Volleyball involves repetitive and strenuous use of the upper extremities, and the shoulder joint is at risk for both acute and overuse injuries. The overhead motions such as serving, spiking, and blocking can place sudden and heavy strain on a number of structures around the shoulder joint. The most common shoulder injuries in volleyball players include internal impingement and labrum tears.
 
Shoulder Internal Impingement
 
Internal impingement of the shoulder may result from improper techniques when serving or spiking the ball, or from extensive overuse of the arm, even with a proper technique. Overhead athletes, including volleyball players, repetitively place the arm into extreme positions. This motion may, over time, lead to excessive stretching in the front part of the shoulder, resulting in partial tears of the rotator cuff and tears of the labrum (ring of cartilage that surrounds the shoulder socket).
 
Athletes with shoulder internal impingement typically complain of pain with overhead activities, especially during the wind-up part of the serve or spike. The condition is usually diagnosed by a careful physical examination; special imaging tests such as an MRI or an ultrasound. The typical initial treatment for internal impingement is non-surgical, unless the tears are significant. Stretching of the shoulder to properly balance the shoulder joint is very important, and is also combined with exercises to strengthen the rotator cuff and normalize motion of the shoulder blade. The more severe cases may require surgical intervention to repair the rotator cuff tear and/or the labrum, and possibly to tighten the front part of the shoulder.
 
SLAP Tears
 
The other injury seen relatively commonly in volleyball players, as well as in other overhead athletes, is a tear of the superior labrum, called the SLAP tear. The labrum—the ring of cartilage attached to the rim of shoulder socket—functions primarily to increase stability of the shoulder, and serves as an attachment for the shoulder ligaments and the biceps tendon. These tears typically occur from repetitive motions where the biceps pulls back on the arm as it is brought into rotation—a movement typical in overhead sports.
 
A SLAP tear may cause deep-seated shoulder pain, weakness of the arm, including an occasional “dead arm” sensation, as well as clicking and catching sensation in the joint. Sometimes these tears allow joint fluid to leak out and form a cyst, which may compress the nerves that supply muscles of the rotator cuff. In such a case the athlete may present with no pain but complaining of weakness with overhead motion, for example a weak serve. Physical examination may reveal weakness of some of the rotator cuff muscles even without any tears of the rotator cuff. In these cases, surgical treatment to repair the SLAP tear and remove the cyst is warranted. The repair is typically done arthroscopically, and requires about six months of recovery and rehabilitation prior to return to overhead sport, such as volleyball.
 
Prevention
 
While the shoulder of a volleyball player is subject to high forces and potential for injury, significant problems can be avoided with a proper training program and adequate time for rest and recovery. Volleyball players may be particularly predisposed to overuse shoulder injury if they have inadequate core strength, as well as abnormal position/motion of the shoulder blade. In order to prevent injuries and overuse conditions of the shoulder, a volleyball player should participate in a regular training program, which includes stretching and strengthening exercises. Specific attention must be paid to core strengthening. Timely evaluation by a sports medicine physician should be performed for all volleyball players who sustain an injury, or have symptoms that are persistent or recurrent..

By Tyler Mosher      @TMosh4UI     Sep 04, 2015
 
A simple catch and move up field turned into another season-ending injury for a premiere athlete. The latest unlucky victim: Green Bay Packers’ wideout Jordy Nelson.
 
After hauling in what appeared to be a routine grab and attempting to make a move to square his body, in hopes of making a would-be Pittsburgh Steeler defender miss, Nelson fell to the ground after a non-contact injury caused him to limp away gingerly in preseason action just days ago. It looked awfully familiar to sports fans.
 
A torn ACL was the not-so-surprising diagnosis following the August 23 tune-up.
 
One Naples Orthopedic Surgeon, Dr. Michael Havig, who is also the Golden Eagles’ football team physician on Friday nights, said football players have increased exposure to ACL injuries due to their susceptibility to both non-contact and contact related incidents.
 
“In most action sports there’s a lot of cutting and pivoting,” he stated. “In football, your foot gets planted, your body is going one way, and your knee goes another. You often see players getting hit from the side pretty viciously, but most instances that I see are non-contact injuries that are a result of a player landing funny.”
 
Before Aaron Rodgers’ favorite target, it was the NFL’s most physical specimen in Adrian Peterson. It was Rob Gronkowski, the league’s most athletic tight end. And it was even young Derrick Rose, the Chicago Bulls’ reputed second coming of Michael Jordan. Sports fans have seen their favorite players go down time and again, to the dismay of their die-hard fandom. So the same story goes, for another season more.
 
Dr. Havig utilized one first-hand example from last season that aids in his belief that contact injuries are harder to prevent, no matter how strong a player truly is.
 
“There was a Naples offensive lineman from last year that probably squatted 600 pounds, and he tore his ACL wearing a protective brace. He was at the bottom of a pile and just got twisted up the wrong way,” Dr. Havig recalled from a season ago.
 
“I think that’s what’s tough, it’s just not preventable sometimes,” he spoke on behalf of some of the aforementioned examples.
 
“In the case of [Adrian] Peterson specifically, he’s atop the pedestal in terms of who we define as an athletic freak, and I don’t think he could have done much more. It’s a wrong place, wrong time type of deal.”
 
The latest notable casualty: Orlando Scandrick, a Dallas Cowboys starting cornerback who reportedly tore both his ACL and MCL at a team practice.
 
“Athletes are bigger, stronger, and faster than they ever used to be. In football, guys just hit much harder. I think there are probably more exposures to injuries today, especially for those that are practicing and playing year-round,” Dr. Havig said.
 
Even at the highest level of play, in all sports, top athletes are ripped out of the first-team lineup and forced to rehabilitate for months on end—all because of a troublesome tendon that’s too well known as the Anterior Cruciate Ligament.
 
Dr. Havig’s reasoning for observers assuming real time knee injuries to be ACL tears in most cases: The media, who often scrolls related information on the ESPN ticker.
 
“Today’s news is 24/7, 365 day reporting,” he noted. “I think there’s a better understanding of it [ACL], everybody on the street has heard what it is. ACL tears resonate with fans as a bad injury, which means there’s a likelihood that a player may be out for a season or more.”
 
It really is the monster of all injuries, but it doesn’t hide under the bed; it shows its ugly colors and maintains its spot atop the most grueling sports obstructions today. Last Wednesday, two more season-ending ACL misfortunes were announced at the college ranks—namely ECU starting QB Kurt Benkert and Duke CB Bryon Fields.
 
But while it’s a painfully common occurrence, it’s survivable, exclaimed Dr. Havig.
 
“It’s terrible news. The good news is we [Orthopedic Surgeons] can fix it, and athletes should be able to get back to playing at the same level they were before.”
 
Returning better than before is increasingly possible, Dr. Havig pointed out. Times have changed, and the numbers prove it.
 
“In the 70’s and 80’s there was only a 45 percent success rate,” he alleged. “Where years ago it was a career-ending injury, we can restructure the ACL to function very well. People didn’t know what to do and didn’t understand the process back then.”
 
However, it’s not an easy trek to full recovery.
 
“The number has come full circle and kind of settled at six months, when we can let people start to think about going back to sports, but they have to have good quad and hamstring strength. A lot of factors go into this,” Dr. Havig recognized.
 
“It’s not just a time. Maybe six months isn’t enough.”
 
“We’re encouraging our athletes to give it a little bit more time, especially in high contact sports where eight to nine months is recommended,” he suggested.
 
Dr. Havig said that the first five to 10 years he was in practice he saw tons of cases where people in their 30s and 40s were experiencing arthritis issues, including his friends that played football alongside him at Naples High School, having trouble because they didn’t get their ACL injuries fixed immediately.
 
That changed in the late 90s, he declared.
 
“We started fixing most of the ACL tears that we’d see, and got better at it. Now I don’t see those same issues, and it used to be a commonplace. We seem to have dramatically reduced this problem of developing arthritis at such a young age,” he confirmed.
 
Today, for every young athlete that feels invincible—those who don’t think it will happen to them—the most elite athletes, like Nelson and Peterson, justify their chances of a sooner-than-expected comeback—and Dr. Havig held his stance that we’re headed in the right direction by continually modernizing ACL reconstruction and repair efforts.
 
“It tells me we’re doing the right thing.”.

Athletes are always looking for ways to be faster, stronger, or have more energy. Every day we are inundated with advertisements claiming to enhance sport performance with various pills, drinks, meal supplements, or cleanses. With so many supplementations available on the market it can be confusing and overwhelming as to what, if anything, people should be taking and the safety of these unregulated supplements. One disclaimer that applies to any supplementation is that you should seek the advice of your athletic nutritionist or physician before starting, to make sure you are taking the appropriate amount and that it is safe.
 
Should I be taking vitamins or minerals?
While most experts agree that people should be able to obtain the necessary vitamins and minerals by eating a well balanced diet there are some cases where adding additional vitamins to a diet can be helpful. First, vitamin and mineral supplements should never be used in place of a healthy diet. The supplementation of vitamins should be just that, a supplement, and should not be used as the main source of the vitamin or minerals. Vitamins can be helpful if, despite eating a nutrient-rich well-balanced diet, you are still unable to reach the recommended daily amount of essential nutrients. Keep in mind that the supplementation often provides more than 100 percent of the daily recommendation of a substance. It is possible to take too much of certain vitamins and minerals, so it is important to follow the recommended dosage. Some vitamins must be taken with food in order adequately absorb them so be sure to take your vitamin supplement with a meal.
 
Should I be drinking protein shakes?
Eating a protein-rich diet provides the amino acids that act as the building blocks of muscles. Many athletes use protein supplementation to help enhance this process and believe this helps build muscle mass. As with vitamins, most people can obtain the recommended amount of protein by eating a balanced diet. Protein supplementation should only be used in those athletes involved in demanding and arduous training. The recommended protein intake for the average adult is 50 to 60 grams of protein a day, which is easily attainable with a well-balanced healthy diet. Those adult athletes who are in training may need to increase that intake to about 80 to 90 grams per day, which can be more difficult to obtain from dietary sources alone. In these cases adding a protein supplement after a rigorous workout may be of benefit to the athlete.
 
What about drinking energy drinks before a workout?
One common ingredient across most energy drinks is caffeine. The use of caffeine has been well studied and, if used properly, may improve athletic performance. In exercise, it is thought to improve performance by allowing athletes to increase the duration of exercise or by decreasing the perception of their exertion. What does that mean? Athletes using caffeine may not realize their muscles are fatigued, thus allowing them to continue working out for a longer duration. However, while it may allow for longer time to fatigue, caffeine is also a diuretic which means it increases urine output and can lead to dehydration. Dehydration in an athlete not only decreases performance but can be dangerous. Those athletes who are looking to improve their performance in high intensity activities for short periods of time, such as sprinting, may not benefit from the use of caffeine.
 
Can supplements be dangerous?
Absolutely. The FDA does not regulate supplements the same way they regulate prescription medications. Supplements are not tested for safety or effectiveness by the FDA and the claims on the bottle are not always verified. Additionally, what the bottle states as the ingredients and quantities of the supplement may not actually be what is in the pill you are taking. It is important to do your own research on manufacturers of various supplements to ensure you are getting what you paid for and putting into your body exactly what you think you are. Discussing the supplement you plan to take with an athletic nutritionist or your physician is helpful as well. Remember that what you put into your body is just as important as what you are doing with your body to prepare for athletic events. When looking to improve sport performance it is imperative to eat a balanced diet first, stay hydrated, avoid fad diets, be wary of claims made about supplements, and choose your supplements wisely by researching products and working with health professionals.

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Softball has become an increasingly popular sport for young athletes. With the advent of Title IX, the popularity of televised collegiate softball games, and the inclusion of softball in the Olympics, the interest in the sport has exploded. Unlike in baseball, many softball teams utilize only one or two pitchers during the season. There is a common perception that softball pitchers are at a low-risk of injury, and that overuse injuries are much less of a concern compared to their overhead pitching counterparts.
 
Belief #1: Softball pitchers are rarely injured
Softball pitchers can be injured just as often as their baseball counterparts. In a study of 181 collegiate softball pitchers, authors found 73 percent of pitchers had obtained an injury during the season. Eighty injuries were directly related to pitching, and 11 required surgery.1 In another study of high-level softball pitchers, authors found that 45 percent of the pitching staff had to miss time during the season due to injury. Most injuries reported involved the front of the shoulder, including the biceps, and rotator cuff.
 
Belief #2: Softball pitching places less stress on the arm than baseball pitching
Biomechanical studies of the softball pitching motion demonstrate a 5–20 percent decrease in force on the shoulder compared to an overhand throw, and a 20–35 percent decrease in force on the elbow. While these numbers are decreased compared to their baseball counterparts, these numbers are not trivial. The forces on the shoulder during a softball pitch can be as high as 98 percent of the pitchers body weight. The windmill force of the softball pitch can easily lead to injury, especially when done repetitively. Interestingly, biomechanical studies demonstrate that the more novice the athlete, the greater the reliance on the shoulder and arm when pitching, likely increasing injury risk in the younger, less experienced athlete.
 
Emphasis on appropriate conditioning and mechanics along with future studies on pitch counts and volume may serve to decrease the risk of injury in this unique population..

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Sports participation results in 70 percent of anterior cruciate ligament (ACL) tears and the majority of these occur in 15 to 45 year olds. Approximately 70 percent of ACL injuries are noncontact injuries that occur during a sudden change in direction with a planted foot (i.e., cutting) or stopping rapidly. In the United States there are between 100,000 to 250,000 ACL ruptures annually.
 
The ACL is one of the main stabilizing ligaments of the knee and helps provide the hinge that allows the knee to remain stable while moving. When an ACL tear occurs the athlete often reports hearing a pop and usually cannot walk on the injured limb. During the injury it is common for the knee to partially dislocate, resulting in bruising and sometimes a small fracture at the back of the tibia and on the femur. Also common is a sprain of the medial collateral ligament (MCL) which is located on the inside of the knee. These injuries result in a painful swollen knee that is tender outside and deep within the knee.
 
Female athletes are two to eight times more likely to rupture their ACL than male athletes. This is primarily due to mechanical reasons, such as weaker core muscles and hamstrings. Another factor that can increase the risk of ligament rupture is the interface between the player’s shoes and the playing surface that results in higher friction. For example, longer cleats or more cleats on a shoe resulting in better traction and more friction. High risk sports include soccer, basketball, volleyball, skiing, and football.
 
Prevention programs have been developed based on analyzing the mechanism of injury of ACL ruptures as well as the kinematics of female body position during landing and cutting compared to males. The goal of these programs is to train the athlete to keep her center of gravity forward and on her toes, as well as encourage better leg rotation and control. These programs may reduce the incidence of ACL rupture by up to 50 percent. Typically a prevention training protocol should be done at least 2 to 3 times a week and last 15–20 minutes. As an added bonus these programs often improve an athlete’s performance such as jump height and speed. Speak with your sports medicine professional about exercises and programs to help prevent ACL injuries.
 
Athletes and patients with a reconstructed ACL often ask if bracing can prevent ACL injuries. Currently there is no evidence that knee braces can prevent an ACL rupture and many orthopaedic surgeons do not routinely use them..

Hiking is a great way to explore the outdoors, breathe some fresh air and vary your exercise routine. But a day of hiking can turn into an unwanted adventure or trip to the emergency room if you do not plan ahead. Following a few simple rules for safety can help prevent injury:
 
▪ Map out your destination and begin with a short hike.
 
▪ Never hike alone and check in with the park ranger when possible, sticking to your planned itinerary. Trail maps are often available and a great resource for distance, terrain, elevation, trail markers and types of nature you may encounter.
 
▪ Always check the weather report before your hike.
 
▪ Know the animals, insects and plants indigenous to your surroundings to avoid bites, stings, or rashes as you enjoy nature.
 
▪ Prepare a first aid kit that will provide immediate attention to sunburn, bug bites, blisters, poison plants, or injuries due to slips or falls.
 
▪ Wear well worn hiking boots or supportive shoes that have been broken in weeks prior. Socks should be made of wick moisture to keep feet dry.
 
▪ A lightweight backpack should contain sunscreen, water, sports drinks, salty food, snacks, a small whistle, compass, and a flashlight.
 
▪ Layer your clothing and wear a hat to shield your head and face from the sun.
 
▪ Keep an efficient pace. You should be able to talk and hike at the same time. A good rule of thumb is to cover one to two miles per hour.
 
▪ Know the signs of exhaustion, dehydration, altitude sickness and how to treat these.
 
▪ Take time to rest and replenish your body with fluid and food. Drink 8 to 12 ounces of fluid per hour.
 
▪ Know your physical abilities and those of the people hiking with you.
 
▪ Hike sober – alcohol and drugs can change your reaction time and cause injury.
 
Advanced preparation is the key to an enjoyable hike. Be aware of your surroundings at all times, the terrain you are hiking, changes in weather, and your overall condition and energy level while hiking and seek medical attention when necessary..

Cross country running has many challenges, including varied terrain, hills, inclines, and uneven surfaces. A cross country runner has to adjust his/her stride length with these many variables. This challenges the athlete differently than running on a flat surface track.
 
Cross country season begins at the start of the school year. Unless the athlete has trained over the summer, a lack of
conditioning could lead to many early season injuries. Instead of progressively increasing the intensity and duration of the workouts, an athlete may try to force too much training during the first part of the season, which often leads to injuries. The injury rate is usually higher for girls than boys. This can be due to physiological differences such as hip and knee angles, as well as lack of preseason conditioning.
 
Injuries can be twisting of an ankle or knee in the uneven terrain but most commonly cross country running injuries
are a gradual onset or related to overuse and affect the knee, hip, shin (tibia), foot, and ankle. It is important to start slow and gradual, and never increase training more than 10 percent at a time. Paying attention to proper nutrition and rest is also important over the course of the season. Some common injuries include:
 
• Patello-femoral pain syndrome
Pain in the front of the knee that is usually worse with stairs, climbing, sitting, and at the start of the run and/or at the end of the run. Treatment includes both stretching the muscles of the leg, as well as strengthening the quadriceps and hip muscles.
 
• Iliotibial band friction syndrome
Pain around the outside of the hip and knee that can be so severe that it that it can be confused with a meniscal tear. Stretching and strengthening is key to treatment and prevention.
 
• Achilles tendinitis and plantar fasciitis
Pain in the heel and foot is common. Stretching and strengthening the muscles of the lower leg as well as paying attention to good, properly fitted footwear, are important prevention strategies.
 
• Shin splints
Lower leg pain in the shin area. If not properly treated, shin splints can lead to a more serious stress fracture of the
tibia. The cause is usually a sudden increase in training volume and intensity. It is important to not only increase the aerobic training capacity, but work on strengthening and stretching of the entire lower extremity.
 
Newer participants, especially young teenagers, are sometimes not strong enough physiologically to handle the increased intensity of cross-country training.
 
Cross country running is challenging but it can provide excellent cardiovascular benefits, as well as improve overall strength. It teaches discipline, and since it is a team sport, can provide a good social atmosphere. The expense of the sport is minimal, with only a good pair of shoes being the main requirement. Paying attention to a proper training program, including regular strengthening and stretching exercises, can make cross country running a very rewarding athletic experience..

Anterior cruciate ligament (ACL), medial collateral ligament (MCL), and other ligament injuries of the knee can be    devastating for football players and may result in significant loss of playing time and/or require surgical treatment. As player safety and injury prevention continue to be a priority, many players and parents wonder if a knee brace can help prevent major football injuries.
 
Several factors come under consideration when trying to decide whether a player should wear a knee brace: 
Effectiveness in preventing an injury
Play hindrance
Added weight
Unnatural feel
Cost
Practicality of routine use
Possibility of increases in injuries in the hip or ankle
 
Prophylactic knee bracing or using a knee brace to prevent injury in football is controversial, with no clearcut answer from quality studies. Some studies suggest that prophylactic knee bracing helps prevent MCL injuries in “high risk positions” such as offensive and defensive linemen, linebackers, and tight ends and may decrease the severity of injuries when they do occur. However, there is no strong evidence to suggest that the rate of ACL  injuries is decreased by routine use of knee braces. Two published review articles on prophylactic bracing for prevention of knee injuries in football players concluded that data was not clear enough to make a recommendation for or against prophylactic bracing.
 
Widespread, routine use of prophylactic knee braces is not supported by available evidence or professional society recommendations. However, each player must consider individual factors such as position, level of competition,comfort, and cost when deciding if prophylactic bracing is advisable. As always, open dialogue among players, parents, coaches, athletic trainers, and team physicians is encouraged..

Millions of athletes compete in baseball and softball on an annual basis, and, as with all sports, injury risk and prevention are important concerns. One type of injury particular to these sports are injuries that occur during a slide to a base.
 
Athletes utilize both head-first and feet-first techniques when sliding. This activity is an important part of the game, and occurs, on average, eight times per game in collegiate and high school baseball, and five times per game in softball. The Centers for Disease Control Estimated that $24 million could be saved annually from sliding injury prevention, underscoring the importance of understanding the risks involved.
 
There are several aspects to sliding injury prevention that can be implemented. As with many sporting activities, proper technique is important. One potential explanation for the increased rate of injury in softball players is a higher incidence of last second sliding decisions. Shorter base paths and smaller fields may also lead to more last second decisions. Players should be coached to consider sliding at all times, to minimize the last second slide. In addition, sliding compression shorts and appropriate baseball pants are important in reducing injury. Some players hold their batting gloves to minimize the risk of jamming their fingers during headfirst slides.
 
Breakaway bases have also been shown to decrease injury rates during sliding. A 1993 study demonstrated a decrease in injury rates from two injuries per 100 baseball games with standard bases, to 0.4 injuries per 100 games with break-away bases. Biomechanical studies have also confirmed the benefit of break-away bases. However, the widespread use of break-away bases has not caught on, with increased costs likely a large reason.
 
Sliding injuries are a common cause of injuries during baseball and softball games. Fortunately, most injuries are minor. Improvement in technique and the use of break-away bases could help decrease the incidence of these injuries..

Stingers or burners are common injuries among collision athletes, but most of these injuries are not long-lasting or serious in nature. A stinger, more formally known as brachial neuropraxia, results when there is injury to the vast network of nerves surrounding the neck and traveling to the shoulder, arm, and hand. These nerves are susceptible to injury when the head is forcibly pushed into an extreme range of motion.Stingers can also occur after a direct blow to the area between the neck and shoulder. This injury commonly occurs in football, wrestling, rugby, and gymnastics.
 
Symptoms include neck pain, numbness, burning, and weakness in one arm. Symptoms in both arms could be indicative of a more serious spine injury and should be evaluated by medical personnel immediately. The symptoms of a stinger usually subside in moments to hours but more serious injuries can last for weeks. Injuries with symptoms that persist should be referred to an orthopaedic surgeon for further evaluation. Permanent injury is rare but can occur.
 

When can an athlete return to his/her sport?

Athletes can return to their sport as soon as they can perform full range of motion of the neck and shoulder without symptoms. Additionally, they should demonstrate full strength and normal sensation in the upper extremities.  Athletes who return to sport with residual numbness or weakness are at increased risk for further injury. Most athletes who sustain stingers can expect to recover and return to their sport within minutes or hours.
 
In rare cases, stingers can become recurrent or chronic. This is commonly the result of accompanying injuries in the spine such as a herniated disk or a narrowed cervical nerve opening. These abnormalities can cause an athlete to be at increased risk for stingers or to experience prolonged symptoms after injury.
 

How can I prevent this injury from happening again?

 Athletes who experience prolonged symptoms should be evaluated by an orthopaedic surgeon and should work with a certified athletic trainer or a physical therapist to improve neck strength and flexibility to minimize the risk of  future injury. Equipment should be assessed to ensure proper fitting. Some additional equipment, such as football cowboy collars and neck rolls designed to limit the range of motion of the neck, may also be helpful to help reduce the risk of re-injury..

Competition is part of life and we are all programmed to strive to be successful. The temptations of winning and of becoming bigger and stronger can be quite powerful. Performance enhancing drugs, especially anabolic steroids, have become widespread, including usage by non-athletes who want to improve their physical appearance. Younger athletes see their role models using these substances, only adding to their appeal. Unfortunately, anabolic steroids have potentially dangerous and permanent side effects.
 
What are anabolic steroids?
Anabolic steroids are synthetic derivatives of the male sex hormone testosterone. These steroids help with the construction of new proteins and increased muscle size and strength. These processes occur naturally in the body, but anabolic steroids enhance these normal biologic activities. Anabolic steroids should be distinguished from other types of steroids that are not anabolic, such as corticosteroids, which reduce inflammation in the body. Anabolic steroids, although illegal, are obtainable in communities, weight rooms, and via the Internet.
 
Steroids can be taken orally or injected. Steroids taken alone without combining with training have no significant effect. Also, any benefits of anabolic steroids are quickly lost after they are stopped.
 
What are the side effects of anabolic steroids?
Some of the side effects of steroids are reversible when the steroid use stops but some side effects are irreversible, including:
 
Males and Females
• Acne, especially on the face and back
• Mood swings, depression, possibly suicidal behavior
• Stretch marks
• Premature balding
• Liver damage
• Tendon rupture
• Heart enlargement
• High cholesterol
• Elevated blood pressure
• Infection or injury from injection of steroids
• (including HIV and Hepatitis)
• Possible increased risk of cancer
• Increased risk of death, especially from cardiac causes
• Dependence—There are withdrawal symptoms after they are discontinued, such as depression, fatigue, and reduced muscle size and strength, which makes it more difficult to stop.
 
Females (these side effects are irreversible)
• Deeper voice
• Clitoral enlargement
• Breast shrinking
• Body hair growth
 
Males
• Testicular shrinking
• Impotence
• Prostate enlargement
• Lower sperm count
 
Children (these side effects are irreversible)
• Premature closure of growth plates, stopping growth
• Early puberty
 
How can we prevent children from using anabolic steroids? 
Parents must realize that anabolic steroids are not only a problem in elite athletics; children are also exposed to these drugs. Parents should talk about steroids and other performance enhancing drugs with their children. Discuss the risks and side effects of these drugs with your children. Parents and coaches should continually stress the values of hard work, training, discipline, teamwork, participation, and fun in sports as opposed to winning at all costs attitude..

With Kobe Bryant’s return to the NBA this season after tearing his Achilles tendon last spring, there has been increased attention on this injury in basketball players. Basketball athletes are at an increased risk for Achilles tendon tears due to the demands of the sport, including repeated acceleration, change of direction and jumping.Older athletes also face a higher risk of Achilles tendon tears,making this a particularly relevant injury for the mature competitive and recreational basketball player.
 
The treatment of Achilles tendon tears is under increasing scrutiny. Surgical intervention is associated with a reduction in re-rupture compared to non-operative treatment, but adds the risk of infection and other complications. Risk factors  for infection include age over 60, diabetes, smoking, delay in treatment more than 7 days, and pain in the tendon before injury.There is a growing body of evidence that functional rehabilitation can have very good outcomes for patients with Achilles tendon tears but there is still debate over the relative rate of re-rupture and the comparative recovery of strength and power.Athletes tend to prefer operative treatment for the potential benefit in terms of decreased re-rupture rate and more complete recovery of strength and power.
 
There is limited data on return to sport after Achilles tendon tears. A recent study of NBA athletes  suggests that Kobe Bryant faces an uphill climb.In a group of 18 NBA athletes who tore their Achilles tendon, seven (39%) never returned to professional basketball and only 44 percent played more than one season after their surgery. Those who returned to play missed an average of 56 games before getting back to competition. Once they returned to the NBA, they demonstrated a significant decrease in
minutes per game and performance (based on the NBA Player Efficiency Rating) compared to their pre-injury performance and compared to healthy controls. Interestingly, those who underwent surgery were significantly less likely to get back to the NBA than those who did not. The good news for Kobe is that a higher Player Efficiency Rating pre-injury was associated with a greater likelihood of returning to professional basketball..

For over a century, downhill skiing has been at the forefront of popular, recreational winter activities. Like any other specialty sport, skiing comes with a unique set of physical demands and risks. While continuing advancements in equipment have created decreasing trends in most ski injuries, knee injuries have remained static, and in some studies, increased in the past forty years. It is estimated that there are approximately 100,000 acute knee injuries in North America in recreational skiers annually. Studies have identified four common mechanisms by which most of these injuries occur:
 
• Valgus-external rotation (falling forward and losing control of the skis)
This commonly occurs at high speeds when the inside edge of one of the skis catches the snow, causing the skier to fall forwards and the lower leg attached to the ski to rotate outwards. Studies have found that this is often the most common mechanism of knee injury in recreational skiers.
 
• Hyperextension/internal rotation (center of gravity shifts forward as the skier begins to lose control)
This occurs when one of the skis catches the snow and rotates inward into the common “snowplow” position and the knee hyperextends, causing injury.
 
• Boot induced mechanism (landing afterlosing contact with the ground such as after a jump)
Instead of a proper landing, the back edge of a ski makes contact with the snow first, causing the top of the boot to force the lower leg forward relative to the upper leg, isolating and focusing the landing force on the knee joint.
 
• Phantom foot mechanism (falling backwards)
In this injury, the skier falls backwards in a seated position, placing the hips below the knees and hyperflexes the knee. As modern ski boots become more rigid, this injury is becoming more common compared to the use of previous, more flexible boots.
 
Like any other recreational activity that has potential hazards, the key to preventing knee injuries while skiing is to enjoy the sport safely and conservatively. Many of the above injuries are the result of high speeds and/or aggressive skiing. A skier being able to gauge his or her own ability level and ski accordingly is perhaps the most important factor in minimizing injuries..

Cycling remains a popular sport for both recreation and competition. Many runners and other endurance athletes use cycling as a form of crosstraining and recovery from hard training sessions. However, too much of a good thing can cause injury just like any other sport.
 
Overuse injuries, although relatively rare compared with running athletes, do occur in cyclists. Many experts believe that errors in riding position and ill-fitting equipment are the biggest contributors to the development of overuse injuries.
 
Many high quality bike shops or endurance training centers can evaluate the fit of the bike to the individual, including seat positioning and individual riding style. These bike-fitting evaluations can also be used to improve body position which in turn may improve overall performance.
 
In addition, the science of cycling training has advanced in the last decade due to the use of heart rate monitors and power output meters. These measurement tools allow for precise monitoring of the athletes performance, and can be used to optimize training, and avoid physiologic training overload, which may lead to loss of conditioning and performance. The use of these tools, when combined with bike fitting, have provided a more evidence base approach to performance improvement..

In the quest for performance and fitness, athletes and the public often turn to recovery drinks for a boost. Research into this area has generated useful information that can guide optimal consumption of these drinks.
 
Recovery drinks should include an adequate amount of carbohydrates to maximize recovery as well as protein. The optimal ratio of carbohydrate to protein is about 2:1, typically 0.8 g of carbohydrate and 0.4 g of protein per kilogram per hour for 4 to 6 hours. For example, a 20 oz bottle of Gatorade, has 34 g of carbohydrate. A 176 lb athlete should drink approximately two Gatorades per hour to meet the carb recommendations.
 
Electrolytes are also important, with an optimal concentration of 0.3 to 0.7 g of sodium per liter.1 The 20 oz bottle of Gatorade has 270 mg of sodium at a concentration of just over 0.45 g per liter. Recovery drinks are not limited to specially formulated beverages, however. Coconut water has been shown to be similar to commercial recovery drinks. More recently, chocolate milk has been shown to be as effective, and perhaps more effective, as a recovery drink. Other commercial drinks with higher protein content are coming on the market. However, the use of specific amino acids and antioxidants has not been proven to be particularly effective although research is ongoing.
 
A closely related topic is the consumption of energy drinks such as Red Bull or Full Throttle. While the consumption of caffeine, more traditionally in the form of coffee or tea, has long been known to have potential benefits for performance, recently there has been a significant increase in the consumption of specially formulated energy beverages for athletes and the general public. These are often displayed in the same area as sports recovery drinks but are not the same product. The benefits are less well established and the risks greater with energy drinks, particularly related to heart issues. Recent recommendations from the Mayo Clinic do not support the use of energy drinks during sporting activities.
 
Research is ongoing into how drinks can provide optimal benefit while minimizing potential health risks. However, the use of both recovery and energy drinks is more often driven by advertising than science. Athletes and the general public should use caution when interpreting claims about the advantages of specific drinks. Nevertheless, commercial sports drinks as well as chocolate milk can be a healthy, helpful addition to speed recovery and improve performance..

Shin splints are an extremely common ailment in runners. Other common names are soleus syndrome  and tibial periostitis, but the proper medical terminology is medial tibial stress syndrome. As this name suggests, this condition involves overload (stress) of the medial (inner border) part of the tibia (shin bone).
 
This overuse condition is usually associated with abrupt changes in training routines. The bone  experiences increased stresses and begins to remodel to adapt to this environment but often needs more time to adapt than the runner allows.
 
Runners with suspected shin splints should seek an evaluation by a sports medicine professional to rule out other diagnoses such as a stress fracture, posterior tibial tendon disease, and exercise-induced  exertional compartment syndrome.
 
The diagnosis is typically made by physical examination, with tenderness along the inside area of the leg. Plain X-rays usually do not show any changes. Advanced imaging, such as bone scan and MRI can sometimes be performed and help confirm the diagnosis, but is usually not necessary.
 
The mainstay of treatment is rest (or a change in training, such as cross training) to allow the tibial bone to heal. Other treatments that may help include:
 

• • Orthotics (specifically those with arch support)
• • Non-steroidal anti-inflammatory drugs
• • Ice
• • Neoprene sleeves

 
However, there is no clear evidence that any of these have significant benefit besides rest. To help avoid  shin splints, runners should be vigilant in allowing adequate time to increase training demands, as well as run in a properly-fitted, well-cushioned running shoe. So, keep on running and don’t let your shins slow you down..

We form some of our earliest athletic experiences on playgrounds and on the blacktop. Unfortunately injuries occur with some frequency in these areas. The key to stopping some of the 250,000 annual playground injuries in the United States is prevention. Monkey bars, swings, and slides account for the majority of injuries, with monkey bars causing more than 75,000 doctor’s visits annually and swings and slides causing around 50,000 injuries each. Here’s a few tips to help prevent a trip to the emergency room:
 
• Pay attention to the equipment, age, and activities of other children and general condition of the playground. Often it is not only the equipment, but a child’s behavior or actions that lead to injury.
 
• Look for loose, damaged, or missing supports, and exposed anchors, footings, nuts, bolts, or other connectors.
 
• Keep an eye out for bending, warping, rusting, or breakage of any components, or sharp edges due to wear or breakage.
 
• Clean up trash in the area (particularly glass or cans); don’t allow play around environmental hazards such as roots, rocks, or poor drainage areas.
 
• Keep your child on age-appropriate and height appropriate equipment.
 
• Utilize playgrounds that have surfaces constructed from appropriate softer material such as rubber or loose fill, such as double-shredded bark mulch, engineered wood fibers, sand, and fine or medium gravel of suitable depth. Unsuitable surfaces include asphalt, concrete, soil, packed dirt, grass, and turf.
 
• Don’t allow children under 3 to ride on slides in someone else’s lap. Their legs can get caught and twisted leading to lower leg fractures.
 
• Look for playgrounds with areas for active play such as swings separated from areas for quiet play like sandboxes. Play areas for preschoolers and older children should be kept apart as well.
 
• Make sure you can see your child at all times.
 
• Look for a barrier around the playground to prevent children from running into a street, especially near basketball or other ball courts.
 
• Ensure the landing area at the bottom of a slide or the area immediately surrounding a merry-go-round is free from other children.
 
Schools and cities should keep playgrounds in good condition by inspecting and maintaining the equipment throughout the year. Heavy rainfall, snow, extreme temperatures, and high winds can damage playground equipment. Heavy use can also cause equipment to wear out quickly. If you find a particular hazard, let the group responsible for the playground know as soon as possible! Most importantly, play safe and have fun!.

Shoulder injuries are commonly encountered by athletes who perform frequent overhead or throwing motions such as divers, basketball players, or pitchers. One of the most common shoulder injuries is a SLAP (superior labrum anterior to posterior) tear or injury to the area that encircles the shoulder socket, and serves as the attachment site for the ligaments that stabilizes the shoulder, as well as the biceps.
 
SLAP tears can have a wide array of symptoms which makes diagnosis difficult at times. Some common symptoms are:
• Deep seated shoulder pain with activity
• Clicking, catching, or popping of the shoulder
• The feeling of the shoulder “slipping”
• Stabbing-type pain with lifting objects
• Shoulder weakness
• Pain or loss of velocity during throwing
 
If a SLAP tear is considered following an appropriate history and physical, advanced imaging is often the next step. Plain X-rays are typically normal. MRI with contrast dye placed into the joint (MR arthrogram) has been shown to be more accurate in the diagnosis of a SLAP tear.
 
The treatment of a SLAP tear depends on a variety of factors. Often, a trial of non-operative treatment is the first step, including rest, anti-inflammatories, activity modification, and physical therapy. In throwers, a complete 6-week rest period along with physical therapy, followed by a graduated throwing program is typically undertaken. Occasionally, a cortisone injection may be utilized to minimize pain.
 
In situations where non-operative options don’t work, arthroscopic surgical options can be used. Arthroscopic SLAP repair can be performed with a few small incisions and minimal soft-tissue trauma. Complications from this procedure are rare, but include infection, bleeding, injuries to vital structures, and failure of repair.
 
Post-operatively, patients are often in a sling for up to six weeks. Physical therapy is started early on. The focus of therapy includes normalizing range of motion and strength while protecting the repair. Return to sports or a throwing program is typically around 4–6 months.
 
Outcomes from isolated SLAP repairs are often very good. Outcomes are worse with a simultaneous injury, especially one of the rotator cuff. Most studies report improvement in pain and function following SLAP repairs, with greater than 80 percent of throwing athletes returning to their previous level of activities. Older age has been associated with worse outcomes following repair.
 
In conclusion, SLAP tears are a common injury in athletes. Treatment usually is non-operative at first. Outcomes following arthroscopic surgery are often very good, but worse with older age. Return to sport following repair is typically 4–6 months..