PPE Coalition for Youth Sports and Safety
PPE Initiative Launch Event & Press Conference: May 13, 2010

Across the U.S. there is no formal standardization of the young athlete’s pre-participation medical evaluation (PPE or pre-participation evaluation). States have varying standards and requirements on what needs to be checked and who may perform the evaluation. These examinations are important since many disorders that can cause serious problems may be picked up during the evaluation.

The newly formed PPE Coalition for Youth Sports and Safety held a press conference at the National Press Club in Washington, DC this morning. This event launched an initiative to standardize and upgrade the pre-participation physical evaluation. This was done in conjunction with the publication of the fourth edition of the PPE Pre-participation Physical Evaluation, written with the collaboration of 6 medical societies, including the American Academy of Family Physicians, American Academy of Pediatrics, American College of Sports Medicine, American Medical Society for Sports Medicine, American Orthopaedic Society for Sports Medicine, and American Osteopathic Academy of Sports Medicine.

A standard and thorough pre-participation physical evaluation is vital for the health and safety of young athletes. The purpose of the Coalition is to encourage the use of a standard PPE. To provide a safer environment for the athletes, the coalition is pressing to create a specific standard.

A website has been established to promote the initiative. You may download the new standardized PPE H&P form

PPE 4th Edition

Information on the organization, the founding and participating organizations, and the newly published text is available at the new website: http://www.ppesportsevaluation.org/ .

The American Academy of Podiatric Sports Medicine is one of the founding members of the coalition and was recognized at the event along with the other founders. I attended this event as a representative of the AAPSM.

Among the speakers was Jim Ryun, was the first high school runner to run a mile in under 4 minutes. He set a high school record of  3:55.3 for the mile, which stood for 36 years.  Former Congressman Ryun also held the world record in the mile, 1500-meter, and 880 yard runs. He participated in three summer Olympic games in 1964, 1968, and 1972. He won the silver medal in the 1500 meter run in 1968. Recently ESPN declared him to be the best high school athlete ever, finishing ahead of Lew Alcindor (Kareem Abdul-Jabbar). Jim Ryun spoke of the importance of having physical education included within a revised “no child left behind” law. With the rise in childhood obesity there is no reason to have only one year of PE required in the 4 years of high school. To much amusement he told of not making the baseball or basketball team, but being able to join the cross country team. With a rapid increase from no running to up to 60 miles per week, he found that his first injury was an incredibly painful case of shin splints.

Also speaking was Congressman Mike McIntyre  of North Carolina. He is the founder of the Congressional Caucus on Youth Sports. As a member of the “Blue Dog Coalition” he attempts to forge a bipartisan agreement on health and fitness related issues. His feelings were strong on the importance of safely encouraging youth health and fitness. He spoke of how what we teach our children is our message to a far-off future that we will not be around to see.

Included in the initiative was recognition of the importance of serving children with special needs an including these special athletes in all of the initiatives that are now set in motion. The AAPSM has long supported initiatives along this line as evidenced by the Special Olympics “Fit Feet” project.

Many other initiatives were discussed including the fight against childhood obesity which has long been a goal of the American College of Sports Medicine, the American Academy of Podiatric Sports Medicine, the American Academy of Pediatrics and the President’s Council on Physical Fitness and Exercise along with all of the organizations which participate in the Joint Commission on Sports Medicine and Sports Science. The recently completed White House Task Force on Obesity and the newly created Let’s Move program were mentioned as hopeful programs to change the trend of increasing childhood obesity.

Encouraging healthy eating and regular exercise for everyone within the context of safe programs is all of our jobs.

PPE

This applies to young and old,  and for those who are slim and not so slim.  Everyone who can do so needs to move for optimal health and to keep both the mind and the body in good working order. The PPE initiative will help  young people as safe as possible and be an aid in detecting serious diseases which may put them at risk. For those who pass successfully through the PPE the greater risk will be in not participating.

Resources:

PPE H&P form (PDF)  http://www.ppesportsevaluation.org/evalform.pdf

Preparticipation Physical Evalution – 4th Edition and further information: http://www.ppesportsevaluation.org/body.html

You Got To Move!

This running season has seen the devastating news of several half marathon deaths. Runner’s as young as their 20’s and 30’s have died. While the odds of dying in a marathon are quite low, it can and sometimes does happen. Some of the latest numbers show that the estimates of 1:50,000 marathoners has now lowered to a bit less than 1:100,000. Figuring that each of these runners at the start has run about 100 hours on the average during training, that works out to be 10,000,000 ( ten million)  hours run per marathon death. Clusters are seen in many medical conditions, and often they are not linked to anything but chance.

The marathon is not a pre-requisite to fitness, it is optional. The first 30 minutes are for your body, the rest is for your mind. But it is something many people enjoy and it is safer than driving in your car or sitting for the next 20 years in front of your TV or computer. We’ll examine this again later. For now, since these are quick tips, let’s get to them.

Your race form has a consent form that uses language that requires you to certify that you are medically fit and have trained for the event. Before training for an event as long and involved as the marathon (and the general advice is before beginning any new exercise program) a visit for a physical examination is a good idea. Colleges, high schools and even elementary schools require a medical examination and clearance before participating in sports. A sample college medical clearance athletic form shows the level of detail requested. An EKG can be helpful and most definitely Blood Pressure measurement should be done. Among many things the EKG can detect are signs of cardiomyopathy, enlarged heart, a variety of arrhythmias including Atrial Fibrillation, PVCs, and certain changes in the T Wave that are associated with sudden death.  You should probably set up a lifetime plan to check your blood pressure regularly. Your blood pressure can go up unexpectedly and leave you at risk for serious problems. There are often no signs of this, that is why high blood pressure is called the silent killer. The following are my suggestions and not an official recommendation of any organization. Following my perhaps over exuberant and obsessive recommendation are  more official recommendations.

Suggested BP Checks With Risk Factors

• Over 18 – Under 30 – Every 12 Months
• 30 – 40 – Every 6 Months
• 41 – 50 – Every 3 Months
• 51 – 60+ – Every 2 Months

Several organizations have gentler, less stringent recommendations. According to their web site, the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (see JNC 7 for documents and complete recommendations) strongly suggests “screening every 2 years in persons with blood pressure less than 120/80 mm Hg and every year in persons with systolic blood pressure of 120 to 139 mm Hg or diastolic blood pressure of 80 to 90 mm Hg.”

Recommendations for getting your training started:

• Before starting a new training program, a pre-participation physical is a good idea.
• Check your blood pressure regularly.
• Eat healthy food.
• Train within your limits.
• Avoid herbal food supplements.
• Avoid stimulants and be careful with supplements which may contain ephedra, caffeine, etc.
• Don’t short change your energy supply by dieting aggressively while working out hard.
• Increase your training gradually.
• Rehydrate wisely. Use a combination protein-carbohydrate drink after the long run for glycogen and fuel replenishment.
• Pay attention to your body. Note dizziness, excess fatigue, chest tightness or pain, pain in your upper back or shoulder, chest or jaw. All can be serious warning signs. Stop and get checked. In a race, stop and seek medical attention.

Be careful out there. Prepare for the big day. Remember, by the time you get to the marathon, you’ve already run several half marathons in training and more – likely up to 20 miles. You should be ready. But do pay attention to your body on marathon day. Taper and rest up before it. Don’t get smashed the night before the marathon. Toxins in your body won’t help your performance.

Read Part 2 “Staying Alive: Tips For the Marathon”

Don’t Eat the Balaclava

A Balaclava is a fine idea for covering your face in cold weather. It will help keep the cold air from triggering bronchospasm, if you have asthma. A number of articles over the years have found that it isn’t merely breathing cold air that contributes to asthma and bronchial constriction, but “facial cooling” that triggers the response. This is a reflexive triggering of the vagus nerve. Facial cooling can trigger other vagal nerve reactions, including slowing up of heart beat, which will limit your ability to exercise.

While we do not recommend speed work in the cold weather, you may as well be exercising optimally. Make sure you have enough fuel, hydration, and don’t overestimate your ability when heading out in the cold. A Balaclava head covering, in addtion to a hat can help. In severe cold you can add a face mask. Other areas on the web offer substantial advice and information on exercise induced asthma, so we will not replicate them here.

Make sure you have clearance from your physician for the exercise you do, and the conditions in which you do it.

And yes, you shouldn’t eat the Balaclava. You now know that it is a head covering. Baklava is what you may be looking for if you are hungry. Baklava is a tasty snack, which may help replenish your carb stores and it since it has some walnuts and almond, there is a bit of protein, micronutrients, and other goodies contained in it. (Although of course we still recommend a protein/carb liquid drink after intense or long work outs.). For lots more information on cold weather exercise visit Dr. Pribut’s Running Injury Site where you’ll find more information on Running In The Cold .

And for the hungry among you, here is a recipe for Baklava. Pictures, coming, when I next see it. It has been a while. Sorry, it doesn’t fall in the healthy food category. You can substitute where it calls for sugar, but if you need to, perhaps making something else would be better. This serves 25, and if you take really small portions, it will serve more. Best for skinny runners in search of carbs. (I was informed, however, if I put up a recipe for Italian style Bakala (cod), that would make for healthier eating.)

Amelia’s Tasty Baklava

INGREDIENTS

* 3 cups Walnuts, finely chopped
* 1 cup almonds, finely chopped

* 2-3 sticks sweet butter
* 1 cup almonds finely chopped
* 1 teaspoons cinnamon
* 1/3 cup of sugar
* 1/8 tsp ground cloves
*  1 lb. (16 ounce) package phyllo dough

Topping:

* 2 cups sugar
* 2 cups water
* 1/2 cup honey
* 1 tsp lemon juice
* ¼ tsp lemon/orange peel
* 1 tsp cinnamon

DIRECTIONS

1. Preheat oven to 350 degrees F
2. Grind the almonds and walnuts in a food processor.
3. Combine the cinnamon, cloves, sugar and nuts and stir to blend.
4. Melt the butter over low heat.
5.  Prepare the 13×9x2” pan by greasing with 2 tablespoons of the butter.
6. Place 5 layered sheets of the phyllo dough into the pan. Each layer should be buttered using a brush. Sprinkle 5 tablespoons of the nut mixture over the phyllo sheets. Place 2 more phyllo dough sheets (brushed with melted butter) on top of this layer.  Sprinkle with 5 tablespoons of the nut mixture.  Continue to layer the dough  and nut layers until pan is 3/4 full or about 4 more times. Place the remaining phyllo on top, and butter every second layer.
7. Score the top layer of phyllo dough in a diamond pattern.  Trim edges to fit the pan.
8. Bake 45 to 55 minutes in the preheated oven. It should appear golden brown. Let cool in the oven.

Topping:

9.  Prepare the topping by combine the sugar, water, lemon/orange peel and cinnamon in a medium saucepan, and bring to boil. Stir continuously and simmer for  10 minutes.
10. Add the lemon juice and honey, simmer for 1-2 minutes more.
11. Pour the topping over the baklava. Allow to cool.

Arctic Monkeys – Balaclava

Looks like for us in the northern hemisphere, summer is just starting to hit hard. Here are some selected tips for safe running in the summertime.

Tips For Safe Running In The Summer

1. Wear socks made of synthetic fibers that wick moisture away from your skin to help prevent blisters and athlete’s foot. For long distance running and long duration exercise, cotton is rotten.

2. Fit your running shoes or other sports shoes with the type of sock you intend to wear them with. Make sure you use sport specific shoes. Running shoes do not have the lateral support needed for tennis. Help yourself avoid ankle sprains and other injuries.

3. Don’t wear sandals when playing sports! Shoes (or barefoot where appropriate and safe) is a better bet. Barefoot beach volleyball, beach or groomed, safe, outdoor surface Frisbee, and some light running is just fine. In general though, be careful when running or walking barefoot outside. Cuts and bee stings are not fun for your feet.

4. Wear protective shoes or sandals at pools and in locker room showers. This will help you avoid warts and athlete’s foot.

5. Replace your running shoes often, at least every 350 – 450 miles run.

6. Break in new sport shoes before racing or using them for a long run or workout.

7. Use sunscreen to prevent solar injury to your skin.

I’m quickly adding this post for a buddy who needed some advice on how to avoid stress fractures and other injuries while returning to a high level of training. The groundwork is done by returning to running slowly. If you’ve been regularly walking already, then start with week 3. More details on my site shortly.

Return to Running: After 8+ Week Lay-off

Week 1: 1-2 mile walks on alternating days
Week 2: 2 – 3 mile walks on alternating days, add-in changing speeds.
Week 3: 5 – 10 minute easy jogs every day. Walk breaks every 3 -5 minutes are ok for 1-4 minutes. Walk 2 – 3 miles on alternate days.
Week 4: 12 minute jogs every other day. Walk 2 – 3 miles on alternate days or 30 minutes of elliptical trainer.
Week 5: 12 minute jogs 4 days per week. 3 mile walk on 2 days, cross training or elliptical 30 -40 minutes .
Week 6: 14 minute jogs + 20 minute walks 4 days per week. Cross train or elliptical 2 days.
Week 7: 16-18 minute jogs + 30 minute walks 4 days per week. Cross train or elliptical 2 days.
Week 8: 20 – 25 minute jogs + 30 minute walks 4 days per week. Cross train or elliptical 2 days.

The first 6 weeks of running after an extended lay off are important to strengthening not only your cardiovascular system and muscles, but more importantly your bones. Make sure that you take in adequate calcium (usual recommendation is about 1500 mg per day for an adult) and Vitamin D.

The Cubs didn’t last past the first 3 games of the baseball playoffs and the Chicago Marathon only lasted 3.5 hours until it was called. Running in the heat is extremely dangerous. There is precedence for closing a race early. The Madison, Wisconsin Marathon in 2006 was closed app0ximately 2 hours early for reasons of temperature. I’m not sure the authorities had any other reasonable choice. One person died, approximately 49 were hospitalized and about 250 people were treated online for presumably primarily heat related illness. Here in Washington, D.C. one person died in the Army 10 Miler. The latest news states that the runner who died in Chicago, Chad Schieber, had Mitral valve prolapse and that was the cause of death. Mild mitral valve prolapse is a fairly common condition and is not usually considered to be a reason to not exercise. Exercise induced mitral valve regurgitation, however, is a reason to not exercise. The condition is thought to occur in 4-7% of the population. Those with Mitral Valve Prolapse usually will need antibiotic prophylaxis for procedures as ordinary as dental tooth cleaning and scaling. If you have this condition, you’ll need to check with your internist or cardiologist on what exercise is safe and suitable for you.

There was advance notice of the ensuing heat. Should there be terms placed in marathon literature detailing under what circumstances the race will be canceled? Should other arrangements have been made? Were all of the runners properly evaluated including those with suspected heat illness with rectal temperatures? What recommendations and guidelines should marathons have for the future? Should the Chicago Marathon be shifted later in October?

When it is thundering, it is probably time to get out of the rain. Lightning can hit miles away from storm centers and each year many are injured or killed from lightning strikes. The usual advice is to seek low ground in an open field if possible.

A new twist though is the iPod injury. A letter to the New England Journal of Medicine reports an injury, 2 years ago, in Canada to a young man while mowing the lawn while using his iPod. The iPod does not act as a lighting rod or attractor, but it does conduct the electricity – right up to your ears. Eardrum injuries and burns along the course of the wires are said to be likely areas of injury. Other reports of similar injuries have occurred in runners, and in individuals using their cell phones. Keep your iPod on low enough to hear, and to especially hear the thunder which means it is time to get out of the storm. And be sure to get those ear buds out of your ears if you can’t get out of the storm immediately. I wonder, just how many dbs must the iPod be at to be heard over the sound of a lawn mower.