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Return to Sport Following the COVID-19 Pandemic

return to sport

The Australian government has released these ‘National Principles for the resumption of Sport and Recreation activities’. While they are specific to the Australian context, the principle make sense and should be taken on board more globally:

1.Resumption of sport and recreation activities can contribute many health, economic, social and cultural benefits to Australian society emerging from the COVID-19 environment.

2.Resumption of sport and recreation activities should not compromise the health of individuals or the community.

3.Resumption of sport and recreation activities will be based on objective health information to ensure they are conducted safely and do not risk increased COVID-19 local transmission rates.

4.All decisions about resumption of sport and recreation activities must take place with careful reference to these National Principles following close consultation with Federal, State/Territory and/or Local Public Health Authorities, as relevant.

5.The AIS ‘Framework for Rebooting Sport in a COVID-19 Environment’ provides a guide for the reintroduction of sport and recreation in Australia, including high performance sport.The AIS Framework incorporates consideration of the differences between contact and non-contact sport and indoor and outdoor activity. Whilst the three phases A, B and C of the AIS Framework provide a general guide, individual jurisdictions may provide guidance on the timing of introduction of various levels of sport participation with regard to local epidemiology, risk mitigation strategies and public health capacity.

6.International evidence to date is suggestive that outdoor activities are a lower risk setting for COVID-19 transmission. There are no good data on risks of indoor sporting activity but, at this time, the risk is assumed to be greater than for outdoor sporting activity, even with similar mitigation steps taken.

7.All individuals who participate in, and contribute to, sport and recreation will be considered in resumption plans, including those at the high performance/professional level, those at the community competitive level, and those who wish to enjoy passive (non-contact) individual sports and recreation.

8.Resumption of community sport and recreation activity should takeplace in a staged fashion with an initial phase of small group (<10) activities in a non-contact fashion, prior to moving on to a subsequent phase of large group (>10) activities including full contact training/competition in sport. Individual jurisdictions will determine progression through these phases, taking account of local epidemiology, risk mitigation strategies and public health capability.a.This includes the resumption of children’s outdoor sport with strict physical distancing measures for non-sporting attendees such as parents.b.This includes the resumption of outdoor recreational activities including (but not limited to) outdoor-based personal training and boot camps, golf, fishing, bush-walking, swimming, etc.

9.Significantly enhanced risk mitigation (including avoidance and physical distancing) must be applied to all indoor activities associated with outdoor sporting codes (e.g. club rooms, training facilities, gymnasia and the like).

10.For high performance and professional sporting organisations, the regime underpinned in the AIS Framework is considered a minimum baseline standard required to be met before the resumption of training and match play, noting most sports and participants arecurrently operating at level A of the AIS Framework.

11.If sporting organisations are seeking specific exemptions in order to recommence activity, particularly with regard to competitions, they are required to engage with, and where necessary seek approvals from, the respective State/Territory and/or Local Public Health Authorities regarding additional measures to reduce the risk of COVID-19 spread.

12.At all times sport and recreation organisations must respond to the directives of Public Health Authorities. Localised outbreaks may require sporting organisations to again restrict activity and those organisations must be ready to respond accordingly. The detection of a positive COVID-19 case in a sporting or recreation club or organisation will result in a standard public health response, which could include quarantine of a whole team or large group, and close contacts, for the required period.

13.The risks associated with large gatherings are such that, for the foreseeable future, elite sports, if recommenced,should do so in a spectator-free environment with the minimum support staff available to support the competition. Community sport and recreation activities should limit those present to the minimum required to support the participants (e.g. one parent or carer per child if necessary).

14.The sporting environment (training and competition venues) should be assessed to ensure precautions are taken to minimise risk to those participating in sport and those attending sporting events as spectators (where and when permissible).

15.The safety and well-being of the Australian community will be the priority in any further and specific decisions about the resumption of sport, which will be considered by the COVID-19 Sports and Health Committee.

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Study looks at excessive exercise in people with eating disorders

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According to researcher Danielle Chapa, “With excessive-exercise behavior, people may be exercising with extreme intensity, for two or more hours, or when they have a fever or when they’re injured. Exercise can be a compulsive behavior — something they have to do. It’s problematic because it could make recovery from an eating disorder a much longer process. There’s also a lot of medical complicati

Press Release:

LAWRENCE — For most people, exercise is healthy for both body and mind. Hours spent jogging, bike riding or lifting weights can elevate mood, boost heart health, build muscle and spur weight loss.

Yet the last of these supposed workout benefits — weight loss — is problematic for people living with an eating disorder such as anorexia nervosa or bulimia nervosa. Both eating disorders are marked by distorted negative perceptions of one’s body and often a compulsive desire to lose weight.

“Excessive exercise is a behavior people with eating disorders can engage in without anybody really noticing that they’re doing something that could be harmful,” said Danielle Chapa, a doctoral student at the Center for the Advancement of Research on Eating Behaviors in the University of Kansas Department of Psychology. “With excessive-exercise behavior, people may be exercising with extreme intensity, for two or more hours, or when they have a fever or when they’re injured. Exercise can be a compulsive behavior — something they have to do. It’s problematic because it could make recovery from an eating disorder a much longer process. There’s also a lot of medical complications that go along with excessive exercise — for instance, increased susceptibility to injury.”

Now, with an $84,940 award from the National Institute of Mental Health, Chapa will investigate the causes and effects of excessive exercise on study participants who are experiencing eating disorders. The investigation, called the FuEL Study (Function of Unhealthy Exercise in Everyday Life), represents Chapa’s doctoral thesis. She hopes it also will expand the tools available to clinicians to help diagnose and treat eating disorders when lives hang in the balance — 20,000 people die each year from eating disorders due to medical complications or suicide.

“Eating disorders have the highest mortality rate out of all other mental health conditions,” Chapa said. “That mortality number comes from death by suicide but also deaths from medical complications associated with eating disorders. It’s really important that we understand excessive-exercise behavior in people with eating disorders, because it can significantly prolong their recovery — and it’s usually missed. Excessive exercise is not always treated in interventions for eating disorders, because it may go unnoticed.”

Chapa now is recruiting 80 participants at fuelstudy@ku.edu. She hopes to better understand the emotional function of excessive exercise in those living with eating disorders, as well as “moment-to-moment predictors” of unhealthy exercise. People in the study will be prompted via smartphone to track their emotional state for seven days.

“We’re interested in seeing how affect changes in relation to exercise — so we’re looking at the hours before somebody exercises,” she said. “How is their affect changing? And then in the hours after exercise, how is their affect changing?”

For a week, each participant in Chapa’s study will receive random surveys via a mobile-phone app every few hours.

“We want to see what their mood is at each of those surveys,” she said. “With enough surveys throughout the day, we can see how affect changes.”

To track exercise, the same participants will wear a research-grade activity monitor for the duration of their participation, allowing Chapa to detect relationships between participants’ emotional states and the timing and intensity of their exercise.

“The Actigraph will collect things like number of steps that a person takes, how long a person is physically active and the level of intensity of their physical activity — if it’s moderate or vigorous,” she said. “We’ll also use that data to identify when exercise occurred in the day, because you get an exact time of exercise. We can then combine the Actigraph data with information we get from the surveys.”

At the end of each day, participants will log information about overall health and injuries.

Chapa, who works with people experiencing eating disorders in a clinical setting as part of her KU doctoral work, said she hoped her study would produce data that someday could underpin effective interventions for excessive exercise as a follow up to her project.

“In this study, we aim to understand what triggers excessive exercise and if there are individual differences,” she said. “If we can predict when someone is going to engage in excessive exercise, then we could send them a quick text message through an app that suggests maybe they use another coping skill rather than exercising excessively. If we know what triggers excessive exercise, we can build these personalized interventions that provide additional support to persons with eating disorders throughout the day.”

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Concussions associated with cognitive, behavioral, and emotional consequences for students

Concussions can have a compounding effect on children, leading to long-term cognitive, behavioral, and emotional health consequences, according to researchers at The University of Texas Health Science Center at Houston (UTHealth), who published their findings in the American Journal of Sports Medicine.

In 2017, approximately 2.5 million high school students in the United States reported suffering at least one concussion related to sports or physical activity in the last 12 months, according to information from the U.S. Centers for Disease Control and Prevention (CDC).

The UTHealth researchers analyzed survey data from more than 13,000 high school students in the United States. According to the authors, it is the first study to report on the association between sports-related concussions and negative health implications based on a representative sample of U.S. high school students.

“We have previously speculated that children who suffer a concussion have more behavioral problems, so this study was able to provide a more comprehensive analysis on the various cognitive and behavioral health issues that this population faces in connection with this type of brain injury,” said Gregory Knell, PhD, the study’s first and corresponding author. Knell is an assistant professor at UTHealth School of Public Health in Dallas and is research faculty at Children’s Health Andrews Institute for Orthopaedics and Sports Medicine.

A concussion is the most common form of traumatic brain injury, caused by a mild blow to the head. Common symptoms include a headache, ringing in the ears, nausea, vomiting, fatigue, drowsiness, and blurry vision.

Participants were asked how many times they had suffered a concussion from playing a sport or during physical activity in the last 12 months. Students were also surveyed on relevant cognitive, emotional, and behavioral factors and related health outcomes, including questions on topics such as academics, suicidal ideation, and substance abuse.

The study revealed that 14.5% of female high school athletes and 18.1% of male high school athletes reported experiencing at least one concussion the previous year. These students also reported at least one factor associated to their behavioral, cognitive, and emotional health. The questions covered topics such as difficulty concentrating, poor grades, drinking and driving, carrying a weapon, getting into a physical altercation, using tobacco or marijuana, binge drinking, feeling depressed, and having suicidal thoughts or actions.

Of the male participants who suffered at least one concussion, 33.8% reported they drank and drove in the last 30 days. For the female athletes who reported suffering more than one concussion, 19% stated they had used marijuana at least once in the last 30 days. Both male and female participants who answered that they had been in at least one physical fight in the last year were significantly more likely to have reported having at least one concussion in that same timeframe.

Other associated factors that were significantly more likely in male students who reported a prior concussion included difficulty concentrating, tobacco/e-cigarette use, and binge drinking. Female students who reported prior concussions were more likely to ride in a car with a driver who had been drinking, and have suicidal thoughts or actions.

“Parents need to understand that a concussion is a very serious brain injury, one which requires treatment every time a concussion is sustained. This study has revealed this type of traumatic brain injury can have a compounding effect on children that could lead to more aggressive behavior, academic problems, and social issues,” said study co-author Scott Burkhart, PsyD, a neuropsychologist at Children’s Health Andrews Institute for Orthopaedics and Sports Medicine.

The research team encourages future studies to continue the surveillance on the prevalence of concussions among student athletes, as well as the severity of these injuries.

Press Release from UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT HOUSTON

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What is metatarsalgia?

Metatarsalgia is a bad term for a foot problem that is common in athlete. It is a phrase that unfortunately gets used often but is quite a meaningless term and diagnosis. The term is like, for example, saying you have a sore hip. That sore hip could be due to any one of many different things. Metatarsalgia means pain in the metatarsals or ball of the forefoot, so it can be due to multiple different things. That is why the term is a bad term.

The cause of the pain could be a corn on the skin under the ball of the foot; it could be a pinched nerve that causes radiating type pains; it could be an atrophy of the fat pad that causes problems only when weight bearing; or it could be osteoarthritis type symptoms inside the metatarsophalangeal joints in the ball of the foot. Each of these possible reasons for metatarsalgia are extremely different to each other with different set of symptoms and different causes which just serves to illustrate just what a bad term it is to use.

Probably the most frequent cause for pain under the ball of the foot is a condition called a plantar plate tear. This is a sprain of the ligament under the joints in the ball of the foot that can progress to a minor tear. The symptoms are typically over the joint on the bottom of the foot and just in front of the joint. Typically it is the second metatarsophalangeal joint, but it can affect all or any of the joints in the ball of the foot. It is more common in those who exercise more and are more active. It starts as a small ache which is often ignored, but it can progress unless there is a therapy started since it does not heal on its own.

Usually the treatment of a plantar plate tear is to make use of strapping to hold the toe in a plantarflexed or pointing downward position to prevent it from bending up so the strain is given a rest. A rocker sole footwear or a shoe that is more rigid can also help do this. If this helps, it can take a long time and patience is needed to get better. If this approach not help, then some plantar plate tears need a surgical treatment.

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Managing pain after sports medicine surgery

DETROIT -A Henry Ford Hospital study published in the Journal of Arthroscopic and Related Surgery, has found that patients who underwent knee surgery and other types of sports medicine procedures could manage their pain without opioids or a minimal dosage.

knee sugery

“This is a large prospective study and our hope is that non-opioid use will gain momentum and that others may tweak our protocol and use it throughout orthopedics, from joint surgery to spine surgery and other surgeries” says Vasilios (Bill) Moutzouros, M.D., chief of Sports Medicine, a division of the Department of Orthopedic Surgery and the study’s lead author, “We hope that we are helping to change practices not just in sports medicine surgery but in all surgery.”

The purpose of the prospective study was to determine whether postsurgical pain following common sports medicine procedures could be managed effectively with a nonopioid multimodal analgesic protocol that relies more on non-steroid and anti-inflammatory medicine. It included 141 patients who underwent surgery between May and December 2018 for ACL reconstruction, shoulder and rotator cuff repairs or a torn knee meniscus. The study is the first in a series by Henry Ford researchers examining the issue.

Researchers found that 45 percent of patients had low levels of pain that was effectively managed by the regimen. Drowsiness was the only side effect reported by patients. All 141 patients were satisfied with how their post-surgery pain was managed by their doctor.

Even though patients were prescribed oxycodone as part of their regimen, none used it for pain control. Researchers say the regimen appeared to be essentially multiplicative, alleviating the need for patients to take the oxycodone.

Patients who required opioids were more likely to have a history of anxiety/depression and reported higher pain scores than those who didn’t need to take them.

“This kind of research has the potential to decrease opioid use in the general population as we find that many patients who abuse opioids started using them after a surgery and got hooked on them. It starts with the more common surgeries. By eliminating surgical opioid use, we are contributing to the reduction in opioids, which helps decrease dependence,” says Kelechi Okoroha, M.D., a Henry Ford sports medicine physician and a study co-author.

Dr. Toufic Jildeh, a study co-author and administrative chief resident in orthopedics at Henry Ford, says sports medicine physicians can “play a direct role in improving pain management and decreasing opioid prescribing.”

“There are currently no protocols that completely eliminate opioid use,” he says. “This study strongly suggests that eliminating opioids postoperatively is actually possible.”

Prior Henry Ford studies that focused on perioperative pain control and minimizing post-operative pain and opioid consumption after sports surgery led researchers to better understand risk factors that contribute to postoperative pain.

“It’s a practice changing study,” Dr. Moutzouros says. “This type of research allows physicians to look at how we manage pain differently in the post-surgical environment. It allows us to change our practices and become safer. What we’re trying to do is support each individual patient and reassure them that we are going to prescribe little if any opioids for their pain control to mitigate or eliminate a potential for addiction.”

Press release from Henry Ford Health System