Re: McMinnville, Oregon: Compartment syndrome, football team, cause unknown - possible poisoning
Re: McMinnville, Oregon: Compartment syndrome, football team, cause unknown - possible poisoning
http://www.registerguard.com/csp/cm...cle-athletes-football-koester-mcminnville.csp
Mystery? ills unraveled |
Eugene sports medicine expert says muscle ailment easy to explain
By Greg Bolt
The Register-Guard
Appeared in print: Thursday, Aug 26, 2010
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The muscle ailments that sent a group of high school football players to the hospital in McMinnville are rare but well understood and shouldn?t raise concern among parents of local athletes, an expert on pediatrics and sports medicine said Wednesday.
Dr. Michael Koester, a Eugene specialist and chairman of both a state and national high school sports medicine committee, said the muscle problems most likely were caused by overexertion possibly exacerbated by heat, dehydration or other issues.
Contrary to some national media reports, he said no ?medical mystery? was involved and it?s unlikely over-the-counter supplements were a cause.
?It?s a known condition,? Koester said. ?It?s an unusual presentation, but it?s certainly not an unheard-of condition.?
Local coaches, expressing surprise at the McMinnville cases, said they haven?t changed their workout programs and are careful not to push athletes too hard too soon. This is the first week of formal practice for football, soccer and cross-country and the start of what is known as daily doubles, with football workouts in the morning and afternoon.
Willamette High School football coach Dan Fritz said he?s never seen or even heard of a situation like the one that occurred in McMinnville.
?I have never really encountered a group of people going to a point where they had to be hospitalized,? he said. ?I can?t imagine what they did. It?s pretty amazing to me.?
Twenty-four McMinnville athletes received hospital treatment Saturday after taking part in an ?immersion camp? at the school that week. Three ended up undergoing surgery to relieve pressure on muscle tissue due to what is known as exertional compartment syndrome.
That syndrome causes painful swelling of muscle tissue, and in extreme cases the muscle sheath, or compartment, must be surgically opened to relieve pressure and prevent nerve and muscle damage.
Koester said the other athletes most likely suffered from what is known as exertional rhabdomyolysis, a breakdown of muscle tissue that can happen after sudden, intense workouts without adequate conditioning. The condition produces an indicator known as creatine kinase, or CK, that signals muscle damage, and CK showed up at elevated levels in the blood of many of the McMinnville athletes.
Koester cautioned that CK is not itself harmful, but he said it means other potentially toxic substances are present that could cause kidney damage. The treatment is proper hydration, intravenously if necessary.
Exertional rhabdomyolysis is accompanied by unusually intense muscle pain. In more severe cases it can be accompanied by numbness or tingling in the extremities, and when kidneys are involved it can cause tea-colored urine.
But Koester said it?s important not to overreact or confuse normal muscle aches or soreness with the more serious syndrome. Parents should expect teenagers to be sore after workouts and practice.
?From an OSAA standpoint, our concern is making sure that everybody doesn?t start worrying about a little bit of muscle soreness and think they need to take their kid to the hospital to get their CK levels checked,? he said. ?That?s not the case at all.?
Koester is chairman of the Medical Aspects of Sports Committee of the Oregon School Activities Association as well as the Sports Medicine Advisory Committee of the National Federation of State High School Associations. He posted a memo to school officials describing the two syndromes and steps to help prevent them.
Muscle ailments rare
Soon after the weekend episode in McMinnville, speculation arose over whether the athletes were using over-the-counter performance supplements, such as creatine. Koester said athletes should be cautious about using such supplements, which aren?t regulated by the Food and Drug Administration, but discounted the idea that they could have caused the ailments.
?They could be contributory, there?s certainly a possibility of that,? he said. ?
As a cause, I think that?s incredibly unlikely.?
The creatine supplement is different from creatine kinase. There have been conflicting reports over whether the creatine supplement can cause illness or injury.
While both muscle ailments are rare, there have been isolated reports. Koester said a girls? lacrosse team overdid biceps curls a few years ago and ended up with rhabdomyolysis, and in one case more than 100 high school gymnasts in Taiwan needed hospital treatment for the condition after being made to do 120 push-ups in five minutes.
Koester said he suspects the boys in McMinnville were pushing each other to see who could do the most and impress their new football coach. Reports also said they were working out in a gym without air conditioning when the temperature outside was in the 90s, and that they weren?t taking frequent water breaks.
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I think it?s just a combination of a bunch of kids at the start of the football season working each other hard,? he said. ?Everybody?s excited about the new coach, everybody?s trying to outdo each other. It was hot, and heat can exacerbate things. Maybe they?re not drinking enough and not getting the best rest and nutrition.?
But Koester emphasized that even with rigorous workouts the condition is rare. And local coaches said they had never heard of anyone being afflicted before last weekend.
Conditioning approach changed
?It?s sort of incomprehensible,? said Craig Rothenberger, longtime athletic director at Junction City High and a member of the OSAA executive board. ?We?ve never had an athlete in all my time at Junction City that?s ever experienced it.?
Fritz said years ago Willamette used to start practices with what was called ?Hell Week,? but he said that has been changed to the current approach of more gradual conditioning.
?Our premise is we get you in shape over a period of time in the offseason and we?re not going to try to jam it down your throat in that four days before practices start,? he said.
On Wednesday, both the football and girls? soccer teams at Willamette were outside for drills as the temperature peaked at 97 degrees. But few players said they?d heard anything about the McMinnville incident and were following coaches? orders by making frequent visits to ?the trough,? a long water fountain fashioned from a length of pipe.
?Coach says to drink as much water as our bodies feel like they need and then drink some more,? said sophomore lineman Ted Fulks. ?Naturally, it?s tiring because it?s daily doubles, but it?s all right.?
Samantha Hammacher, the senior captain on the soccer team, said she?d heard about the situation in McMinnville but wasn?t concerned. She said players were following their coaches? directions and taking frequent water breaks.
?We have to, or we get in trouble,? she said.
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health TIPS FOR STUDENT ATHLETES
Gradually increase the intensity of both strength training and aerobic conditioning over the first weeks of practice. Avoid doing too much, too soon.
Ensure adequate hydration before, during and after practice.
Muscle soreness after initiating a new activity is normal. Any athlete with severe muscle pain, swelling of the arms or legs and/or numbness or tingling in the hands or feet should be taken to the emergency room.
Testing of CK (creatine kinase) levels in athletes with muscle soreness is not routinely done but may be considered when pain is severe or persistent or accompanied by tea-colored urine or diminished urine output.
Source: Oregon School Activities Association
