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COACHING THE ATHLETE WITH SICKLE CELL TRAIT

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Sickle Cell Trait In Athletes REAL LIFE A Common Sense Approach Chris A. Gillespie, MEd, ATC, LAT THE FACTS Since 2000 exertional sickling is the leading ... – PowerPoint PPT presentation

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Title: COACHING THE ATHLETE WITH SICKLE CELL TRAIT


1
Sickle Cell Trait In AthletesREAL LIFEA
Common Sense Approach
Chris A. Gillespie, MEd, ATC, LAT
2
THE FACTS
  • Since 2000 exertional sickling is the leading
    cause of non-traumatic death in NCAA Football
    All Divisions.
  • In FBS --- if you add heat, heart, and asthma ---
    Combined, match the total dead from sickling.  
  • In the last 12 years there have been NO traumatic
    deaths in FBS no catastrophic head injury no
    catastrophic neck injury no comotio cordis. 
    (although three deaths in non FBS schools One
    cardiac non-trauma related AND two head injury
    related)
  • Not one single FBS football player in the last
    12 years has died playing football.  
  • Not one single FBS football player in the last
    12 years has died practicing football. 
  • They have ALL died PREPARING to play football 4
    in winter workouts, 4 in summer workouts, and 2
    in September conditioning drills ALL in
    STRENGTH/CONDITIONING SESSIONS!

3
NOT JUST COLLEGE or FOOTBALL
  • 2000 - 12 y/o male football, conditioning, Ohio
  • 2002 - 14 y/o female basketball, conditioning,
    Texas
  • 2004 - 15 y/o male football, pre-season practice,
    Texas
  • 2006 - 12 y/o male football, conditioning,
    Florida
  • 2009 - 16 y/o male football, conditioning,
    Maryland
  • 2010 - 15 y/o male football, pre-season practice,
    Florida
  • 2011 - 14 y/o male football, conditioning, South
    Carolina
  • 15 y/o male football, conditioning, Texas
  • 16 y/o male football, conditioning, Florida

4
HIGH SCHOOL FOOTBALL 2011
  • 7 non-traumatic practice deaths
  • 5 were African-American
  • 3 deaths attributed to exertional sickling
  • 4th is suspected exertional sickling
  • 60-80 of African-American high school football
    players who collapsed and died in summer
    practices had SCT/sickling as a COD

5
Case Study
  • 1990 football season
  • 19 year old black male football player
  • Collapsed after running one and one half mile
    distance run
  • Complained of leg pain and mid low back ache
  • Sickle cell crisis with acute exercise related
    rhabdomyolysis
  • Increased Creatine Kinase level (CK)

6
Rhabdomyolysis
Definition A disorder involving injury to the
kidney caused by toxic effects of the contents of
muscle cells.
7
Rhabdomyolysis
Causes Incidence Myoglobin is an oxygen binding
protein pigment found in skeletal muscle. When
skeletal muscle is damaged, myoglobin is released
into the bloodstream. It is filtered out of the
bloodstream by the kidneys. Myoglobin may
occlude the structures of the kidney, causing
damage such as acute tubular necrosis or kidney
failure. Myoglobin breaks down into potentially
toxic compounds, which will also cause kidney
failure. Necrotic (dead tissue) skeletal muscle
may cause massive fluid shifts from the
bloodstream into the muscle, reducing the
relative fluid volume of the body and leading to
shock and reduced blood flow to the kidneys.
8
Creatine Kinase (CK)orCreatine Photokinase (CPK)
An enzyme found predominantly in the heart,
brain, and skeletal muscle. When the total CPK
level is substantially elevated, it usually
indicates injury or stress to one or more of
these areas.
9
Normal Creatine Kinase (CK) Values
Male 38 - 174 units/L
Female 96 140 units/L
10
CK Levels
A high CK, or one that goes up from the first to
the second or later samples, generally
indicates that there has been some damage to the
heart or other muscle. It can
also indicate that your muscles have experienced
heavy use.
11
CK Levels
People who have greater muscle mass have higher
CK levels than those who dont,
and African-Americans may have higher CK levels
than other ethnic groups. Very heavy exercise
(such as in weight lifting, contact sports, or
long exercise sessions) can also increase CK.
12
What is Sickle Cell Trait?
  • Not itself a disease
  • Hereditary condition
  • One abnormal gene for hemoglobin (S)
  • Genetic type AS
  • Sickle Cell Anemia Disease is SS

13
Who has Sickle Cell Trait?
  • About 8-10 of the U.S. black population has
    sickle cell trait
  • Only about 1 have the disease
  • SCT is also found in non-blacks as well, but less
    frequently

14
For Many YearsAthletic Organizations
  • Characterized SCT as a benign condition that does
    not affect the longevity of the individual

15
Genetics
Education is the Key
16
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17
Testing for Sickle Cell Trait?
  • Simple blood test
  • Mandatory vs. voluntary (changes)
  • What do we do if the test is positive?
  • Genetic Counseling
  • Health care issues
  • Work-out adaptation

18
Sickle Cell Trait Medical Problems
  • Inability to concentrate urine normally
  • Blood in the urine
  • Spleen problems especially at high altitudes
  • Exercise related rhabdomyolysis
  • Exercise associated sudden death

19
Warning Signs
  • Leg pain
  • Back pain
  • Hematuria
  • Dehydration
  • Fatigue
  • A positive SCT test
  • When in doubt..

20
Crisis Time is of the Essence!
  • Must seek timely and appropriate medical care for
    the athlete who is potentially suffering from
    sickle cell crisis.This is a TRUE medical
    emergency !

21
Proper Hydration Hot Weather
  • Avoid dehydration
  • Acclimatization is key
  • Condition before athletic bouts begin
  • Do not exercise in a dehydrated state or during
    acute illness
  • Drink fluids all day
  • Know your athletes

22
Exercise and Work-Out Routine
  • CONTROVERSIAL
  • No running over 100 yards at any time!
  • Increased rest periods between bouts of exercise
  • Unlimited hydration before, during, and after
    exercise
  • Performance levels increase with these changes

23
Precautions per the Inter-Association Consensus
Statement
  • Exclude from Day-1 conditioning tests
  • Slow, paced progressions of training
  • Allowing longer periods of rest and recovery
    between repetitions
  • Heat stress, dehydration, asthma, illness, and
    altitude create additional risk
  • Stop activity with onset of symptoms
  • Set a tone that encourages consideration for the
    athlete with sickle cell trait

24
Selectively Opting Out of Sports
  • All SCT positive athletes at Samford University
    since 1990 have been football players
  • In interviews with these athletes, we have
    hypothesized that athletes choose sports where
    they will excel
  • Athletes with SCT most likely cannot excel in
    sports with high aerobic demand so they opt out
    of these sports at an early age

25
Medical History Questions
  • Do any of your close relatives suffer from SCD or
    SCT?
  • Have you ever been tested for SCT?
  • If yes, was the test positive?
  • If yes, what have you done differently?
  • Do you fatigue more than your peers in aerobic
    related activities?
  • If yes, explain?
  • Have you ever selectively opted out of a sport or
    activity because of fatigue?
  • If yes, explain why and list the types of
    symptoms that you have had during these
    situations.

26
CONCLUSION
  • Most of the studies in this area have been done
    in the military setting
  • Most of the knowledge that we have gained in
    athletics is gained from anecdotal information
  • More studies regarding the risk involved in
    athletics must be done
  • An Inter-Associational SCT Task Force met in
    February 2007 to discuss ways to prevent the
    senseless deaths of athletes with Sickle Cell
    Trait. As a result the NCAA took some corrective
    action but its not enough!

27
THE FACTS
  • Since 2000 exertional sickling is the leading
    cause of non-traumatic death in NCAA Football
    All Divisions.
  • In FBS --- if you add heat, heart, and asthma ---
    Combined, match the total dead from sickling.  
  • In the last 12 years there have been NO traumatic
    deaths in FBS no catastrophic head injury no
    catastrophic neck injury no comotio cordis. 
    (although three deaths in non FBS schools One
    cardiac non-trauma related AND two head injury
    related)
  • Not one single FBS football player in the last
    12 years has died playing football.  
  • Not one single FBS football player in the last
    12 years has died practicing football. 
  • They have ALL died PREPARING to play football 4
    in winter workouts, 4 in summer workouts, and 2
    in September conditioning drills ALL in
    STRENGTH/CONDITIONING SESSIONS!

28
Thank Youfor yourtime attention!
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