The Role of the Pharmacist in Sports Medicine & Training Anthony J Longo, Sr, BS, RPh, PharmD Cohen Children s Medical Center Adjunct Professor Hofstra University Physician Assistant Program USA Cycling Coach Crohn s & Colitis Team Challenge Endurance Cycling Coach Lake Placid, NY January 2014 Goals & Objectives To define the role of a Sports Medicine Pharmacist To define the role of the pharmacist in Anti doping Describe physiology of endurance training Identify slow twitch vs fast twitch To explain the role of nutrition in training To describe the importance of hydration in training Sports Medicine Role of the pharmacist Education Consultation Inter disciplinary team member Team dispensing Knowledge of banned substances Vaccinations 1
2013 14 NCAA Sports Medicine Handbook Anti doping The role of the pharmacist in anti doping Pharmacists at the 2012 London Summer Olympics 2
Stimulants Caffeine Amphetamine Cocaine BUILD Muscle / Bone Anabolics B2 Agonists HCG LH IGF 1 Insulin Relaxants Alcohol B blocker Cannabinoids Mask Drug Use Diuretics Epitestosterone Plasma Expanders Secretion Inhibitors Reduce Weight Diuretics Increase Oxygen Delivery EPO Blood Doping Artificial Oxygen Carriers Mask Pain Narcotics ACTH Cortisone Local Anethetics Muscle Face Off Slow Twitch (Type I) Efficient in using oxygen Delayed muscle firing Do NOT fatigue easily Best suited for: Endurance sports Endurance Cycling Marathon running Long distance triathlons (ie. Ironman) Fast Twitch (Type II) Do not burn oxygen for energy (anaerobic) Fast firing Explosive body movements Fatigue easily Best suited for: Short bursts of activity Sprinting Pole vaulting Cross fit events Physiology Types of muscles Slow Twitch (Type 1) Efficient O2 usage = inc d fuel production (ie. ATP) Continuous & extended muscle contractions over extended periods. Slow firing Takes a long time to fatigue Marathons & Endurance cyclists 3
Physiology Types of muscles Fast Twitch (Type 2) Anaerobic metabolism creates fuel Short burst of: Strength Speed Easily fatigue Rapid firing Fast Twitch vs Slow Twitch Fast Twitch vs Slow Twitch 4
Endurance Training The role of the pharmacist in endurance training Nutrition What & When to eat? Before During After http://www.scandpg.org/local/resources/files/2010/sd USA Fact Sheet_May 2010_Eating Before Exercise_aa.pdf http://www.scandpg.org/local/resources/files/2009/sd USA_Fact_Sheet_Eating_During_Exercise_Apr09.pdf http://www.scandpg.org/local/resources/files/2009/sd USA_Fact_Sheet_Eating_for_Recovery_Apr09.pdf Hydration What is the best way to hydrate? Drink before exercise Drink before you get thirsty (it too late by then) Is water the best? Depends Exercise less than 60 minutes Water Exercise greater than 60 minutes Carbohydrate& electrolyte solutions (ie. Quality sport drinks) Swiss Journal of Sports Medicine and Sports Traumatology; 51 (1), 25 29, 2003 http://www.scandpg.org/local/resources/files/2010/sd USA_Fact_Sheet_Performance_Hydration_Jul_2010.pdf http://www.scandpg.org/local/resources/files/2010/sd USA Fact Sheet_May 2010_Exercise Hydration_aa.pdf 5
http://www.eload.net/eload/eproductchart1.htm Last Accessed 1/4/14 Pain FIFA Football World Cup 2002 and 2006 (Scholl et al 2008) Most frequently prescribed medication 46.5% and 47.7% of all medication prescribed 30.8% of players took NSAIDs before match >10% took more than one preparation before matches Estimated use 6 10 X higher than population NSAIDs Anti inflammatory Cyclo oxygenase inhibition Excludes corticosteroids & disease modifying antirheumatic drugs 6
12 24 hrs 7 14 days Ho, AM, et al. The role of non steroidal anti inflammatory drugs (NSAIDs) after acute exercise induced muscle injuries. International SportMed Journal. Vol.5 No.3 2004. pp. 209 227 To NSAID or Not to NSAID? Inflammatory pathways and healing potential negative effects Inflammatory process is needed for regeneration of skeletal muscle (Lapointe et al. Am J Physiol Regul Comp Physiol 282; R323 R329, 2002) Cox 2 pathway is essential during early states of skeletal muscle regeneration (Bondesen 2004 Am J Physiol Cell Physiol, August 1, 2004; 287(2):C475 c483) 7
To NSAID or Not to NSAID? PGs modulate skeletal muscle protein metabolism and inflammation and pain IBU inhibits normal increase in skeletal muscle protein synthesis after high intensity eccentric resistance exercise 24 males 3 groups max OTC IBU or placebo after 10 14 sets of 10 eccentric contraction at 120% of 1 RM IBU suppresses normal increase in PGF2a which may profoundly influence the anabolic response of muscle to this form of exercise Trappe et al. J Clin Endocrinology and Metabolism 86:10; 5060 5070 When to start? COX inhibitors are most harmful during the early phase of healing in animals and is related to the duration of treatment Simon, J Bone Res 2002 Vuolteenaho, Clin Phar Tox, 2007 Types of Injuries Sports Injuries Overview Children s injuries Boomeritis Injury Prevention 8
Sports Injuries Simple precautions keep sports fun! Acute vs. Overuse Injuries Acute - sudden trauma such as sprains, strains, bruises & fractures Overuse - series of repeated small injuries Children & Sports 9
Children s Sports Injuries, 2007 Sport Number of Injuries Requiring Treatment Per Year Football 556,928 Basketball 412,075 Baseball/Softball 276,733 Soccer 220,162 Playground Injuries 410,634 Children & Sports Young athletes are NOT small adults! Children & Sports Child Adult Growth plates are weaker than ligaments. 10
Children & Sports Youths of same age can differ tremendously in size and physical maturity. When to see the Physician Inability to play Decreased ability to play Limp, loss of motion or swelling Visible deformity Severe pain Treatment R.I.C.E. Rest, Ice, Compression and Elevation Modify athletic activity Cooperation and communication between patient, parents, coaches and physician 11
Boomeritis Born 1946-1964 More than 1 million sports-related injuries each year Boomeritis Exercise key, but... Bike accidents prevail Mortality > children < 50% wear helmets Boomeritis tendinitis sprains bursitis strains 12
Treatment R.I.C.E. Alter or stop sports activities Physical therapy & medication Surgery may be warranted Preventing Sports Injuries Kids should be well coached & supervised Wear properly fitted, maintained & appropriate protective gear Play on safe surfaces Children should train for their sport prior to playing Preventing Sports Injuries Know and abide by rules Wear appropriate protective gear Know how to use equipment Never play through pain 13
Preventing Sports Injuries Be sure your child s coach is qualified to supervise the sport Preventing Sports Injuries Make Sure Your Young Athletes Always Warm Up First! Preventing Sports Injuries Skilled instruction Wear safety gear! Year-round conditioning 14
Stretching Warm up: Break a sweat Marching Walk in place Jumping jacks Mimic the sport you are about to do Stretching: You should NOT feel pain Hold stretch 30 seconds Relax into the stretch Stretching Stretching Breathe deeply & slowly Avoid bouncing Stretch both right & left sides 15
Sports Injuries Common Sports Injuries Ankle Sprain Ligament injury Ankle pain, tenderness, swelling Growth Plate Fractures in Children 16
R.I.C.E. Rehabilitation Range of motion Strengthening Flexibility Balance Ankle Sprain Plantar Fasciitis Microtears of plantar fascia Painful heel Tape heel, arch Orthotics Stretch (calf and plantar fascia) Against wall On a step Plantar fascia stretch Plantar Fasciitis 17
Plantar Fasciitis Massage may be helpful Warm up well before stretching Ice heel, 20-30 minutes Anti-inflammatories Night splint Plantar Fasciitis Wear good, supporting shoes Arch support Avoid activities that cause heel pain See your physician if pain persists Tennis Elbow & Golfer s Elbow 18
Tennis Elbow & Golfer s Elbow Warm up, stretch before play Correct, maintained equipment Condition beforehand Evaluate play techniques to minimize irritation Take a lesson Direct blow to knee Non-contact injury, with foot plant Landing on straight leg Making abrupt stops Back seat skiing ACL Injury ACL Tear Anterior cruciate ligament Normal anatomy Patella Femur Anterior cruciate ligament tears Hyperextension Femur slips Tibia Fibula Illustration reproduced with permission from The Body Almanac, Rosemont, IL American Academy of Orthopaedic Surgeons, 2003 19
ACL Tear - Women Athletes Incidence of ACL much higher among female athletes Combination of causal factors Neuromuscular prevention programs Meniscus Tear Helps knee joint carry weight, glide, and turn Twisting injury Football and other contact sports Meniscus Tear Pain Giving way Locking Clicking Swelling 20
Traumatic Shoulder Dislocation Traumatic Shoulder Dislocation Closed grip pull downs Rotation exercises Resistance exercises Surgery Shoulder Overuse Injuries Tendonitis Throwing sports Weight lifting Use proper technique, good supervision 21
Rotator Cuff Tears Acute injury Overuse injury Sports and occupations that involve repetitive overhead motions Stress Fractures Imbalance bone loss vs. replacement Micro-cracks Pain Overuse Injuries Thorough history & physical exam X-rays, MRI might be needed Specialists in sports medicine can be particularly helpful 22
Overuse Injuries Reduce intensity Warm up before Ice afterwards Work with a coach Overuse Injuries 10% Rule Don t Increase Activity by More Than 10% Per Week Sports Injuries Sports are fun! The goal is a pain and injury free balanced fitness program for all ages. 23
Questions? 24