Background: Despite a perception that retired professional football players have poor health, there are little supporting data.Hypothesis: Retired football players have poor health compared with age-matched population norms.Study Design: Cross-sectional study; Level of evidence, 4.Methods: Thirty-six of 41 members of the 1969 Super Bowl winning team were contacted 35 years after that event (3 were deceased, and no contact information was available for 2). Players completed an SF-36 health survey and a medical history and football-specific questionnaire. Each player's football-related injury history before 1969 was documented from medical records. It was estimated that there was 80% power to detect a 10% difference in physical and mental health scores between the retired football players (age, 62 +/- 3 y) and population norms (n = 741) at an alpha level of 0.05.Results: SF-36 scores for physical and mental health were not different from age-matched norms (physical health P =.69; mental health P =.49). The most prevalent medical conditions were arthritis (24 of 36 players), hypertension (13 of 36 players), and chronic low back pain (13 of 36 players). SF-36 physical health scores were 21 % lower in players with arthritis (P <.01) and back pain (P <.05) compared with the other players. Physical health scores were 19% above normal for players without arthritis (P <.01) and not different from normal for players with arthritis (6% lower; P =.6). Four of 8 players who had major ligamentous injuries to the knee before 1969 had total knee arthroplasty in the intervening years, compared with 3 of the remaining 28 players (P <.05). The men played professional football for 8.3 +/- 3.8 years, and 33 players (94%) reported having had "very fulfilling" (n = 24) or "somewhat fulfilling" (n = 9) careers.Conclusion: These professional football players had long and fulfilling careers with no apparent long-term detrimental effects on physical or mental health scores despite a high prevalence of arthritis.

We examined the recovery of plasma volume, plasma osmolality, renal water and sodium handling and fluid-regulating hormones to dehydrating exercise in well-trained women and compared them to men. Ten male and eight female athletes cycled at anaerobic threshold at an ambient temperature of 32 degrees C until dehydration by 3% of their body mass (mb). After exercise, they drank water equal to 1% mb and rested for 240 min. Plasma renin activity (PRA), serum aldosterone [ALDO]s, plasma arginine vasopressin [AVP]pl, norepinephrine concentrations and plasma osmolality (Osmpl) were determined at baseline, end of exercise, 30, 60, 120 and 240 min postexercise. Urine was collected at baseline, end of exercise, 60, 120 and 240 min postexercise. Renal free water and sodium handling were assessed. The recovery of OSMpl and plasma volume occurred within the first 60 min of recovery and at similar rates between the groups. However, women had lower PRA at the end of exercise (P = 0.05), an earlier recovery of [ALDO]s, and a slower [AVP]pl recovery. Overall fluid balance was similar between the men and women, as were the early recovery of renal free water clearance (CH2O). During the last 120 min of recovery CH2O was more negative (greater water reabsorption) and fractional sodium excretion was increased in the women compared to the men. Despite small differences in sodium and water reabsorption following dehydration, it appears from other study that recovery from dehydrating exercise in well-trained men and women is remarkably similar.

We feel some clarification is required regarding statements made in the article entitled &dquo;Anterior-Posterior and Rotational Displacements of the Tibia Elicited by Quadriceps Contraction&dquo; that appeared in the May/June 1991 issue (pages 299-306, by Hirokawa et al.). On page 302, paragraph 3, line 1, the authors state: &dquo;It is well known that the tibia rotates internally as the knee extends. This rotation is especially prominent in the last 20° to 25° before full extension.&dquo; In the &dquo;Results&dquo; section (page 302, paragaph 4), the authors state that peak internal tibial rotation during knee extension occurred at 15° of knee flexion while peak external tibial rotation occurred at 120° of knee flexion. These data

To improve endurance athletes' performance, exercise physiologists and coaches often recommend over-distance training. Frequently, though, athletes misinterpret this recommendation and increase their risk of injury and staleness by training excessively.

In brief Orthopedic injuries are quite common among children, but if treated appropriately, permanent disability is rare. Certain injuries, however—such as supracondylar humerus fractures, meniscal tears, traumatic hip dislocations, and fractures of the distal femoral growth plate—are notorious for complications that lead to permanent disabilities. These orthopedic injuries often appear to heal uneventfully, yet they can result in delayed problems such as pain, deformity, or loss of function. Early identification of these injuries, followed by urgent treatment, minimizes complications.

Coplan, Nell L; Gleim, Gilbert W. F. A.C. S.M; Eskenazi, Mark; Slachenfeld, Nina; Nicholas, James A. Author Information

Exercise prescription is frequently based on the premise that an equivalent oxygen consumption achieved on different exercise modalities will result in a similar cardiovascular response. To test this, a comparison was made of the rate pressure product occurring at an equivalent systemic oxygen consumption (VO2) while exercising on different modalities. Subjects (n = 20) performed maximal exercise tests at random over a 2-week period on nonconsecutive days on a treadmill, bicycle, rowing, and arm ergometers with an intermittent/incremental protocol and continuous ventilatory measurements. The heart rate and systolic blood pressure at equivalent VO2 on each exercise modality for each subject was determined from highly significant regression formulas based on the measures made during the tests. Rate pressure product was significantly higher (P < .01) during arm ergometry compared with other modalities at all intensities. Bicycle exercise resulted in a higher rate pressure product than treadmill exercise at high VO2 (P < .01), but did not differ significantly at lower intensities. Rowing elicited a lower rate pressure product at low VO2 (P < .01), but did not differ significantly from treadmill exercise at higher intensities. The results were gender independent. Different exercise modalities may result in a significantly different rate pressure product at an equivalent VO2. This should be considered when formulating an exercise prescription.

Serum potassium levels, catecholamines, and plasma renin activity are elevated during maximal dynamic exercise. Catecholamines and plasma renin activity have been shown to rise nonlinearly during exercise and to parallel changes in venous blood lactate. Since the hyperkalemia of exercise is modulated by catecholamines, we studied the changes in serum potassium in relation to attaining the exercise intensity associated with a rise in blood lactate (the lactate threshold). Eight healthy male subjects 25 to SO years of age underwent progressive cycle ergometry (PE) at increments of 25 W/4 min. During PE, absolute levels of peripheral venous potassium increased significantly only after the lactate threshold was exceeded (T < .01). In a control study (TC), subjects exercised to their lactate threshold and remained at that work rate for a time equal to that of PE. During TC, there were no significant increases in potassium until the final four minutes of exercise (T < .05). Plasma aldosterone levels rose comparably during PE and TC. These results demonstrate that significant potassium elevation during dynamic exercise begins at the lactate threshold. This threshold response of potassium may have clinical implications for exercise prescription in patients with impaired potassium homeostasis.

The injury experience of 5,128 boys (8 to 15 years of age, weight 22.5 to 67.5 kg [50 to 150 lb]) participating in youth football revealed an overall rate of significant injury of 5%, with 61% classified as moderate and 38.9% as major injuries. No catastrophic injuries occurred, and it was rare for a permanent disability to result from any injury. The upper extremity was most likely to be injured, and fractures were the most common injury to occur. The rate, site, and type of injuries experienced by the pre- and early adolescent players differed from the pattern for older players at higher levels of competition. Variables related to an increased risk of injury included participation in the older and heavier divisions, heavier weight, and involvement in contact activities. Factors associated with the occurrence of an injury were evaluated and provided areas for future study for the prevention of injuries. The medical care received by youth football participants was appropriate, although improved sideline surveillance for injured players is required.

Exercise performance is determined by the interaction of many systems. Cardiac disease, non-cardiovascular pathology, physical training, and the hemodynamic response to the type of exercise the patient wants to perform should all be considered when developing an exercise prescription. There are two stages for deriving a complete exercise prescription, determination of optimal exercise intensity from an exercise test and adaption of the recommendation to include other forms of exercise. The recommendation is usually based on a target oxygen consumption or a target heart rate derived from a treadmill test, but both of these methods may be of limited effectiveness. Ventilatory measurements during exercise, which reflect metabolic changes, are a useful adjunct. The exercise prescription must be individualized to the patient's needs, and may have to be modified so that exercise intensity remains within acceptable limits.

The Lenox Hill derotation brace fashioned by Castiglia and his staff at the Lenox Hill Hospital Brace Shop (New York, New York) under the direction of Nicholas during the 1960s has been worn successfully by thousands of patients with unstable knees, including elderly arthritic patients, adolescents with congenital instability, and professional athletes. Nearly 9000 braces were worn by patients in the United States during the period from 1976 to 1980. The brace, with its sliding axis of motion, corresponds to the axis of movement in the knee. The combination Lenox Hill brace includes not only the sliding axis of motion, but also a second below-knee leg pad, second derotation strap, and hyper-extension stop. It is designed to resist the combination anteromedial-rotatory, anterolateral-rotatory, and anteromediolateral-rotatory instabilities. More than 70% of the braces prescribed during the last five years have been the combination type. The derotation brace is a significant advance in brace designs for supporting chronic unstable and surgically reconstructed knees. It can function effectively even when the wearer is actively participating in sports.

Transient peaks or "spikes" frequently appear in the initial segments of torque curves recorded with the Cybex isokinetic dynamometer. The purpose of this investigation was to determine whether these spikes represent artifact or transient initial surges of true muscular force output. Cinematographic analysis using both inert weights and a human subject as the source of torque input to the Cybex revealed that the dynamometer's input lever initially exceeded the pre-set angular velocity by an amount ranging from 11% (inert weight; pre-set Cybex velocity = 180 degrees/s) to 200% (human hip abduction; pre-set velocity = 30 degrees/s). The majority of this "overspeeding" occurred in the latter part of the free acceleration period, prior to the engagement of the dynamometer's resistance mechanism. The remainder occurred in the initial part of the elastic loading phase, just after resistance had engaged. A sharp deceleration of the overspeeding lever and the affixed weight or limb then followed in response to the dynamometer's continuing build-up of resistance. Simultaneous with this deceleration, a prominent torque spike was recorded that superseded the correct (mechanical equilibrium) torque value. Within our error of measurement, the deceleration observed in the film quantitatively accounted for all of the "overshoot" torque, i.e., that amount of the spike that exceeded the correct value. It was concluded that such prominent, initial torque spikes represent inertial forces and should not be confused with true muscular tension development.

In this study of 51 children's sports injuries, 21 injuries occurred in a nonorganized setting and 32 were deemed avoidable. Preventive measures are discussed.

Middle-aged athletes are just like other athletes-they don't want to stop participating when they are injured. This article describes some special problems and solutions for this group.