Cycling is on the rise, but injuries may be, too

Bicycle riding is increasingly popular, thanks to more environmentally conscious people, a desire to be fit, and wanting to save money on gas. The downside, however, is that cyclists may be suffering more injuries.

That's the conclusion of researchers who looked at accident rates and severity from 1996 to 2006. Among 329 bicycle accident cases admitted to the Rocky Mountain Regional Trauma Center at Denver Health Medical Center, the length of stay increased substantially over those years. In addition, an increase was seen in chest injuries (up 15%), and abdominal injuries tripled over the last five years of the study. About one-third of 118 patients had head injuries.

In a Reuters story, lead researcher Dr. Jeffry Kashuk from the University of Colorado, Denver, said, "Although the public is very enthusiastic about bicycle use as a means of transportation, we think that infrastructure has lagged behind in the U.S. The government is pushing bike days, and rebates for bike use. Communities are putting in bicycle kiosks." He added that only limited data exist showing there are bikeways to support an increase in bike use.

The findings from the study were presented at the American College of Surgeons' 95th annual Clinical Congress being held this week in Chicago.

-- Jeannine Stein

Photo credit: Irfan Khan / Los Angeles Times

A nod to prostate cancer, vegetarianism, rehab, recovery awareness

Pity the awareness raiser who has little to use but a calendar date that rolls around once every year. But try they must. And so in the last five days alone, we've been told:

- "This week, the NFL and the American Urological Association Foundation (AUAF) launched on a campaign for men called “Know Your Stats” in honor of September’s Prostate Cancer Awareness Month." 

- "We hope to coordinate an interview for Suicide Prevention Month (September)."

- "Sept 20-26 is National Rehabilitation Week, and (Julia) Keller’s new young adult novel -- based on her personal and professional experiences, and written from the point of view of a young teenage girl -- tells the story of a family coping with the return of a severely injured soldier father."

- "Following is some detailed information which you may find interesting for a story in support of World Vegetarian Day and Vegetarian Awareness Month throughout the month of October." 

- "With National Breast Cancer Month coming up in October, we thought information on a new breast cancer radiation technique with proven life-saving benefits would be of interest." (This was just one of the breast-cancer-awareness suggestions received this week.)

- "The celebration, Batter Up! A Home Run for Recovery Month was part of National Alcohol and Drug Addiction Recovery Month celebrated annually in September."

- "The webinar, which comes on the final day of National ADHD Public Awareness Month, will report on published research on the effects of the Transcendental Meditation technique for improving academic achievement and executive brain function while reducing learning disorders, anxiety, depression, metabolic syndrome, diabetes, and heart disease."

We give in. Coming soon: A special Health section issue with no news or trends or context, just efforts to make you aware. (Kind of like this blog post.) 

Until that carefully unspecific time, allow me to recommend the list of 2009 National Health Observances. It's one-stop shopping for those who need to know which diseases, conditions and issues warrant awareness today, this week, this month.

After I make it through my inbox, I'll really have to figure out whose idea that was.

-- Tami Dennis

Photo: Even the NFL is on the game.

Credit: Matthew Emmons / US Presswire

ACL injuries: A bigger ligament may be a better ligament

When it comes to ACL injuries, size may matter.

The anterior cruciate ligament is the bane of many exercisers and athletes. Found behind the kneecap, it's responsible for keeping the knee stable and is the most often injured knee ligament. Athletes are especially vulnerable because the ACL can tear or fray during moves such as jumping, pivoting or stopping quickly. Women are especially at risk.

A recent study found that injured ACLs are also often smaller ACLs. Researchers from Ohio State University performed magnetic resonance imaging scans on the non-injured knee of 27 people who had suffered a previous non-contact ACL injury. They compared them to a 27-person matched control group to see if there was a difference in the size of the ligament between the two groups.

Among the previously injured study participants, 16 had smaller ACLs than the control group. The average ACL volume of the injured participants was 1,921 cubic millimeters, while the non-injured group had an average ACL volume of 2,151 cubic millimeters.

A larger ACL could equal a stronger ACL, according to Ajit Chaudhari, assistant professor of orthopedics at Ohio State and lead author of the study, the results of which appeared recently in the American Journal of Sports Medicine. "If you have a weaker ACL, it's more likely to tear if all other factors are equal," he said in a news release. "If being larger in size means the ACL has more fibers, then that would make it stronger. If the individual building blocks are of similar strength, then it comes down to how much total tissue there is."

The researchers caution that this doesn't mean that having a smaller ACL will always trigger an injury. And they don't recommend having knees screened via MRIs to see if they may be at risk. But they do think there may be potential in finding out how the ACL can be strengthened, made larger, or both, while a child is still developing.

-- Jeannine Stein

Photo: Antti Aimo Koivisto / Associated Press

All high school sports injuries are not created equal

As the kids head back to school they'll also head back to team sports. So brace yourselves, moms and dads, for the inevitable injuries that can come with that.

A new study sheds some light on which sports are more likely to produce severe injuries, derailing athletic participation for weeks. Injury data on nine sports were collected during the academic year from 2005 through 2007 in 100 high schools nationwide by researchers from the Ohio State University College of Medicine and the Center for Injury Research and Policy in the Research Institute at Nationwide Children's Hospital, both in Columbus, Ohio. A severe injury was defined as one that resulted in losing three weeks or more of sports participation. During that time, 1,378 severe injuries were noted, comprising 14.9% of all high school sports-related injuries. Severe injury rates were higher in competitions than during practices.

Football ranked as having the highest injury rate of 0.69 per 1,000 athletic events, defined as participation in one practice or competition. Second was wrestling (0.52), then girls' basketball (0.34), and girls' soccer (0.33). While the injury rate was higher in all boys sports versus all girls sports, when injuries in certain sports (soccer, basketball, baseball/softball) were directly compared, the results were different: Girls had a higher severe injury rate overall than boys, and girls basketball ranked higher in injuries than boys basketball.

The study also described which parts of the body took the most hits. Knees were on top, followed by the ankle and shoulder. The most common diagnoses were fractures, complete ligament sprains, and incomplete ligament sprains. Among all the severe injuries, 28.3% needed surgery.

The injuries were costly in other ways. On the whole, 43% of severe injuries meant a loss of more than 21 days, and almost 57% of the injuries resulted in medical disqualification for the rest of the season.

But such injury data shouldn't deter parents from allowing their children to play sports, says Dawn Comstock, a study co-author and assistant professor in the department of pediatrics at Ohio State University College of Medicine. "We have an epidemic of obesity in this country," she says, "and most kids today get the majority of their physical activity from organized sports. We should focus on making sports as safe as possible so kids can incorporate them as part of a healthy lifestyle."

Comstock recommends some tactics to reduce injuries and their severity: make sure appropriate protective gear is fitted properly, is in good repair, and is worn by the athletes; improve protective equipment by tailoring it to younger athletes; change rules if necessary to protect players, and educate coaches about signs and symptoms of concussions, which can go undiagnosed.

The study appears in the September issue of the American Journal of Sports Medicine.

-- Jeannine Stein

Photo credit: Christine Cotter / Los Angeles Times

Car-surfing injuries linked to video games

A group of neurosurgeons analyzing the dangerous teen activity known as car surfing has concluded that its popularity corresponds with the release of the Grand Theft Auto video game series and YouTube clips glorifying the activity.

Car surfing, thought to have originated in the Bay Area in the 1980s, is a stunt in which the "surfer" sits or stands on the hood, roof or trunk of a moving vehicle, hangs onto the sides or is dragged from a rope trailing behind. It is also called ghost riding. From 1998 to 2006, 51 California youths died in car-surfing accidents.

The study, published in the Journal of Neurosurgery, is the first comprehensive look at the rising rate of injuries related to car surfing and why teens engage in such reckless behavior.

The authors analyzed statistics from the states with the most car-surfing injuries -- California, Florida and Texas -- and found a steady rise in accident rates starting in 2000. The increase in injuries corresponded to the release of the Grand Theft Auto video games (editions one through three) and the Jackass video game series and movie in 2002, according to the authors of the paper, from University Hospitals Rainbow Babies and Children's Hospital in Ohio. An increase in fatalities occurred from 2004 to 2005 with the release of GTA San Andreas and the growing popularity of YouTube, the study finds. A search of YouTube archives from 2006 to 2008 produced 350 video clips showing children and teenagers engaging in car surfing.

In a study of seven car-surfing injuries at their own hospital, the authors found most injuries were to males; the average age was 13.4 years; all sustained head injuries; four suffered longterm neurologic damage.

Why would kids do this? The report is unusual because the authors conducted a broad search of statistics and popular culture to show how video games and YouTube clips appear to influence the behavior, says Dr. Ann-Christine Duhaime, in an editorial accompanying the paper.

"People do stupid things, and adolescents do some of the stupidest," Duhaime wrote, in what is perhaps one of the most accurate observations in medical literature on accidental injuries. "It is well documented that children and adolescents imitate what they see in the media, even when this is deleterious to their health."

Adults, she says, need to channel teens' need for adventure into "activities with less likelihood of life-altering, or life-ending, outcomes."

-- Shari Roan

Photo: Carlos Chavez / Los Angeles Times

ACL surgery may be what knees need

Tears of the anterior cruciate ligament, one of four main knee ligaments, are all too familiar to serious athletes and even weekend warriors. ACL tears commonly happen when the knee is hyperextended during activity, or is suddenly torqued.

Two recent studies present new takes on ACL surgery and recovery.

NFL players who underwent ACL surgery had longer careers than their peers who had meniscus repairs, or who underwent both procedures. Researchers analyzed a database of NFL player injuries from 1987 to 2000 and found 54 who had had meniscus repairs, 29 with a history of ACL reconstruction, and 11 with a history of both. They were matched with a control group with no prior surgeries and matched by position, year drafted, round drafted and other injury history. ACL surgery alone didn't substantially shorten the careers of the players, either by year or game number. However, the careers of those who had had meniscus repairs shrunk were about 1.5 years shorter, or 23 games. And players who had both procedures had careers cut by almost two years, on average, and 32 games.

"A combination of ACL reconstruction and meniscectomy may be more detrimental to an athlete's durability than either surgery alone," said lead author Dr. Robert Brophy of the Washington University School of Medicine, in a news release. "With further research, we will be able to better understand how these injuries and surgeries impact an athlete's career and what can be done to improve long-term outcomes."

ACL surgery in young athletes is becoming more common. But some health experts (and parents) worry that such surgery could carry risks because bones haven't finished growing. But a new study suggests that delaying surgery might have even worse consequences. Researchers examined records of 70 children 14 and younger who had ACL reconstruction surgery between 1991 and 2005. A little less than half (29) who put off treatment for more than 12 weeks had four times as many medial meniscus tears, 11 times as many lateral compartment chondral injuries, and three times as many patellotrochlear injuries. They also had more instability in their knees.

Both studies were presented this week at the annual meeting of the American Orthopaedic Society for Sports Medicine in Keystone, Colo.

-- Jeannine Stein

Photo: US Presswire

The face of domestic violence

Domestic violence is believed to be vastly under-reported, and emergency and other physicians have long been urged to be on the alert for patients with unexplained injuries. The right questions can help identify victims -- the  majority of them women -- and secure referrals to community service agencies.

Now doctors have a new clue. Rather than trying to read injured patients' faces for signs of fear or shame, physicians can read their facial injuries.

Women who had been assaulted by intimate partners generally sustained different patterns of facial injuries than women who were injured in car crashes, falls or assaults by strangers, according to a study published today in Archives of Facial Plastic Surgery.

Women who were assaulted by a husband or boyfriend had higher than expected numbers of orbital blow-out fractures (breaks or cracks in the bones surrounding the eye) and traumatic brain injuries.

Previous studies of facial injuries in men and women from car accidents and assaults had found that mandible and nasal fractures -- broken jaws and noses -- were the most frequent injuries, followed by zygomatic complex fractures, or cracks in the cheekbones and the bones that adjoin them.

Researchers had expected to find similar results in women who were victims of domestic violence. They looked at medical records of women age 18 years and older who went to the University of Kentucky Medical Center to be treated for trauma to the face.

The most common cause of facial injury was car accidents, followed by falls, then assaults. Of 45 assault victims identified, 19 were documented victims of domestic violence.

Women who were in motor vehicle crash or had suffered falls had higher than expected numbers of fractures to the alveolar ridge fractures (the horseshoe of bone directly beneath the teeth) and facial cuts. Women who were assaulted by a stranger were more likely to have broken jaw bones and zygomatic complex fractures.

In addition to distinctive patterns of injury, domestic violence victims also differed in presentation: They were more likely to delay seeking care for their injuries.

"For more than a decade, we have known that when healthcare providers assess patients for domestic violence and refer those who need help to local domestic violence programs, it can save victims' lives," said Esta Soler, president of the San Francisco-based Family Violence Prevention Fund. "But not nearly enough doctors, nurses and other providers are doing this. This study  makes it even easier for surgeons and other providers to recognize when patients are victims of violence -- and creates an even more urgent mandate for them to intervene."

-- Mary Engel

Credit: Myung J. Chun/Los Angeles Times

It's all in the wrist: Gymnasts may be developing more hand and wrist injuries

Considering the pounding gymnasts’ bodies take, it’s no secret they’re prone to chronic and serious musculoskeletal injuries. This is especially worrisome since many start at a young age when bones are still growing.

A new study finds that teenage gymnasts may be developing some injuries to their wrist and knuckle bones that have not been seen before.

Researchers did MRIs on the wrists and hands of 125 adolescent gymnasts ages 12 to 16, including 12 who had chronic wrist or hand pain. Injuries were found from the radius bone (a long bone in the forearm), to the small bones of the wrist, and the ends of the finger bones at the knuckles. Some had necrosis, or early, unnatural death, of their knuckle bones.

"The broad constellation of recent injuries is unusual and might point to something new going on in gymnastics training that is affecting young athletes in different ways," said Dr. Jerry Dwek, assistant clinical professor of radiology at UC San Diego, and the study’s lead author, in a news release. The research was presented at the Radiological Society of North America’s annual meeting this week in Chicago.

He added that more research is necessary to find the cause of the injuries, and said, "It is possible that by changing the way that practice routines are performed, we might be able to limit the stress on the joints and on delicate growing bones."

-- Jeannine Stein

Photo: Japanese gymnast Koji Yamamuro. Credit: Udayan Nag / Associated Press

The agony of aches and pains -- amateur athletes feel them, too

We all know professional athletes suffer injuries all the time, but that’s an understood part of the gig.

But amateur athletes can experience serious aches and pains as well, according to a study that examined amateur bowlers. Researchers at Tel Aviv University in Israel surveyed 98 amateur bowlers involved in two bowling clubs. They were given questionnaires to assess musculoskeletal disorders as well as other factors such as features of the game itself.

Some 62% of bowlers said they experienced musculoskeletal symptoms in one or more joints during the last year. The number of leagues that bowlers participated in was a predictor of painful joints in the upper extremities, and the average achievement of bowlers predicted the number of painful joints in the entire body.

A few tips for amateur athletes was offered by Navah Ratzon, lead author of the study published recently in the journal Work, and director of the occupational therapy department at Tel Aviv University, via a release. She said that players of ball sports such as tennis, golf and basketball should understand that one unnatural move, such as a twist of the back, could have painful consequences. While stretching is always important, so is exercising the muscles that don’t get used that often. For example, tennis players and bowlers need to work their non-dominant arms, as well as shoring up other muscle groups to balance any asymmetries.

"Increasing numbers of adults are pursuing amateur athletics during their leisure hours," Ratzon said. "But we've found worrying indications that this activity — when not done properly — may have negative effects on the musculoskeletal system."

She added that people should avoid stressing out about their amateur endeavors. Becoming anxious about missing practices or spending too much time on a sport can aggravate persistent health issues.

-- Jeannine Stein

Photo credit: Mark Boster / L.A. Times

A U.S. Olympic team doctor blogs from Beijing: The guts, the glory, the gastrointestinal problems

Amid all the hoopla that is the Beijing Summer Olympics, it’s understandable that some things are lost in the wake of feats such as acquiring eight gold medals.

Take, for instance, the live-from-the-Beijing Olympics blog being written by Dr. Scott Rodeo (pronounced row-dee-oh, not the fancy row-day-oh), an orthopedic surgeon on the medical team treating U.S. Olympic athletes. He may not have the cachet of Oprah-approved Dr. Mehmet Oz, but Rodeo has great creds — he’s the co-chief of the Sports Medicine and Shoulder Service at the Hospital for Special Surgery in New York City, associate team physician for the New York Giants, and a former competitive swimmer. He’s done the Olympics gig before as the U.S. Olympic team’s physician at the Athens Games in 2004. The hospital’s public relations director suggested he blog via his Blackberry about his experiences as one of several medical personnel at the event, and so he has, starting with the swim team’s training camp in Singapore. Which is great, except the posts are … less than spine-tingling.

"I have continued to treat both gastrointestinal illness as well as sinusitis, upper respiratory conditions, coughs, and sore throats," he writes. "We have also had a few minor injuries in swimmers (finger, elbow) which occurred from a forceful finish."

All righty then.

Frankly, we feel for Rodeo, who must be caught between a rock and a hard place. On one hand, he certainly has no desire to see nasty injuries befall the athletes, most of whom have trained years for this opportunity. On the other hand, flying about 7,000 miles to treat diarrhea must be … a touch of a disappointment.

"There’s enough other stuff going on," he says, chuckling. "The less I see the better, because it means that everybody’s healthy."

A phone conversation (part of which took place en route to an event as Rodeo’s bag, filled with syringes and such, was being checked by security) yielded more info on what Rodeo’s been up to. Although his main focus is on swimmers, he cares for other U.S. and foreign athletes as well, plus a few media people and NBC staffers thrown in for good measure.

As for the athletes, "There may be a number of little things that you treat," he says. "More significant things are small fractures, which can be taped, and if it’s not too serious the athlete may keep competing. Most things are muscle strains — some are acute and demand attention." Those, he adds, are usually treated with ice and anti-inflammatory medications.

Various sports, he explains, yield specific types of injuries. Swimmers, for example, typically suffer overuse injuries such as shoulder strains, caused by repetitive arm movements. They can also suffer acute injuries such as fractures if they smash their hands against the pool wall during a finish. Track athletes can have stress reactions, a chronic bone injury that can be a precursor to a stress fracture.

It’s obvious that Rodeo must be prepared to treat anything, like the aforementioned gastrointestinal issues, which are typical for travelers and can stem from changes in water, food, and environment and can alter the GI tract’s bacterial balance. Nerves, he adds, are probably a factor in some of these cases. He’s been treating most mild cases with anti-diarrheal medications, and more serious ones with antibiotics. The danger here, Rodeo says, is dehydration: "Athletes can lose a lot of fluid, and that can affect performance."

For those hoping Rodeo would name names of who’s been injured and how, don’t hold your breath. The United States Olympic Committee prohibits him from giving out specifics. But a couple of nuggets were extracted: Michael Phelps is a stand-up guy who hasn’t gotten a swelled head from his phenomenal accomplishments. "He’s a good person, normal, he puts his pants on one leg at a time." Or should that be super-duper Speedos? Most athletes at this level, he adds, are pretty savvy about injuries and treatment and don’t act like prima donnas around the docs.

Despite a rigorous work schedule (he’s had little time to sightsee), Rodeo’s perks are getting to attend the competitions (he witnessed Phelps’ win in the 100-meter butterfly), as well as gather useful information to take home.

"You see injuries as they occur, as opposed to people coming in to see me a day later," he says. "So we can see what the best scenario is right away and learn how to get someone back quickly."

The blog has received about 1,000 visitors over seven days of tracking, and has received five comments. He sums up his month away from home this way: "It’s a neat experience on a lot of levels."

-Jeannine Stein

Photo credit: Martin/Presse Sports via US PRESSWIRE.