gaining weight

Monday, April 14, 2014

Jordan Spieth‘s appearance in Sunday’s final pairing in the Masters was a reminder that age is not always an indicator of skill and the ability to compete. Spieth had already turned pro but there were three amateurs under the age of twenty who might consider forgoing their education to play on the pro golf tour. Sports commentator, Bomani Jones had an interesting observation on twitter about leaving college early: “Anyone think golf needs a rule requiring players to stay in school for three years? Or that only apply to sports you like to watch?”

Presumably the correct answer could be found in physics class and Newton’s second law of motion. Force equals mass times acceleration helps explain why it would be that a teenager never be allowed in an NFL locker room.

College seems to be the place where football players grow larger and their size has become the focus of medical study. Researchers from Oklahoma State University followed football players over the course of their college career and found that linemen’s weight increased by only 3% but at the same time their body fat dropped from 22.5% to 20.6%. Their strength increased by almost 20% but in exchange, they became a little slower. Skill players, like running and defensive backs had a larger weight gain of 9%, they became more just a little more lean, dropping their body fat on average to 8.1% and their strength also increased.

But college players might be considered obese compared to their NFL colleagues. Researchers assessed the height, weight, body fat and BMI (body mass index) of all players who attended the 2003 training camp for the Indianapolis Colts. Skill positions players had body fat measurements as low as 6.3%, while the defensive lineman were 10% leaner than their college counterparts. Only offensive linemen were bulkier, much bulkier at 25% body fat. NFL players represent the players whose talent and body composition have allowed them to rise to the top of their profession. Their performance on the filed mirrors their physical development. As bodies become larger and leaner and as strength increases, the mass and acceleration in F=ma both increase. Unless there is a disparity in skill that can offset the disparity in size, the person with greater F will win the battle in the football trenches.

So how do college players get larger? The Associated Press scoured records from all 120 schools that played in The Football Championship Division, the top tier of college football over an 11 year period. While they weren’t scientists, their data had validity. They found that of 61,000 players reviewed, more than 4,700 had gained more than 20 pounds in a single season. According to the National Center for Drug Free sport, that amount of weight gain should raise suspicion for the use of performance enhancing drugs and yet the number of football players who test positive for steroids and PEDs range between ¼ and a little more than ½ percent. However, the question that could not be answered from the AP review was whether the weight gain was due to fat or lean muscle.

And the trend begins in high school football, more than a decade earlier. Researchers looked at the height and weight of Parade All American football players from 1963 to 1983. Their average height increased by four inches to 6’5” and their average weight went from 213 pounds to 268 pounds. The reason for the rapid growth was not completely clear, though the authors suggested the following: “data do raise questions as to what portion of these gains can be attributed to improved nutrition and training techniques and what portion may be the result of use of performance-enhancing drugs such as anabolic steroids.” (Wang, M. Q., Downey, G. S., Perko, M. A., & Yesalis, C. E. (1993). Changes in Body Size of Elite High School Football Players: 1963 – 1989. Perceptual and Motor Skills, 76, 379-383.)

While those who are blessed with speed and agility are able to progress to the next level in football, for many position players, size matters. Technical skills need to grow alongside physical development but some athletes are in a rush and perhaps use extra help to reach their goal.

Bomani Jones is right when he wonders why we don’t care about golfers or tennis players leaving college early for the pro ranks, but raise the red flag about the integrity of the student athlete. Perhaps it’s because golfers like Jordan Spieth don’t have to evade 300 pound linemen to hit the ball. Few college football players make it to the NFL and those who do have short careers and are unlikely to emerge without significant injury.  And perhaps for that reason alone, football players should be allowed the time to grow in college, though how they grow is a topic for another time.

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one hit to the jaw…two injuries

Tuesday, April 8, 2014

It takes the blink of an eye for a fastball to travel the 60 feet 6 inches from pitches hand to home plate…literally, less than a half second for each. It takes instinct for the batter to decide whether to swing at a strike and survival to duck out of the way of a wayward pitch. Yesterday, a blink of an eye wasn’t fast enough for Omar Infante of the Kansas City Royals to get out of the way of an errant pitch that hit him in the jaw. The extent of the injuries are to be determined but there are concerns for a broken jaw and a concussion.

In boxing, the purpose of a cross or jab to the jaw is to inflict a concussion and a blow to jaw can aggressively rattle the brain. The jaw is semi-circular bone that attaches to the skull at the temporomandibular joint or TMJ. While the mandible or jaw bone is fixed, the TMJs move and can be felt just in front of the ear. The TMJ allows the mouth to open and close and do important things like chew. When hit in the jaw, the diagnosis of concussion may be very easy to make or it may be challenging. It is all about history and there is no specific test that can confirm or deny the diagnosis. A person who is knocked unconscious, even briefly, or is dazed and confused has obviously had his brain rattled. It is the person who has minimal initial symptoms that is the challenge. The symptoms of brain injury might be subtle and not be recognized for hours or days. It is hard to quantify difficulty with concentrating, being irritable or moody and having trouble with sleep. The best that medicine can do is image the brain looking for structural changes in the brain, perhaps with CT or MRI, but proving that a concussion does not exist is very difficult.

Deciding whether a jaw is broken is somewhat easier. Physical exam looks for tenderness or swelling along the mandible. It’s important to remember that the jaw forms a circle and like a pretzel, it’s hard to break in just one place. For that reason, if one fracture is present, another on the opposite side might be missed. The mandible also holds teeth in place and when broken there may be a sense that the teeth upper and lower don’t quite fit quiet right or are shifted. The inside of the mouth needs to be evaluated as well, looking for lacerations or damage to gum tissue or teeth. Feeling the TMJs is relatively easy because the can be palpated or felt in front of the ear. As well, a finger in the ear canal almost touches the joint. While fractures can occur near the TMJ, a blow to the jaw can cause damage within the joint. Bleeding or torn cartilage can cause significant swelling and pain preventing the jaw from opening appropriately.

While concussion may be tough to visualize, a jaw injury can be imaged in a variety of ways. Plain x-rays are sometimes done, but good pictures require the skill of a good x-ray tech and still may be difficult to interpret. A panorex is a curved x-ray that is often performed in a dentist or oral surgeon’s office that allows the whole jaw bone to be seen in one picture, a panorama type effect. Should plain films be less than helpful, the next method to look at the bone is by CT scan, but if it’s available, CT is often the first imaging choice for many doctors.

While the anatomy and function of the jaw can be determined with a few x-rays or scans, it’s the concussion that becomes the injury that will potentially sideline Mr. Infante for a prolonged period of time. The healing of broken bones can be monitored but concussions are different. Just as there is no specific test to confirm the presence of a concussion, there is no test that confirms when the brain is completely healed. Guidelines exist that can help decide when a person is ready to resume activity, but every brain is different and while one patient might take a few days to return to “normal”, it might take weeks or longer for another. It’s just another reminder that for all the technology available to inflict upon a patient, in some instances, the art of medicine remains less than precise.



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