We asked physicians and trainers who have covered United States athletes at past Winter Olympics games to do a mental instant replay of their experience and share some tips for treating or preventing winter sports injuries. The lessons they learned with elite athletes are equally relevant for everyday athletes who pursue winter sports or who exercise outdoors in forbiddingly cold conditions.
Take Arms Against Asthma
When examining young athletes who have exercise-induced bronchospasm (EIB), I am often reminded of my experience as a team physician for the Winter Games in Sarajevo, Yugoslavia, in 1984. At that time, we weren't completely aware of all the ins and outs of treating patients with EIB and the need to take preventive measures. Sarajevo, with its coal-fed steam heating systems, tremendous environmental pollution, and subzero dry air, put several of our athletes at risk. At least three Americans had trouble, and one who seemed destined to medal failed because of persistent bronchospasm.
Our experience with EIB in Sarajevo was one of the things that prompted the United States Olympic Committee medical staff, in conjunction with the American Academy of Allergy and Immunology, to test all US athletes before they competed in the 1984 Summer Olympic Games in Los Angeles.
How important was testing? Eleven percent (67) of the athletes were at risk. They received prophylactic treatment and won 47 medals (15 gold, 21 silver, and 5 bronze).
Remember that the No. 1 inciting factor in asthma and EIB is cold, dry air. Cromolyn and nedocromil work well prophylactically. Two albuterol puffs 10 minutes before exercise are a great preventive. If athletes forget to take their medications or start to cough or wheeze before an event, albuterol is very effective in managing EIB, and it works fast with an almost instant onset of action. Nedocromil works well also, but the onset of action is somewhat slower. Use a spacer with nedocromil, or give orange juice before and after to minimize the unpleasant taste.
Let's bring home the gold!
Robert O. Voy, MD
Nosebleeds are a common and recurring problem during the winter because of dry air.
The quickest way to stop a nosebleed is to soak a cotton pledget with Afrin (oxymetazoline hydrochloride) nasal spray, gently insert it into the nose, and apply steady pressure to the nose with the thumb and forefinger. This will stop most nosebleeds in short order.
To prevent bleeding and rebleeding, I recommend keeping the nostrils moist by applying petroleum jelly in the morning and at bedtime. During the rest of the day, I suggest spraying the nostrils with an over-the-counter or homemade saline solution. To make your own saline solution, mix 1/4 tsp of salt in 4 oz of warm water. (This solution is also a good sore throat gargle.)
Ron Grossman, MD
An Icing Strategy for Thigh Bruises
One of the most common injuries in ice hockey and in all contact and collision sports is an anterior thigh contusion. These injuries usually result form a direct blow from an opponent's knee.
Proper initial treatment can dramatically decrease the residual loss of range of motion and strength in the quadriceps muscle. The key to initial management is to ice the contusion with the knee on the involved side flexed as far as is comfortable. Ice the area for 15 to 20 minutes each session about every 2 hours for the first 24 hours. Icing during the quadriceps stretch helps maintain as much range of motion as possible; athletes regain full range of motion and strength much sooner this way than if the muscle is iced in the straight-leg position.
After full range of motion and strength have been regained, the athlete returning to play should protect the area from reinjury and the development of myositis ossificans by wearing additional padding over the injured thigh.
Michael Johnson, MA, ATC
Conditioning Tips for Winter Sports
Winter sports such as ice skating, hockey, and Alpine skiing may produce strength imbalances in the quadriceps and gluteus muscles that can cause overuse problems of the lower extremities.
Conditioning exercises that work the hip flexors and hamstrings, a stretching program that focuses on the psoas and adductor muscles, and strengthening of the internal and external obliques provide balanced conditioning for winter sports. Doing crunches and back flexibility-extension exercises is helpful. Cross-training for skiing is best done with stationary cycling and stair climber workouts rather than with wall sits.
James B. Montgomery, MD
When participating in vigorous aerobic exercise outdoors in the cold, one of the most common medical problems is frostbite. Skin can easily be damaged because of wind chill, skin wetness, and depletion of glycogen and fluids.
I advise patients to exercise with a buddy and check their partner's earlobes and nose tip frequently. These are the most common sites of asymptomatic injury. As soon as white or blanched areas appear, people should stop exercise, go inside, and get warm. Otherwise, their outdoor exercise could be curtailed for several weeks while the skin heals.
Barry Mink, MD
Take a Hot Chocolate Break
Skiers should know that a majority of injuries occur in the afternoon when the snow conditions change and when fatigue sets in. Therefore, my best advice for avoiding ski injuries is to stop for a midafternoon cup of hot chocolate and get off the hill if you're tired or if snow conditions are bad.
James B. Montgomery, MD
Rule of Threes For Those Who Ski
In more than 12 years of doing ski-slope medicine and surgery, my philosophy has been that skiers can prevent injuries. To help them do so, I've developed a rule of threes for patients who are bound for ski vacations:
John A. Feagin, MD
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