area where the groin muscles also insert which can lead to the confusion.

This is usually a long process where the insertion of the abdominal muscles is weakened over many years. Finally the area is weakened where it becomes inflamed as it can no longer handle the forces going through it or it can in fact tear. I have seen this injury in hockey players at all levels as they get older, mature long distance runners and it is apparently very common in Europe in soccer players. There are three main causes of this syndrome:

1/ It is called slapshot gut as we implicate the slapshot as one of the main causes. When one takes' a slapshot a player torques the torso to get the power behind the shot. The buttock muscles on the opposite side pull that half of the body backwards while the other side of the body is forced forward as you bring the stick through to hit the puck. This puts enormous stress on the abdominal muscles on the side of the shot. Now imagine a player lining up rows of pucks to shoot day after day. The similar forces will apply to the soccer player on their main kicking leg.

2/ The skating motion in that it takes the body from side to side will constantly put stress on the abdominal muscles as well as the groin muscles.

3/ Muscle imbalances or weaknesses will put tress on the abdominal muscles and will eventually lead to it breaking down where it will become inflamed and prone to tearing. This syndrome is very hard treat. I will tell patients that they can expect a long course of recovery. They have to avoid any side to side motion. We have them cycle or go on the stairmaster to maintain fitness. The inflammation is reduced with medication and physiotherapy. Once the therapist has reduced the inflammation the next job is to strengthen the abdominal and pelvic muscles.

We then gradually increase the athlete back to their sport. Due to the chronic and severity of this injury we take the athlete back extra slowly to allow the injury to fully heal. In the more severe instances or if the injury is not responsive to conservative management, then surgery is required. Once back playing an extra long warm up and cool down are emphasized. The athlete wears a extra support compression short with a groin wrap. As always the area is iced for 15-20 minutes after sport. Wendyl will hopefully be back playing soon and lighting up the red light with of course his famous wrist shot.



 

In-Line Skating

Perhaps the fastest growing sport in Canada for the summer months is in-line skating. The stores are full of the fastest sleekest skates made today. There are several manufacturers who depend mainly on this market for their sales. A representative of one of the major skate companies recently told me that they did not care if they sold any regular bladed skates at all this year as their sales of in-line skate so far exceeded their regular bladed skate market. Spring has come very early this year and the streets are already full of in-line skaters eager to get out and enjoy the sport.

Recently the Canadian Academy of Sport Medicine(CASM) which is the national body of Sport Medicine Physicians published a position statement for safe in-line skating. The CASM has concerns about injuries and safety in in-line skating. The CASM's recommendations for safe in-line skating are based on the current limited scientific literature, experience from roups involved in in-line skating and knowledge of safety issues in similar sporting activities.

1/WEAR COMPLETE PROTECTIVE GEAR The CASM recommends the use of a regulation helmet(CSA), wrist guards, knee pads and elbow pads. Equipment should fit properly and be secured in place before each excursion. Protective equipment is most effective when ALL the gear is worn together.

2/LEARN THE BASICS The CASM recommends that an individual must learn proper in-line skating technique. When beginning to take up the sport, take the time to learn how to stop and maintain balance while skating. Practice in a flat area free from obstacles and vehicles. Avoid hills until you feel comfortable controlling your speed and have learned to stop effectively.

3/ANTICIPATE HAZARDS Be alert for pedestrians, vehicles and cyclists. Look for obstacle on the ground like uneven pavement and tree branches. Proceed with caution if a potential hazard is identified especially going downhill and approaching blind corners.

4/OBEY THE RULES OF THE ROAD Traffic signals should be adhered to and signs posted in parks should be followed. This is especially important in crowded areas.

5/SKATE IN SAFE AREAS UNDER GOOD CONDITIONS Skate in parks, playgrounds and roller rinks. Avoid wet conditions and always skate during daylight hours.

6/ DO NOT SKATE WHILE BEING TOWED It is dangerous to be pulled by cars, bicycles or pets. Excessive speeds are generated which can not be easily controlled. The risk of injury and severity of the injury increases when vehicles are involved. This new sport is a fun fantastic form of exercise, but it is important to follow these guidelines to ensure your future enjoyment without injury.



 


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