Overhydration potentially deadly for athletes

New guidelines: Athletes should drink only when thirsty

While the risks of dehydration are well known, new international guidelines seek to protect athletes from the serious health risks associated with drinking too many fluids while exercising. Read more here:




Madden leads theme issue and podcast addressing the Preparticpation Evaluation of the Wilderness Athlete and Adventurer in September Clinical Journal of Sports Medicine

Over the past several decades, wilderness, adventure, endurance, and extreme events have seen a surge in popularity both in the United States and around the world, with increasing number of events and participants each year. Events often occur at environmental extremes involving hot and cold climates, variable weather, water conditions, and high altitude. Events are becoming increasingly more challenging and involve remote locations that increase the potential for injury, illness, and worsening of existing medical conditions. Wilderness sports and adventures combine the traditional risks of physical activity and exertion with the remoteness and exposure associated with backcountry environments.

The purpose of this Wilderness Medical Society–American Medical Society for Sports Medicine (WMS-AMSSM) collaboration is to outline an appropriate process for evaluation of wilderness athletes and adventurers, to factor comorbidities and unique event and environment demands into the preparticipation evaluation (PPE), and to advise on education, prevention, and training specific to these unique individuals.

A discussion focused on evaluation rather than “clearance” for sport in the typical PPE fashion, and important issues such as risk assessment and tolerance consultation as well as shared decision making are reviewed.

See more at: http://journals.lww.com/cjsportsmed/toc/2015/09000

#MountainBiking Injuries lecture presented by Madden at #ACSM in San Diego

Chris Madden, MD of #LongsPeak #SportsMedicine presented the #AMSSM 2015 Exchange Lecture on Friday, May 29 at the #ACSM Annual Meeting in San Diego, California. The Immediate Past President of AMSSM is invited to present the exchange lecture yearly at the ACSM Annual Meeting, part of an ongoing exchange between AMSSM and ACSM. This year, Madden discussed the unique challenges and limitations facing the mountain biking medical literature, reviewed what studies have adequately addressed, identified the many areas where evidence is lacking, and filled in the gaps with expert and anecdotal experience regarding mountain biking injuries. Injuries were broken down into three categories: acute traumatic, overuse, and environment-related. Each area was discussed in relation to both the rider and the bike, both important considerations when addressing injury causes, treatment, and prevention. Madden also authors a chapter on the topic in a book he co-edits and authors various chapters in, #NetterSportsMedicine, which is the most comprehensive piece of literature addressing #mountainbiking injuries to date. Madden is an avid mountain biker and enjoys working with many fellow mountain bikers in his practice, #LongsPeakSportsMedicine. However, he much prefers to ride trails than lecture and author chapters about the sport!

Popular sports text – Madden to do 2nd edition

Netter Sports Medicine, a popular sports medicine text used widely by sports medicine professionals and in fellowship training, both nationally and internationally, will hit the shelves and electronic world with an exciting second edition, likely in fall 2016.

Madden and the other co-editors work closely with national and international leaders and authors  in sports medicine to produce the quality clinical ready reference that is complimented by a broad collection of Netter anatomical graphics. Trained as a surgeon, Frank Netter was one of the top human anatomy artists in the history of medicine. The new text will have various other graphics and tables, expanded online content, new and updated chapters, and online video.

Two more  #LongsPeak #Sports Medicine physicians will be on board as authors. Eric Traister will lead a new chapter on ultimate frisbee, and Rebecca Myers will take over the Taping and Bracing chapter and become a co-author on the Snowboarding chapter. In addition to editing the text, Madden will be involved with chapters on mountain biking, cold injuries & illnesses, the team physician, and preparticipation evaluation of athletes.


Chris Madden of #LongsPeak #SportsMedicine was recently quoted in the #WallStreetJournal addressing #ECGscreening in athletes: http://www.wsj.com/articles/ncaa-doctor-backs-off-recommending-heart-tests-for-athletes-1429291801#livefyre-comment


Madden likes to listen to both sides of the argument on screening, but ultimately feels that patients and athletes should be involved in the decision making. Embracing a term called “shared decision making,” Madden works toward this in his practice in Longmont, Colorado. Shared decision making (SDM) is a collaborative process that allows patients and their providers to make health care decisions together, taking into account the best scientific evidence available, as well as the patient’s values and preferences.

Madden also points out, “I practiced before health care reform (renamed “transformation” to avoid the negative tone) and managed care labeled and is trying to re-brand and monitor much of what quality physicians were already doing. We learn to speak the “modern” language (e.g., SDM) for our practices to survive. To this day our practice has avoided a high volume model that leaves little time for patients. I teach the motto: Would you rather see more patients with less patience, or fewer patients with more patience? Which do you think leads to higher quality care and patient satisfaction? There are ways to do both, yet much of the US healthcare system embraces the former.

In an online forum following the article, Madden explains:

“For a screening test to be effective, it needs be able to reduce morbidity and mortality through early disease detection, AND early disease detection needs to lower risk and not cause harm. That is where it becomes complicated with ECG, especially when entertained universally for athletes.

Even if sudden cardiac death occurs more frequently (incidence) than previously estimated, and even if ECG may be able to identify some of the athletes at risk, the number of athletes that would be needed to be screened (NNS) is still extremely large to prevent a single fatality. And athletes who may never have a problem may face difficult decisions about continuing sport.

If data was statistically significant, the number of athletes in this HIGH RISK subset would still have to be 8500 to identify a single ECG abnormality that may prevent sudden cardiac death. And I say “may” because what we are doing is simply identifying those at risk, but we have no way to know how the disease will behave over time (natural history) or if it would have ever manifested as sudden cardiac death.

Now think of how many asymptomatic athletes you would have to screen with a universal recommendation in the lower risk population where the incidence is 1:40,000!

I know this is a difficult topic to grasp for many, and there is much debate within our own organization about it.

I would offer the there is new data that may support that ECG screening in a select population of high risk athletes (collegiate basketball players) may reduce the risk of sudden cardiac death. But that is a very different issue than universal ECG screening in all asymptomatic athletes, where the incidence of disease is still so low that universal screening will likely yield far more false positives that may cost athletes their careers or mental health because they are disqualified from something they love (that is the harm).

If you look at the numbers – they illustrate the answer to the questions:-even if the higher incidence of SCD in male collegiate basketball players is 1:7000 which some new studies show, ECG would still have to be performed on ~90,000 athletes to reach statistically significant data that would support screening!”

Madden feels it is important for both athletes/patients and physicians to understand what we know and what we don’t know to be able to make meaningful, quality, individualized decisions together.

Rebecca Myers of #LongsPeak #SportsMedicine brings the 24th #AMSSM Annual Meeting to a close last Sunday while moderating a thought-provoking session titled, #Return to Play: What is the Evidence?

Hosting nationally prominent Team Physicians and leaders in US #SportsMedicine, Myers mediated topics in athletes such as blood clots, challenging fractures, missing an organ or body part, heart abnormalities, spinal cord injuries, abdominal trauma, pregnancy in sports, high blood pressure, how certain antibiotics affect tendons, compartment syndrome, and entrapment of arteries.

Return to play or activity decisions are often difficult to make, and it is important that athletes and active individuals work closely with their physicians to discuss the best scientific evidence available while taking into consideration patient values, risk tolerance, and preferences. In many areas, evidence for what we do in medicine is still lacking, which can make decisions more challenging.

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