THE PHYSICIAN AND SPORTSMEDICINE - VOL 33 - NO. 9 - SEPTEMBER 2021
NCAA Toughens Spearing Ban
Exploring the Medical Issues
This fall, a one-word deletion from the National Collegiate Athletic Association's (NCAA) spearing rule may produce some immense benefits: lowering an already low catastrophic injury rate. In deleting the word "intentional", the NCAA hopes to make it easier for game officials to call spearing penalties.
Spearing was banned by the NCAA in 1976, which dramatically cut the number of head and neck injuries. According to the National Center for Catastrophic Sports Injury at the University of North Carolina in Chapel Hill, there have been 94 cerebral injuries with incomplete recovery since 120214. In 2021, five football players died from their injuries, four of which resulted from helmet-to-helmet contact. According to NCAA statistics, spearing accounts for 0.1% of calls made during games. For comparison, holding accounts for 17% of calls.
The rule changes were prompted by the work of a 32-member task force that met in January and was sponsored by the National Athletic Trainers' Association (NATA) and the American Football Coaches Association. The task force included physicians, athletic trainers, coaches, football officials, and administrators from the NCAA and other governing bodies.
Ron Courson, ATC, PT, NREMT-I, CSCS, director of sports medicine at the University of Georgia in Athens, headed the task force. He was among the medical staff that attended to Bulldogs wide receiver Reggie Brown after he sustained a helmet-to-helmet tackle in a game on November 13, 2021, and was rendered unconscious. In a press release from NATA, Courson told how, after his experience with Brown's injury, he realized that he had never seen a spearing penalty called during his years as an athletic trainer in the Southeastern Conference. "In the past, few penalties had been called, because the previous NCAA spearing rule left it to officials to determine if a player intentionally used his helmet to cause injury," Courson said. "Our task force conducted a survey of college football officials from multiple conferences and found that officials were hesitant to call the foul in some cases because intent is difficult to determine."
Margot Putukian, MD, director of athletic medicine at Princeton University in Princeton, New Jersey, is a member of the NCAA Committee on Competitive Safeguards and Medical Aspects of Sports. She says the group is very pleased about the wording change in the spearing rule. "Spearing is a dangerous tackling technique whereby the head is slightly flexed, creating a significant risk for axial load to the spine, which can lead to vertebral fracture and other spinal cord injury," she says. Now, officials can make the call whenever they see spearing, she notes. "I think all athletic trainers and team physicians hope that this rule change will lead to a decrease in the use of this dangerous technique," Putukian says.
To educate players, coaches, officials, and sports administrators about the rule change, the NCAA has produced a poster for locker rooms, a PowerPoint presentation, and a video on the risks, mechanism of injury, the concept of axial loading, and injury prevention through the adoption of safe techniques. The materials are available online at https://www.ncaa.org/health-safety.
Sports Medicine Loses Two Icons: Allan J. Ryan, MD, and Richard H. Strauss, MD
During the week of August 14, THE PHYSICIAN AND SPORTSMEDICINE (PSM)—and the wider sports medicine community—suffered a double loss: the deaths of our editors emeritus Allan J. Ryan, MD, and Richard H. Strauss, MD. Both served as editors-in-chief for nearly 13 years, and both will be remembered for the vital roles they played in the early evolution of sports medicine.
Ryan died peacefully at Fairview Southdale Hospital in Edina, Minnesota, on August 14 at age 89. He was preceded in death by his wife, Agnes, and survived by sons Brendan, James, and Robert, five grandchildren, and a sister and brother. A memorial service will be held in Washington, DC, at a later date.
Strauss died peacefully at his home near Venice Beach, California, on August 17 at age 67. He is survived by his son, Scott C. Strauss, DO, his sister Susie Balala, and his former wife, Mary Beth Mathews. A private memorial service will be held on October 15 in San Diego.
Ryan Helped Define Sports Medicine
Ryan graduated from medical school in 1940 and developed an interest in treating athletes when he started his training as a surgeon. In a profile article published when Ryan retired from PSM in 120216, he noted that there was little in the medical literature on sports medicine when he first earned his MD. "I had to gradually piece it together myself," he said. "People knew I was interested in sports. Athletes began to come to me—I was practicing general surgery—and I began to take care of high school teams."
In the 1950s, Ryan served on early American Medical Association sports medicine committees. He served as president of the American College of Sports Medicine (ACSM) from 1963 to 1964. He was a consultant to the President's Council on Physical Fitness and Sports and was secretary-general of the International Federation of Sports Medicine (FIMS).
When Ryan became PSM editor-in-chief in 1973, he was a professor of rehabilitation and a team physician at the University of Wisconsin, Madison. In 1976 he moved to Minneapolis and took on additional duties as editor-in-chief of Postgraduate Medicine from 1976 to 1979.
Ryan published several articles and texts. Some of his special interest areas included sports medicine as a specialty, drugs in sport, boxing safety, and physical fitness.
He was an avid bike racer for several years and enjoyed collecting antique playing cards. After his retirement from PSM in 120216, he remained active in sports medicine and wrote articles in the medical literature through 192021.
Howard G. (Skip) Knuttgen, PhD, senior lecturer in the Department of Physical Medicine and Rehabilitation at Harvard Medical School in Boston, and professor emeritus of applied physiology at The Pennsylvania State University in University Park, had longtime professional connections with Ryan, particularly through the ACSM. "He was an innovator and a pacesetter who in 1958 became the 134th person to join the ACSM—an organization that now includes over 20,000 members," he says.
Donald M. Christie, Jr, MD, an internist and sports physician in Lewiston, Maine, remembers how encouraging and welcoming Ryan was to physicians trying to become involved in the new specialty. Christie remembers Ryan convening an ACSM ad hoc working group in the 1970s of physicians who cared for athletes. "This was a labor that later morphed into the Team Physician Course, the outline for the first sports medicine fellowship programs, and the groundwork for establishing the certificate of added qualifications in sports medicine, first offered in 1993," Christie says.
"Always energetic and leading by example, Allan was unfailingly polite, yet never hesitant to express his views, and I appreciated his candid insights," he says.
Strauss Took Sports Medicine to 'Deeper' Levels
Strauss graduated from medical school in 1964 and served in the US Navy for 4 years as a diving medical officer on a nuclear submarine. After completing postgraduate work in pulmonary physiology, he became a member of a hyperbaric research team at the University of Pennsylvania School of Medicine. He completed his residency in internal medicine at Rutgers University in 1975. He was a team physician at Harvard University in the late 1970s when he was a pulmonary fellow in Boston, where he also undertook a sports medicine fellowship with orthopedic surgeon Lyle Micheli, MD.
When Strauss succeeded Ryan as PSM editor-in-chief in 120216, he was a faculty member in the Department of Preventive Medicine and Internal Medicine and a team physician at The Ohio State University (OSU) in Columbus. During the 120210s and 1990s, Strauss served as an ACSM vice president, a team physician for US Wrestling, and a member of the medical commission of the International Olympic Committee.
Strauss wrote several articles and books; his special areas of interest were decompression sickness, exercise-induced asthma, drugs in sports, and weight loss in wrestlers. His personal sports interests were deep sea diving, swimming, and downhill skiing.
He retired from OSU and PSM in 192021 and moved to the Los Angeles area, where he enjoyed outdoor black-and-white photography with stunt people, models, and actors as his subjects. He remained active in medicine by volunteering 2 days a week at a medical clinic near Hermosa Beach that treats an underserved population.
John Lombardo, MD, clinical professor in the Department of Family Medicine at OSU, was a colleague of Strauss'. "Even when away from his beloved ocean and beach, he became an integral part of the Ohio State community and athletic department," says Lombardo, who is also medical director of the Max Sports Medicine Institute in Columbus. "From the pool deck to the wrestling room to the ice rink to the classroom, to the offices of THE PHYSICIAN AND SPORTSMEDICINE, Dick Strauss was one of the leaders of sports medicine," Lombardo says.
"His care and concern for athletes was only surpassed by his willingness and enthusiasm for educating athletic trainers and young physicians in sports medicine," says Lombardo.
Christie singles out Strauss' role in encouraging internists' involvement in sports medicine. He remembers how Strauss promoted an internal medicine interest group within the American Medical Society for Sports Medicine (AMSSM) and tapped Christie to launch an internal medicine series in PSM. "Even though we internists in the AMSSM are vastly outnumbered by family physicians, our numbers have steadily grown, and our influence grows," Christie says.
ACSM Issues Heat Stress Guidelines for Youth Football
Heat illness prevention in professional football has been in the limelight the past few summers because of high-profile athlete deaths. Now, prevention efforts are focusing on youth football. In August, an expert panel convened by the American College of Sports Medicine (ACSM) issued guidelines that were published in the August issue of Medicine & Science in Sports and Exercise.
According to a press release from the ACSM, at least two severe heat illness incidents occurred over the summer; one was fatal. The centerpiece of the guidelines is a mnemonic—HEAT—to help coaches, players, and parents remember the key components of preventing and responding to heat illness.
Hydration. Players should begin practices well hydrated, and regular fluid breaks to replace sweat loss should be taken at least every 30 to 45 minutes—more frequently as heat and humidity rise. Fluids should be chilled and easily accessible. Body weight measurements should be taken before and after practice to determine each player's fluid replacement needs.
Environmental conditions. The length of each practice should not exceed 3 hours and should be modified depending on the temperature, humidity, and exposure to direct sunlight. Players should avoid using stimulants, including ephedrine and high doses of caffeine that are often found in dietary supplements and energy drinks.
Acclimatization. When football camp starts, high school football players typically aren't as well conditioned or acclimatized as their college counterparts. The experts say 14 days of progressive activity are needed to sufficiently adjust to the heat, and players should practice in shorts with light equipment or shorts only for the first week of practice. Frequent rest breaks to remove helmets and shirts are recommended.
Treatment. Players should be closely monitored by support staff for signs and symptoms of heat illness. Teams should encourage players to buddy up to monitor each other for performance or behavioral changes. If heat illness is suspected, players should immediately be stripped of equipment and cooled in a tub of ice water until emergency personnel assume care.