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Competitive Edge: Fall 2011


Research Aimed at Protecting Athletes from Concussion

Perhaps surprisingly, researchers at Cleveland Clinic Neurological Institute found that in some instances, certain of these vintage helmets actually protected on par or better than some of those modern helmets we now trust to protect our athletes.

This finding by Edward Benzel, MD, and Adam Bartsch, PhD, is a prime example of why more research is needed into how to better protect players and to further understand the effect of concussion on health long-term.

Similar Cleveland Clinic Spine Research

Laboratory studies on boxing and mixed-martial arts protective padding found that padding the head and hand does not always significantly reduce the risk of head and neck trauma.

Now, thanks to a 2011 NFL Charities grant, our experts will be studying the role of the cervical spine (a.k.a. neck) in football-related concussions. This work is desperately needed since current youth helmets are scaled-down “little adult” versions of adult helmets that fail to consider youths developing spines and brains.

All of this research is part of a larger Cleveland Clinic-wide effort to improve awareness about concussions, improve concussion management, and stress the importance of prevention. A few other examples: appearing at regional coaches’ clinics to discuss concussion risks and management best practices and partnering with biomedical engineering to evaluate cognitive motor control to guide return-to-play decisions.

These are just a few of the ways our multidisciplinary team consisting of providers from Sports Health and the Neurological Institute, is striving to ensure athletic competition is as safe as possible and long-term brain health is preserved in all who participate in contact sports.

To learn more about concussion management at Cleveland Clinic, call 877.440.TEAM.


Diabetes and the Athlete

By Leonardo Oliveira, MD

Insulin is responsible for bringing the sugar (glucose) from your blood stream into your cells. Diabetes essentially prevents your body from properly using the energy from the food you eat.

There are two forms of DM:

  • Type 1 – Caused when the body’s autoimmune processes destroy islet beta cells, which are the cells in the pancreas that produce insulin. This lack of insulin production requires those who suffer from this form of diabetes to use insulin injections to control their blood sugar levels. Type 1 diabetes usually affects children and young adults.
  • Type 2 – Unlike people with type 1 diabetes, people with type 2 diabetes produce insulin. However, the insulin produced is either not enough or doesn't work properly in the body. Most commonly seen in adults, this type of diabetes has been linked with obesity, high blood pressure and kidney failure. Oral glucose-lowering medications are most commonly used, but insulin injections also may be needed if blood sugars are not adequately controlled.

For both forms, appropriate diet and exercise is the mainstay of therapy.

Does diabetes mean poorer sports performance?

Poor glucose control may affect an athlete’s performance, regardless of if it is low or high.

Athletes with diabetes need to have a glucose management plan that matches the intensity and duration of his or her exercise. Studies have shown that when blood glucose levels are controlled appropriately, exercise capacity is the same for diabetics and non-diabetics. Keep in mind: athletes with diabetes have won Olympic medals!

How do athletes know their glucose levels?

“Just test it!” Diabetics involved in sports should have a thorough understanding of monitoring their blood sugar levels and medications. Because exercise can alter glucose levels significantly, diabetic athletes should measure their glucose level before, during (in 30 minutes intervals), immediately and hours after exercise.

What complications can arise from poor glucose control?

Short-term complications of poor glucose control range from poor performance in school or work to increased risk of infection. Long-term complications are higher rates of heart attacks, strokes and peripheral nerve damage (called peripheral neuropathy).

Leonardo Oliveira, MD, recently completed his primary care sports medicine fellowship at Cleveland Clinic. His research interests are exercise performance and injury prevention.


Bone density and menstrual disorders in athletes

By Susan M. Joy, MD

Bones depend, in part, upon calcium to maintain strength and withstand stress, particularly that associated with running and higher impact sports. Estrogen (predominantly a female hormone) and testosterone (primarily a male hormone) both influence how calcium and minerals are taken up by bone. Testosterone generally has a more potent effect than estrogen doing this, thus female bones can be more susceptible to hormone fluctuations. Poorly mineralized bone may literally start to give way under the pressure and develop a stress fracture.

Period loss is detrimental

Energy intake is one thing that can definitely affect hormones. If an athlete is not taking in enough energy (calories) to meet the demands of training, the body starts to suspend reproductive function, protecting other important organs such as the brain and heart. Menstrual function is one measure of hormone status and even subtle irregularity can signal energy imbalance.

As unpleasant as it might seem, active women of all ages should take the time to understand their menstrual cycle, as changes in their periods may mean problems for their bones over time. Most concerning are periods that stop during times of intense training. While thought to be “normal for athletic women” for many years, it is now well understood that it is detrimental to the bones.

Calcium & vitamin D are critical

All athletes can help to minimize their risk of stress fracture and maximize the future health of their skeleton by paying attention to their nutrition. Calcium, vitamin D and adequate caloric intake for a given level of training are vital to keep the hormones circulating normally and nourish the bones.

Nobody wants to see athletes of any age sidelined by injury, especially if there is a chance to prevent them. Everyone should strive to help younger athletes understand nutritional and training strategies that can not only optimize their performance, but also help to protect their bones for the rest of their lives.

Susan Joy, MD, is a primary care sports medicine physician with Cleveland Clinic Sports Health and is the Director of Women's Sports Health. To make an appointment with Dr. Joy or any of our primary care sports medicine physicians, please call 877.440.TEAM.


Meet one of our Newest Team Members

Q: Why did you choose a career in medicine?

A: Two things: I’ve wanted to be a physician since I was about 8 years old. Around that time, I began having seizures and spent a lot of time in and out of hospitals before I finally grew out of them. From early in life, I wanted to help people like my pediatrician helped me. My Grandmother was a registered nurse at the Veteran’s Administration Hospital here in Cleveland. She was my role model and also helped inspire me to pursue a career in medicine.

Q: What is your favorite thing about being a sports health orthopaedic surgeon?

A: The very best thing about being a sports medicine physician is the opportunity to get people back to doing all the things that they love after they have been injured. Whether it is a competitive athlete, recreational athlete or just someone trying to get back to working without pain or disability, I love the fact that I have the opportunity to fix their ailments and significantly improve their quality of life.

Q: What advice do you offer athletes faced with an injury?

A: With very few exceptions, first and foremost I never try to discourage any athlete from doing what they love. Instead, I try to devise a treatment program that will return the athlete to their prior level of functioning. I do advise athletes to be realistic about their goals and to dedicate the appropriate amount of time to their recovery, whether they have surgery or not.

Q: What sports did you play growing up and what do you do now to keep in shape?

A: I started out playing soccer, but gave it up when I went through a growth spurt. From there, I gravitated toward football and it has always been my first love. I played football at Cleveland South High School and went on to play at Baldwin-Wallace College where I was an Academic All-American defensive end and Team Captain in my senior year. I recently lost 70 pounds when I began a running program last December. Now, I run 18 to 20 miles a week to stay in shape.

Q: Do you have a favorite team?

A: I am a diehard Cleveland Browns fan. I grew up watching the great Cleveland Browns teams of the mid-80s. It was a great time to grow up in Cleveland.

Q: Is there anything interesting you’d like to share about yourself?

A: I overcame a lot of obstacles to get to where I am today. I grew up in a single-parent household in the Garden Valley neighborhood of Cleveland. This is one of the roughest neighborhoods in Cleveland and we did not have a whole lot. My mom is the most phenomenal person I know and she worked very hard to keep us out of trouble. Her work ethic continues to help me succeed in my career. Furthermore, it has helped me try to be the very best husband to my wonderful wife, Tenisha, and a great father to my three sons, Andrew, Donovan and Jackson.


5 On-The-Go

PB&J – This portable snack provides the right balance of carbohydrate, protein and fat to fuel you before or after a game. To reap the most benefits, use natural peanut butter, which provides protein and heart healthy monounsaturated fat, on whole-wheat bread to provide complex carbohydrates, and your favorite flavor of jelly.

Banana – You can never go wrong with a ripe banana. A banana is prepackaged, often provides two to three servings (depending on the size) of easily digestible carbohydrate for energy, plus supplies potassium that is essential to regulate muscle and nerve function while you are active.

Trail mix – Try making your own trail mix with whatever you have in your kitchen cupboard! To supply a sufficient dose of sustained energy, be sure to include a whole-grain, dry cereal (such as Cheerios® or oatmeal squares) dried fruit (try raisins or cranberries), peanuts or almonds, and mini dark chocolate chips.

Pretzels – Pretzels are just the right snack to munch on if your stomach is growling right before your game starts. After eating a handful, your body will quickly digest them into an immediate energy source that will likely fuel you through at least the first period. Reach for another handful during half-time if you still feel hungry or fatigued. Salted pretzels also help replace sodium that is lost through sweat during play.

Chocolate milk – Low-fat chocolate milk is an excellent post-game recovery drink that supplies the right ratio of glycogen-replacing carbohydrate and complete protein to repair damaged muscle fibers after a long game. Look for convenient eight- to 16-ounce bottles to pack in a mini cooler or lunch box to keep cold.

Katherine Mone, MEd, RD, CSSD, LD, is a board-certified specialist in sports dietetics for Cleveland Clinic Sports Health. She specializes in any type of athlete, including those with diabetes and cardiovascular disease. If you have any questions about your sports nutrition needs or want to make an appointment, call 877.440.TEAM.


Ladies: Slim Down and Build Bone with Strength Training

“Women need a combination of cardiovascular exercise and weight training. Cardio exercise is best for the heart and for weight control, and strength training is best for bones and for muscle mass,” says Heather Nettle, MA, a Cleveland Clinic Sports Health exercise physiologist.

No Hulk, No Bulk

Women will not gain excess bulk like men do with continued heavier weight training. It will give you muscle definition, but will not leave you looking like a male bodybuilder. Typically, women do not have the kind of hormone levels needed to dramatically increase muscle size. Instead, strength training in women leads to a higher resting metabolic rate (RMR), which keeps body fat down and increases lean mass.

What’s more, weightlifting has added benefits: promoting strong bones to protect against osteoporosis and helping with balance to reduce risks of traumatic falls.

Find Your “Six Pack”

“Everybody has ‘six-pack abs’ under there somewhere; you just have to find them. You want to make sure you’re building your muscle mass to boost your metabolism, which will help define the muscles. Without this muscle size increase, you won’t have tone. But know that the tone will not leave you looking masculine,” Ms. Nettle says.

How to Begin

Begin your weight-training program by performing 10 to 15 repetitions of eight exercises, two to three days per week. You may wish to start off using lighter weights (low resistance) and then increase your resistance one or two pounds at a time, every one to four weeks, depending on your progress. Also, start with larger, multi-jointed lifting exercises such as lunges and chest presses, instead of the smaller muscle group exercises such as bicep curls.

Remember to check with your doctor before beginning any fitness regimen.

Heather Nettle, MA, is an exercise physiologist at Cleveland Clinic Sports Health.

Strength Training Tips
  • To encourage weight loss, try alternating lower intensity exercise for a longer period of time – walk for an hour instead of jogging for half an hour – with shorter, heavier cardiovascular workouts such as intervals. The lower intensity the exercise, the less total calories burned, but the greater number of calories used from your fat stores.
  • For maximum benefit, use heavier weights in strength training until your muscles become fatigued, rather than doing more repetitions with your lighter weights.
  • Eat enough calories if you’re exercising a lot. Eating too few calories may start to break down muscle mass and slow your RMR.

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This information is provided by Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition.

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