Bulletin Board

By Staff

Training & Conditioning, 15.9, December 2005, http://www.momentummedia.com/articles/tc/tc1509/bulletinboard.htm

ACSM Recommends Preseason Football Changes
With hopes of reducing heat-related illness and death among football players, the American College of Sports Medicine (ACSM) recently released guidelines for youth and high school preseason practices. The most prominent recommendation is to prohibit two-a-day practices during the first week of preseason. According to the ACSM, “the overwhelming majority of serious heat illnesses occur in the first four days of preseason football practice (especially on the first and second days), when players are not acclimatized to the heat, the intensity/duration of practice, or the uniform.”

Similar to those adoted by the NCAA two seasons ago, the guidelines also:

• Restrict multiple workouts on consecutive days.
• Limit single practices to no more than three hours, including conditioning drills.
• Limit practice time for multiple sessions to no more than five hours a day.
• Require a minimum of three hours between sessions.
• Prohibit wearing full uniforms and pads, which can increase heat risk, until day six.
• Prohibit full contact until week two.

Jerry Diehl, Assistant Director of the National Federation of State High School Associations (NFHS) and liaison to the organization’s Sports Medicine Advisory Committee, says that heat illness is a point of concern for his group. Along with re-evaluating its current guidelines on this topic, which do not include any language pertaining to two-a-day practices or session length, Diehl says the NFHS will examine the ACSM’s recommendations.

The ACSM guidelines are from an ACSM roundtable series called Youth Football: Heat Stress and Injury Risk. Copies of the report can be obtained by e-mailing the ACSM Communications and Public Information department at: cdickey@acsm.org.

NATA Fights CMS Decision
Despite protests from the National Athletic Trainers’ Association (NATA), the Centers for Medicare and Medicaid Services (CMS) has implemented rules that limit athletic trainers’ ability to be reimbursed by Medicare for their services. The NATA, however, continues its legal battle to have the decision overruled.

The new CMS rules allow only physical therapists, occupational therapists, and speech and language pathologists to receive Medicare reimbursement for service provided incident to a physician’s office visit. Previously there had been no restriction on who could provide “incident to” therapy services. Certified athletic trainers were sometimes used by physicians to provide those services and received reimbursement.

The NATA filed a lawsuit challenging the CMS decision, but a Federal District Court ruled it did not have jurisdiction to decide the case because administrative remedies available to physicians to challenge the rule had not been exhausted. The court, which did not rule on the merits of the case, also declined the NATA’s request for an injunction, citing its lack of jurisdiction.

The NATA maintains that CMS rules are illegal and has filed an appeal with the Fifth Circuit Court of Appeals, located in New Orleans, but Hurricane Katrina has slowed the appeals process. Briefs and motions will be filed in the coming months, with no decisions likely in the near future.

“The NATA continues to maintain that what the CMS has done is illegal and will continue to seek a ruling on the merits of CMS’ actions,” says Paul Genender, the NATA outside legal counsel handling the case. “Until an injunction is granted by the court of appeals or the district court, the new rule is in effect. Athletic trainers should check with their billing coordinators regarding the effects of the new rule on their practices.”

While relatively few athletic trainers are directly affected by the CMS rules, they are still a major concern to the NATA. “This isn’t just about ATCs who are practicing as physician extenders,” Marjorie Albohm, MS, LAT, ATC, Director of Business Development and Orthopaedic Research at OrthoIndy and The Indiana Orthopaedic Hospital, said in the NATA’s Convention Daily News. “This is about every athletic trainer, because the rule incorrectly implies that athletic trainers are not trained to provide rehabilitation services. That will affect every ATC in every practice setting, and if that’s not overturned, it will be used against us as we go forward.”

Can Diet Stress Cause Fractures?
Cutting out the stress over eating might help reduce stress fractures in women runners. Or so a group of sports-nutrition researchers hypothesize after studying the eating attitudes and behaviors of 79 Canadian women with and without stress fractures in their legs.

Researchers at the University of British Columbia asked the runners, whose average age was 29 and most of whom were recreational distance runners, to record what they ate for three days and answer a questionnaire assessing physical activity, age, height, weight, their menstrual cycle history, and their perceived stress. Their diets were analyzed and found to be basically sound and similar, with calcium intakes about average and even slightly higher than that of American or Canadian women as a whole, according to Susan Barr, PhD, RDN, FACSM, FDC, Professor of Nutrition, who worked with lead researcher Nanci Guest, MS, CSCS, then a graduate student at UBC.

The only difference between those with stress fractures and those without was their focus on limiting what they ate, called cognitive dietary restraint (CDR). “Restraint reflects the perception that one is constantly monitoring and attempting to limit food intake,” Barr says, “but actual intakes were similar between groups.”

To explain the results, Guest and Barr note that high levels of CDR have been associated with irregularities in the menstrual cycle and increased levels of cortisol. Elevated in the “fight or flight” stress response, cortisol is a hormone that can retard muscle and bone growth and recovery from exercise. “We hypothesize that if women could avoid stressing about what they eat (and what they weigh), it might help reduce the cortisol levels that seem to be implicated in the risk for bone,” Barr says.

The study is “Cognitive Dietary Restraint Is Associated with Stress Fractures in Women Runners,” in the International Journal of Sport Nutrition and Exercise Metabolism, 15.2, April 2005, published by Human Kinetics Publishers, Inc.

Simple Tool, Important Job
When it comes to removing face masks from injured football players, a cordless power screwdriver is usually the best option, according to a group of New Hampshire researchers. Led by Erik Swartz, PhD, ATC, Assistant Professor in the Department of Kinesiology at the University of New Hampshire, the researchers reported that a screwdriver removed a variety of face masks in less time and with less movement than specialized cutting tools.

Swartz’s study had 19 certified athletic trainers remove masks from a variety of helmets using cutters and screwdrivers. Trials were timed and taped with a six-camera motion analysis system, which allowed measurement of helmet movement during the removal process. The athletic trainers were also asked to report their perceived exertion in removing the face mask.

Regardless of the helmet, mask, and loop strap combination, the screwdriver was the quickest tool, working as much as three times quicker than the two cutting tools. It also produced the smallest amount of helmet movement and was the easiest to use.

However, Swartz recommended that athletic trainers have a backup cutting device available. In the study, loop straps and helmet hardware (screws, T-nuts, and washers) were replaced after each removal. In the real world, screws may fail after being exposed to use and weathering, in which case cutters must be used to remove the face mask.

The study was published in the August edition of the American Journal of Sports Medicine, which can be accessed at: ajs.sagepub.com.