Spine & Sports Institute

Philippe Tscholl, MD†*, Juan M. Alonso, MD‡§, Gabriel Dollé, MD‡, Astrid Junge, PhD†|| and Jiri Dvorak, MD†||¶

Abstract

Background High use of medication and nutritional supplements has been reported in several sports.

Purpose To document the use of prescribed medication and nutritional supplements in female and male junior, youth, and adult track and field athletes depending on their sports discipline.

Study Design Descriptive epidemiology study.

Methods Analysis of 3 887 doping control forms undertaken during 12 International Association of Athletics Federations World Championships and 1 out-of-competitions season in track and field.

Results There were 6 523 nutritional supplements (1.7 per athlete) and 3 237 medications (0.8 per athlete) reported. Nonsteroidal anti-inflammatory drugs (NSAIDs; 0.27 per athlete, n = 884), respiratory drugs (0.21 per athlete, n = 682), and alternative analgesics (0.13, n = 423) were used most frequently. Medication use increased with age (0.33 to 0.87 per athlete) and decreased with increasing duration of the event (from sprints to endurance events; 1.0 to 0.63 per athlete). African and Asian track and field athletes reported using significantly fewer supplements (0.85 vs 1.93 per athlete) and medications (0.41 vs 0.96 per athlete) than athletes from other continents. The final ranking in the championships was unrelated to the quantity of reported medications or supplements taken. Compared with middle-distance and long-distance runners, athletes in power and sprint disciplines reported using more NSAIDs, creatine, and amino acids, and fewer antimicrobial agents.

Conclusion The use of NSAIDs in track and field is less than that reported for team-sport events. However, nutritional supplements are used more than twice as often as they are in soccer and other multisport events; this inadvertently increases the risk of positive results of doping tests.

Clinical Relevance It is essential that an evidence-based approach to the prescribing of medication and nutritional supplements is adopted to protect the athletes’ health and prevent them from testing positive in doping controls.

Background High use of medication and nutritional supplements has been reported in several sports.

Purpose To document the use of prescribed medication and nutritional supplements in female and male junior, youth, and adult track and field athletes depending on their sports discipline.

Study Design Descriptive epidemiology study.

Methods Analysis of 3 887 doping control forms undertaken during 12 International Association of Athletics Federations World Championships and 1 out-of-competitions season in track and field.

Results There were 6 523 nutritional supplements (1.7 per athlete) and 3 237 medications (0.8 per athlete) reported. Nonsteroidal anti-inflammatory drugs (NSAIDs; 0.27 per athlete, n = 884), respiratory drugs (0.21 per athlete, n = 682), and alternative analgesics (0.13, n = 423) were used most frequently. Medication use increased with age (0.33 to 0.87 per athlete) and decreased with increasing duration of the event (from sprints to endurance events; 1.0 to 0.63 per athlete). African and Asian track and field athletes reported using significantly fewer supplements (0.85 vs 1.93 per athlete) and medications (0.41 vs 0.96 per athlete) than athletes from other continents. The final ranking in the championships was unrelated to the quantity of reported medications or supplements taken. Compared with middle-distance and long-distance runners, athletes in power and sprint disciplines reported using more NSAIDs, creatine, and amino acids, and fewer antimicrobial agents.

Conclusion The use of NSAIDs in track and field is less than that reported for team-sport events. However, nutritional supplements are used more than twice as often as they are in soccer and other multisport events; this inadvertently increases the risk of positive results of doping tests.

Clinical Relevance It is essential that an evidence-based approach to the prescribing of medication and nutritional supplements is adopted to protect the athletes’ health and prevent them from testing positive in doping controls.

1. Philippe Tscholl, MD†*,
2. Juan M. Alonso, MD‡§,
3. Gabriel Dollé, MD‡,
4. Astrid Junge, PhD†|| and
5. Jiri Dvorak, MD†||¶

Abstract

Heat stroke in athletes is entirely preventable. Exertional heat illness is generally the result of increased heat production and impaired dissipation of heat. It should be treated aggressively to avoid life-threatening complications. The continuum of heat illness includes mild disease (heat edema, heat rash, heat cramps, heat syncope), heat exhaustion, and the most severe form, potentially life-threatening heat stroke. Heat exhaustion typically presents with dizziness, malaise, nausea, and vomiting, or excessive fatigue with accompanying mild temperature elevations. The condition can progress to heat stroke without treatment. Heat stroke is the most severe form of heat illness and is characterized by core temperature >104°F with mental status changes. Recognition of an athlete with heat illness in its early stages and initiation of treatment will prevent morbidity and mortality from heat stroke. Risk factors for heat illness include dehydration, obesity, concurrent febrile illness, alcohol consumption, extremes of age, sickle cell trait, and supplement use. Proper education of coaches and athletes, identification of high-risk athletes, concentration on preventative hydration, acclimatization techniques, and appropriate monitoring of athletes for heat-related events are important ways to prevent heat stroke. Treatment of heat illness focuses on rapid cooling. Heat illness is commonly seen by sideline medical staff, especially during the late spring and summer months when temperature and humidity are high. This review presents a comprehensive list of heat illnesses with a focus on sideline treatments and prevention of heat illness for the team medical staff.

1. Allyson S. Howe, MD† and
2. Barry P. Boden, MD‡

Abstract

Background: Tendon injuries that occur at the osteotendinous junction are commonly seen in clinical practice and range from acute strain to rupture. Nonsteroidal anti-inflammatory drugs are often prescribed in the treatment of these conditions, but the effect that these agents may have on the healing response at the bone-tendon junction is unclear.

Hypothesis: In response to an acute injury at the osteotendinous junction, the healing patellar tendon will have inferior biomechanical properties with administration of anti-inflammatory drugs as compared with acetaminophen and control.

Study Design: Controlled laboratory study.

Methods: A total of 215 Sprague-Dawley rats underwent transection of the patellar tendon at the inferior pole of the patella, which was subsequently stabilized with a cerclage suture. The animals were then randomized into 7 groups and administered 1 of the following analgesics for 14 days: ibuprofen, acetaminophen, naproxen, piroxicam, celecoxib, valdecoxib, or control. At 14 days, all animals were sacrificed, and the extensor mechanism was isolated and loaded to failure. Biochemical analysis of the repair site tissue was performed. Animal activity throughout the study was monitored using a photoelectric sensor system.

Results: The control group demonstrated greater maximum load compared with the celecoxib, valdecoxib, and piroxicam groups (P < .05). The acetaminophen and ibuprofen groups were also significantly stronger than the celecoxib group (P < .05) but not statistically different than the control group. A total of 23 specimens had failure of the cerclage suture with the following distribution: control (0/23), ibuprofen (0/23), acetaminophen (0/24), naproxen (3/24), piroxicam (4/24), celecoxib (6/22), and valdecoxib (10/24). The difference in distribution of the failures was significant (P < .001).

Conclusions: Anti-inflammatory drugs, with the exception of ibuprofen, had a detrimental effect on healing strength at the bone-tendon junction as demonstrated by decreased failure loads and increased failures of the cerclage suture. Acetaminophen had no effect on healing strength. The biomechanical properties paralleled closely with the total collagen content at the injury site, suggesting that these agents may alter healing strength by decreasing collagen content.

Clinical Relevance: Selective and nonselective cyclooxygenase (COX) inhibitors should be used judiciously in the acute period after injury or surgical repair at the bone-tendon junction.

1. Scott T. Ferry, MD,
2. Laurence E. Dahners, MD,
3. Hessam M. Afshari, and
4. Paul S. Weinhold, PhD*

Abstract

Background

The purpose of the present study was to examine the acute effects of a thermogenic nutritional supplement containing caffeine, capsaicin, bioperine, and niacin on muscular strength and endurance performance.

Methods

Twenty recreationally-active men (mean ± SD age = 21.5 ± 1.4 years; stature = 178.2 ± 6.3 cm; mass = 76.5 ± 9.9 kg; VO_{2 PEAK} = 3.05 ± 0.59 L/min^-1) volunteered to participate in this randomized, double-blinded, placebo-controlled, cross-over study. All testing took place over a three-week period, with each of the 3 laboratory visits separated by 7 days (± 2 hours). During the initial visit, a graded exercise test was performed on a Lode Corival cycle ergometer (Lode, Groningen, Netherlands) until exhaustion (increase of 25 W every 2 min) to determine the maximum power output (W) at the VO_{2 PEAK} (Parvo Medics TrueOne^® 2400 Metabolic Measurement System, Sandy, Utah). In addition, one-repetition maximum (1-RM) strength was assessed using the bench press (BP) and leg press (LP) exercises. During visits 2 and 3, the subjects were asked to consume a capsule containing either the active supplement (200 mg caffeine, 33.34 mg capsaicin, 5 mg bioperine, and 20 mg niacin) or the placebo (175 mg of calcium carbonate, 160 mg of microcrystalline cellulose, 5 mg of stearic acid, and 5 mg of magnesium stearate in an identical capsule) 30 min prior to the testing. Testing included a time-to-exhaustion (TTE) ride on a cycle ergometer at 80% of the previously-determined power output at VO_{2 PEAK} followed by 1-RM LP and BP tests.

Results

There were no differences (p > 0.05) between the active and placebo trials for BP, LP, or TTE. However, for the BP and LP scores, the baseline values (visit 1) were less than the values recorded during visits 2 and 3 (p ≤ 0.05).

Conclusion

Our findings indicated that the active supplement containing caffeine, capsaicin, bioperine, and niacin did not alter muscular strength or cycling endurance when compared to a placebo trial. The lack of increases in BP and LP strength and cycle ergometry endurance elicited by this supplement may have been related to the relatively small dose of caffeine, the high intensity of exercise, the untrained status of the participants, and/or the potential for caffeine and capsaicin to increase carbohydrate oxidation.

Abstract

Background

High-intensity interval training has been shown to be a time-efficient way to induce physiological adaptations similar to those of traditional endurance training. Creatine supplementation may enhance high-intensity interval training, leading to even greater physiological adaptations. The purpose of this study was to determine the effects of high-intensity interval training (HIIT) and creatine supplementation on cardiorespiratory fitness and endurance performance (maximal oxygen consumption (VO_2PEAK), time-to-exhaustion (VO_2PEAKTTE), ventilatory threshold (VT), and total work done (TWD)) in college-aged men.

Methods

Forty-three recreationally active men completed a graded exercise test to determine VO_2PEAK, VO_2PEAKTTE, and VT. In addition, participants completed a time to exhaustion (TTE) ride at 110% of the maximum workload reached during the graded exercise test to determine TWD (TTE (sec) × W = J). Following testing, participants were randomly assigned to one of three groups: creatine (creatine citrate) (Cr; n = 16), placebo (PL; n = 17), or control (n = 10) groups. The Cr and PL groups completed four weeks of HIIT prior to post-testing.

Results

Significant improvements in VO_2PEAK and VO_2PEAKTTE occurred in both training groups. Only the Cr group significantly improved VT (16% vs. 10% improvement in PL). No changes occurred in TWD in any group.

Conclusion

In conclusion, HIIT is an effective and time-efficient way to improve maximal endurance performance. The addition of Cr improved VT, but did not increase TWD. Therefore, 10 g of Cr per day for five days per week for four weeks does not seem to further augment maximal oxygen consumption, greater than HIIT alone; however, Cr supplementation may improve submaximal exercise performance.

Abstract: Dietary protein is required to promote growth, repair damaged cells and tissue, synthesize hormones, and for a variety of metabolic activities. There are multiple sources of proteins available; however, animal sources of protein contain all essential amino acids and are considered complete sources of protein, whereas plant proteins lack some of the essential amino acids and are therefore classified as incomplete. There is a significant body of evidence to indicate that individuals who are engaged in intense training require more dietary protein than sedentary counterparts (ie, 1.4–2 g/kg/day). For most individuals, this level of protein intake can be obtained from a regular and varied diet. However, recent evidence indicates that ingesting protein and/or amino acids prior to, during, and/or following exercise can enhance recovery, immune function, and growth and maintenance of lean body mass. Consequently, protein and amino acid supplements can serve as a convenient way to ensure a timely and/or adequate intake for athletes. Finally, adequate intake and appropriate timing of protein ingestion has been shown to be beneficial in multiple exercise modes, including endurance, anaerobic, and strength exercise.

Abstract: Vitamin B₁₂ affects the peripheral and central nervous systems, bone marrow, skin and mucous membranes, bones, and vessels, as well as the normal development of children. Although there is undoubtedly an association between vitamin B₁₂ and homocysteinemia, their relative influence on cardiovascular events is controversial. Some large studies confirm that a supplementation with group B vitamins did not reduce the risk of major cardiovascular events or all-cause mortality in patients with vascular disease. The outcomes of these and similar trials could have been different had the researchers considered the following points: Using vitamin B₁₂ or B-complex as secondary prevention of cardiovascular events for patients with irreversible changes of blood vessels is probably in error. Rather, vitamin B₁₂ or B-complex should be used as primary prevention. Also, using high doses of vitamin B₁₂ will probably be more effective than using low doses of “group B vitamins” The effect of vitamin B₁₂ on the proliferation of malignant cells has been examined in vivo and in vitro in numerous studies. Their results indicate that methylcobalamin inhibits the proliferation of malignant cells and propose the possibility of methylcobalamin as a candidate of potentially useful agents for the treatment for some malignant tumors. There are many articles indicating the increasing prevalence of low vitamin B₁₂ level in different segments of general population. In order to prevent serious health problems, vitamin B₁₂ routine fortification should be seriously considered and discussed.

Keywords: vitamin B12; homocysteine; malignancy; vitamin B12 routine fortification; recurrent aphthous stomatitis

Abstract: Preventing many chronic diseases in North America requires substantial changes in dietary habits. Achieving a better balance of grain-based foods through the inclusion of whole grains is one scientifically supported dietary recommendation. Epidemiological and other types of research continue to document health benefits for diverse populations who have adequate intakes of both folic acid-fortified grain foods and whole grains. Folic acid fortification of grains is associated with reduced incidence of neural tube and other birth defects and may be related to decreased risk of other chronic disease. Whole grain intake is associated with reduced risk of chronic disease. Specifically, there is a decreased risk of obesity, coronary heart disease, hypertension, stroke, metabolic syndrome, type 2 diabetes, and some cancers observed among the highest whole grain eaters compared with those eating little or no whole grains. Nationally promulgated dietary recommendations such as those in the US Dietary Guidelines or by health promotion organizations such as the American Heart Association have incorporated the science on whole grains, recommending that consumers increase their whole grain intake. The US Dietary Guidelines state that consumers select half of the recommended bread and cereal servings as whole grain. Thus, the recommendations recognize the importance of adequate folic acid intake from refined, fortified grains to reduce the risk of birth defects and other disorders and to reflect the existing science on whole grains. The association between whole grains and decreased chronic disease is not surprising because whole grains are a source of vitamins, minerals, fatty acids, anti oxidants, and other phytochemicals and dietary fiber. Each of these components can act singly or in tandem to contribute to specific health-maintaining and disease-preventing mechanisms. Health professionals should be aware of these benefits and advocate these dietary strategies to help prevent chronic disease and to improve overall health.

Keywords: nutrition; whole grain; folic acid; disease prevention; diet; mortality; diabetes; cereal; pseudocereal; phytochemicals; anti-oxidants