Play Safe Health Concerns for Young Athletes: Presented by the NFL Youth Football Health and Safety...

8/6/2019 Play Safe Health Concerns for Young Athletes: Presented by the NFL Youth Football Health and Safety Series

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Health Concerns Forealth Concerns ForYoung Athletes 4b o o k F O U R

Play Safe series produced inpartnership with:

American College of Sports Medicine401 West MichiganIndianapolis, Indiana 46202

American Red Cross8111 Gatehouse RoadFalls Church, Virginia 22042

National Athletic Trainers Association (NATA)2592 Stemmons FreewayDallas, Texas 75247

The Institute for the Study of Youth SportsMichigan State UniversityEast Lansing, Michigan 4882

NFL Players Association2021 L Street N.W., Suite 600

Washington, D.C. 20036

National Football League280 Park AvenueNew York, New York 10017(212) 450-2000

Internet: www.NFL.com / AOL Keyword: NFL.comwww.NFLHS.com

2003 National Football League. All rights reserved.

Series Editor: Barry Goldberg, M.D.

Series Consultants: Elliott Hershman, M.D.; Elliot Pellman, M.D.

NFL Project Editor: Jim Natal

Graphic Design: Morrissey Gage

Cover photo by Peter Newcomb


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CHARACTERISTICS OF A SUCCESSFUL YOUTH FOOTBALL PROGRAMFROM THE SERIES EDITOR

Football is Americas passion, so it is not surprisingthat football is the number-one high school partici-patory sport among boys. And increasingly, girls areenjoying the game.

For youth, high school, and college players, it is agame loved for its challenge and competition.Parents watch their children play, and coaches helpteach the game. But no matter the level of involve-ment, all agree that football must be played safely.

The NFL and the NFL Players Association havedeveloped this Youth Football Health and Safetyseries to promote the awareness of health issuesrelated to sports participation and to maximize thesafety of young athletes. Play Safe! is a series offour books containing relevant and practical articles,along with instructional posters distributed toschool programs and youth football organizations.It is designed to help parents and coaches maximizethe benefits of football for young competitors whileminimizing the risks.

Four subject areas are discussed in this series:First Aid

Communication and Awareness

Strength and Conditioning

Health Concerns For Young AthletesRespectively, the information for this series isprovided by highly respected experts from:

The American Red Cross, The Institute for the Study of Youth Sports at

Michigan State University The National Athletic Trainers Association, and The American College of Sports Medicine.

In developing this program, the National FootballLeague and NFL Players Association are proud tohave enlisted the expertise of these four leadingorganizations in the field of health and medicine.For the first time, these nationally renowned organi-zations have pooled their knowledge and informa-tional resources to create an aggressive and excitingseries to help educate young football players,coaches, and parents on the subjects of health andsafety in football. The information will allow coach-es and parents to advise players how to Play Safe!as well as optimize their enjoyment and perform-ance.

Topics include important areas such as: immediaterecognition of injury and response to emergencies,psychological management, instructional tech-niques, training and conditioning techniques, andpregame meal preparation and proper nutrition.

All of us involved with this worthwhile projectappreciate the enthusiastic support and love of thegame expressed by its fans. We are committed toworking with our partners to ensure that youngfootball players continue to Play Safe!

Barry Goldberg,M.D.,series editorDr. Barry Goldberg is the Director of

Sports Medicine, Yale University

Health Service, and Clinical

Professor of Pediatrics,

Yale University School of Medicine.

Notice: Sports medicine is an ever-changing specialty. As research and clinical experience broadens, changesin the scope of information on medical treatment, conditioning, nutrition, etc. are always occurring. Theauthors, editors, and publishers of this publication have reviewed the presented information and feel it is inaccord with current standards at the time of publication. However, in view of the possibility of human erroror changes in the current informational standards, neither the authors, editors or publisher, or any party

who has been involved in the preparation of this publication warrants that the information contained hereinis in every respect accurate or complete, and they disclaim all responsibility for any errors or omissions orfor the results obtained from the information contained in this publication. Readers are encouraged toconfirm the information with other sources and remain aware of any future advances in sports medicine.


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From the American College of Sports Medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4

Nutrition For Sport . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5

Nutrition For Optimal Performance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6Vitamin and Mineral Supplements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8

Vegetarian and Fad Diets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10

Heat and Hydration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12

Pregame Meals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14

Weight Loss In Youth athletes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16

Youth Athletes and Weight Gain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18

Substance Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20Substance Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21

Suspecting Drug Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23

Tobacco Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24

Dietary and Supplement Performance Enhancement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26

Anabolic-Androgenic Steroids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .29

Medical Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31Preparticipation Examinations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .32

Growth and Development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .33

Working With a Team Physician . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35

Working With an Athletic Trainer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .36Colds and Flu In Athletic Competition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .37

Blood-borne Pathogens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .39

Asthma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .40

Diabetic Athletes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .42

Understanding and Responding to Injuries . . . . . . . . . . . . . . . . . . . . . . .44Head Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45

Neck and Spine Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .47

Dental Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .50

Sprains and Strains . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .51

Common Knee Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .53

Foot and Ankle Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55

Common Shoulder Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .57

Common Elbow and Hand Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .59

Overtraining . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .61

Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .63

TABLE OF CONTENTS


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FROM THE AMERICAN COLLEGE OF SPORTS MEDICINE

Football participation can be a rewarding and charac-ter-building experience in a young persons life. It pro-vides opportunities for physical activity, learning newskills, understanding the fundamentals of the game,participating on a team, and working toward a com-mon goal. Likewise, there are many rewards in nur-turing young players. In short, the game is meant tobe fun for coaches and athletes alike.

In addition to the many teaching and leadershipresponsibilities entrusted to a youth football coach,the health and safety of every player should be a pri-ority. It is important to understand the risks of thegame, how to prevent injuries, and appropriate safe-ty responses to a variety of circumstances that canthreaten the health and safety of players. Youth foot-ball coaches must be keenly aware of special issuesrelated to growth, development, and maturation ofyoung athletes, which can have a long-lasting impacton their well being.

The four sections in this book provide a fundamen-tal overview of 29 critical areas of health and medi-cine in youth football. The key topic areas includeinformation on nutrition, substance abuse, injuries,and specific critical player health and safety issues allyouth football coaches need to know. The informa-

tion in these chapters is meant to be a resource tohelp educate coaches on appropriate preventionstrategies, action steps, and emergency reactions. Itis not intended that these resources replace the skillsand guidance of qualified medical personnel. It ishighly recommended that the coach of a youth foot-ball team seek ongoing volunteer support from aqualified physician with expertise in sports medicine.

The American College of Sports Medicine(ACSM), founded in 1954 and located inIndianapolis, is an association of more than 20,000international, national, and regional sports medicineprofessionals. Its mission is to promote and inte-grate scientific research, education, and practicalapplications of sports medicine and exercise scienceto maintain and enhance physical performance, fit-ness, health, and quality of life. ACSM membersare committed to the diagnosis, treatment, and pre-vention of sports-related injuries and the advance-ment of the science of exercise.

Acknowledgments:Several dedicated individuals have helped tobring this project to completion:

Writers and ReviewersKristin H. Norton, Ph.D., Principal WriterKristine S. L. Clark, Ph.D., R.D., FACSMJim Gleason, M.S.Gail N. HuntMelinda Manore, Ph.D., R.D., FACSMWilliam O. Roberts, M.D., FACSMGary I. Wadler, M.D., FACSM

ACSM StaffJames R. Whitehead, Executive Vice PresidentChrista DickeyJane Gleason Senior

Project EditorHarold W. Kohl, III, Ph.D., FACSM

P L E A S E V I S I T O U R W E B S I T E : W W W . A C S M . O R G .


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GO ONLINE AT WWW.NFLHS.COM/HEALTHMORE READING

Nutrition For Sport


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Muscle requires fuel, and the primary fuel for mus-cle involved in moderate to high-intensity exercise isderived from carbohydrates. When carbohydratesare ingested, they are broken down into glucoseand then converted to glycogen, which is, in part,stored in muscle. During exercise, glycogen is con-verted back into glucose for use as fuel.

During intense training, young football playersshould be encouraged to maintain a carbohydrateintake of as much as 70 percent of their diet,

approximately 10 grams of carbohydrate per kilo-gram of body weight (or 4-5 grams per pound). Inpractical terms, one slice of bread equates to 12grams of carbohydrates; one cup of cooked pasta,24 grams; one cup of dry cereal, 30 grams; andone granola bar, 22 grams. Fruits are good sourcesof carbohydrates, with one medium banana yield-ing about 27 grams; 1 medium apple, 22 grams;and 1 cup of canned fruit cocktail in heavy syrup,44 grams.

Fat is also an important energy source for ath-

letes, but it should be consumed in limitedamounts, not exceeding more than about 20 per-cent of total energy intake. Good sources of fatinclude olive, peanut, and canola oils, but mostyoung athletes will consume adequate amounts offat in snacks and fast-food meals.

Protein is another essential dietary component foroptimal health and athletic performance. Althoughit is known that athletes build muscle through exer-cise and not extra protein, growing athletes do

need a higher intake than adult athletes or seden-tary individuals. Advise players to consume approxi-mately 1-2 grams of protein per day per kilogramof body weight. Generally, one ounce of meatyields about 6-7 grams of protein. However, it maybe helpful to use familiar references such as a quar-ter- pound burger, which is 4 ounces of meat con-taining about 24 grams of protein, or a 6-ouncecan of tuna, which contains about 28 grams. By fol-lowing these guidelines, protein should account forapproximately 15 percent of a players diet, an

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A properly balanced diet of fats, carbohydrates, and protein is importantfor young football players to perform at optimum levels.

NUTRITION FOR OPTIMAL PERFORMANCE

W H A T C O A C H E S S H O U L D K N O W

Young athletes should consume a diet containing about60-70 percent carbohydrate and 15 percent protein,which equals about 1-2 grams of protein per kilogramof body weight.

Athletes also need to consume dairy products for strongbones as well as a limited amount of fat, which may serveas an additional energy source.

To be sure athletes ingest sufficient micronutrients,coaches should encourage a widely varied diet ofcomplex carbohydrates, fruits and vegetables, andlean meats or beans.

When in doubt regarding a healthful diet, refer to theUSDA food pyramid for guidelines.


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ACSMS Handbook for the Team Physician, Williams & Wilkins, 1996. pp. 442-451.

ACSM brochure: Nutrition and Sports Performance http://www.acsm.org.

ACSM Current Comment: Vitamin and Mineral Supplements http://www.acsm.org.

Clark N. Nancy Clark's Sports Nutrition Guidebook. Human Kinetics: 1996, 2nd Edition.

Coleman E. The Ultimate Sports Nutrition Handbook. Palo Alto: Bull Publishing Company, 1996.

United States Department of Agriculture (USDA) food guide pyramid: http://www.nal.usda.gov:8001/py/pmap.htm.

amount easily attained in a balanced diet with noneed for supplementation.

Athletes also need milk and other dairy productsfor the growth and maintenance of healthy bones.In addition, dairy products such as low-fat milk,cheese, pudding, yogurt, and frozen dairy deserts

are considered both carbohydrates and proteins,contributing to the recommended portions above.Although vitamins and minerals are needed for

the chemical reactions that produce energy, it isunlikely that supplemental vitamins or minerals willenhance performance. A well-varied diet that ishigh in fruits, vegetables, whole grains, and leanmeats will include sufficient quantities of allmicronutrients.

Coaches are in a unique position to influenceathletes and may want to guide players toward

specific food choices such as bagels or cereal withmilk and/or juice for breakfast and pasta, breads,

or rice with lean meats or beans for lunch and din-ner. It may also be helpful to refer players to theUSDA food guide pyramid for more specific infor-mation. The food guide pyramid provides recom-mendations for daily food choices. It highlights andreinforces the need for the right variety of foods

necessary to help promote health, including a dailyemphasis on low-fat foods and fruits and vegeta-bles. Finally, adequate hydration should always beencouraged for young athletes before, during, andafter physical activity.

A healthy diet plays an enormous role in success-ful athletic performance. Coaches should encourageyoung football players to consume a widely varieddiet consisting of complex carbohydrates, vegeta-bles, dairy products, and protein with a sampling offats and sugars. Given such a diet, protein, vitamin,

and mineral supplementation are not necessary forgood health and optimal performance.

MICHAELZ

AGARIS


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Vitamins are naturally occurring organic compoundsthat act as regulators of protein, carbohydrate, andfat metabolism in the body. Some vitamins, includ-ing C, E, and beta carotene, are also taken for theirantioxidant properties, which are touted to include

improved immune function and maintenance ofskeletal muscle. Minerals are inorganic elementsthat act as helpers for the enzymes involved increating energy from food.

Physical activity, especially of a prolonged andstrenuous nature, may increase the bodys need forcertain vitamins and minerals. However, individualswho consume a low-energy diet for long periods oftime risk vitamin and mineral imbalance. Eventhese individuals tend to exhibit only a marginaldeficiency.

Many athletes choose to supplement their dietaryintake with over-the-counter vitamin and mineralsupplements. However, there is no scientific evi-dence to support the use of vitamin and mineralsupplements to improve athletic performance.

There may be some benefit to calcium and ironsupplementation in female athletes who may notconsume adequate calories or who may not havevariety in their diet.

Moreover, large doses of certain vitamins andminerals can cause adverse effects. Excess vitamin Chas been shown to cause kidney stones, decreasedblood clotting, and gastrointestinal disturbances;excess zinc may induce a secondary copper defi-ciency and decrease HDL, or the good cholesterol,in the blood stream; and the fat-soluble vitamins A

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Surveys of high school athletes indicate a greater-than-normal use ofvitamin and mineral supplements, but most supplemented micronutrientscan be provided with a balanced diet.

VITAMIN AND MINERAL SUPPLEMENTS


Vitamins and minerals act as regulators of metabolism.

Prolonged and strenuous exercise coupled with alow-energy diet may cause a marginal vitamin andmineral deficiency.

Athletes can reduce their risk of developing deficienciesby consuming a balanced and varied diet with adequatecalories to support growth and activity levels.

Supplementation is not necessary to maintain adequatelevels of vitamins and minerals and can be dangerous iflarge doses of certain supplements are taken (e.g. vitaminsC, A, and E; and minerals iron and zinc).

No scientific evidence supports the belief that vitamin

and mineral supplementation enhances performance. Coaches should provide guidelines and serve as role models

to help players maintain a balanced and varied diet.


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and E are dangerous at high doses.In order to meet their dietary needs, young foot-

ball players should consume a balanced diet with a

variety of foods, including lean meats, fish, beans,skim milk, and yogurt for minerals and B vitamins;and carrots, skim milk, peanuts, orange juice, greenvegetables, and fruits for vitamins A, C, and E. For

more information on nutrition for young athletes,see Strength and Conditioning, the third book inthe Play Safe Series.

Although physical activity may increase the needfor some vitamins and minerals, the increasedrequirement can usually be met by consuming abalanced diet that includes a wide variety of foods.

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ACSM Current Comment: Vitamin and Mineral Supplements http://www.acsm.org.

Coleman, E. Eating for Endurance. Palo Alto, CA: Bull Publishing Company, 1988.

PETER

NEWCOMB


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Some athletes may choose or require special dietsfor health, personal, or religious reasons. The mostcommon special diets include vegetarian, high-car-bohydrate, or high-protein diets. It is importantthat they provide a nutritional balance.

Vegetarian DietForms of vegetarianism include: (1) modified veg-etarian, who eats fruits, vegetables, grains, milkproducts, eggs, and occasionally seafood or poul-try, but no red meat; (2) lacto-ovo vegetarian,

who excludes seafood and poultry but will con-sume eggs and milk products; (3) lacto-vegetari-an, who consumes a similar diet but also excludeseggs; and (4) vegan, who eats only plant-basedfoods such as fruits, vegetables, and grains.

When discussing nutrition with vegetarian ath-letes, coaches can refer to professional vegetarianathletes who follow strict guidelines to ensureproper nutrition for health and athletic competi-tion. The primary concern of vegetarian athletes isto consume an adequate amount and variety of

protein. Eating a wide variety of protein-richfoods such as beans, grains, seeds or nuts, soy,and tofu will help supply the amino acids neededto build and maintain muscle mass. Peanut but-ter, protein shakes, and tofu dishes can accom-modate protein needs while providing a smallamount of fat that may also be missing from theathletes diet. In addition, vegetarians must becareful to consume enough calcium, iron, zinc,and B-complex vitamins.

High-Carbohydrate or High-ProteinAlthough many nutritionists and professional ath-letes tout the benefits of high-carbohydrate orhigh-protein diets, young athletes should generallyconsume a diet that is about 60 to 70 percent car-bohydrate and about 15 percent protein, with awide variety of vegetables and fruits and a sam-pling of fats. It is important to understand thepotential benefits and limitations of high-carbohy-drate and high-protein diets.

Many young athletes confuse foods high in milk

Some young athletes may opt for a diet different from the majority of theteam. A youth coach should be prepared to deal with such situations.

VEGETARIAN AND FAD DIETS


Certain young athletes may choose to consume a differentor special diet that may pose health risks if minimumnutritional requirements are not met.

Vegetarian athletes must be sure to consume an adequateamount of protein as well as fat, vitamins, and minerals.

Young athletes should consume a diet based on about 60to 70 percent carbohydrates and 15 percent protein.

A good rule of thumb for growing athletes is toconsume about 1-2 grams of protein per kilogram ofbody weight per day.


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products and fat for carbohydrates, when in fact theyare high in fat with few carbohydrates. To avoid con-fusion, create a list of healthy meals and snacks forathletes and their parents.

High-protein diets have the potential of supplyingmore building blocks for muscle growth, but con-suming excessive amounts of meat and protein pow-ders can limit the bodys ability to absorb certainamino acids. Furthermore, athletes build muscle

through exercise, not extra protein. Protein-heavymeals can also be difficult to absorb. A simple rule is

to advise players to consume approximately 1-2grams of protein per day per pound of body weight.

Coaches should also be aware and considerate ofother special diets, such as those based oncultural and religious requirements.

Coaches should be aware of the potential limita-tions of special diets that may be consumed byyoung players. No matter the type of diet followed,athletes should be encouraged to consume a variety

of foods rich in carbohydrates and low to moderatein protein content.

GO ONLINE AT WWW.NFLHS.COM/HEALTHMORE READINGBerning, J.R. The vegetarian athlete. In: Maughan, R.J. Nutrition in Sport. Blackwell Scientific, Oxford, 2000. pp. 442-456.Larson, D.E. Vegetarian Athletes. In: Rosenbloom, C.A. (Ed.). Sports Nutrition: A guide for the professional working with active

people. American Dietetic Association, Chicago, IL, 2000, pp. 405-425.Manore, M.M. Nutritional needs of the female athlete. In: Wheeler, K.B., & Lombardo, J.A. (Eds.). Clinics in Sports Medicine:

Nutritional Aspects of Exercise. W.B. Sanders Co., Philadelphia, PA, 1999: 18(3): 549-563.Manore, M.M., & Thompson J.L. Sport Nutrition for Health and Performance. Human Kinetics Publishers, Champaign, IL, 2000.

JONATHAN

DANIEL


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Heat illness is caused by doing too much work in hot, humid conditions.It is sometimes accompanied by dehydration. Youth coaches should knowhow to prevent itand how to recognize warning signs when it occurs.

HEAT AND HYDRATION


In order for players to be well hydrated, they should drinkfluids before, during, and after activity.

Cool fluids containing carbohydrates and/or electrolytesmay provide additional benefit.

In hot seasons, allow for acclimatization by graduallybuilding exercise and practice intensity as well as theamount of equipment worn (e.g. without pads the firstthree days) throughout a period of 10-14 days.

When exercising in the sun or heat, players should wearlight-colored clothing made of fibers that absorb sweat.

In extremely hot environments, provide multiple ways tocool down athletes, including ice-down tubs, shaded

areas, fans, and mist coolers. Children sweat less than adults and have lower heat

tolerance.

Warning signs of heat exhaustion include headache,dizziness, chills, and even fainting.

Players suspected of heat exhaustion should be rehydratedand allowed to rest in a cool, shaded area and, if possible,examined by a health-care professional. If the player does not

respond to first-aid measures, get the player to a doctor. Warning signs of heat stroke include disorientation, hot

and dry skin, high body temperature, nausea, and seizure.

When in doubt about hydration or possible heat illness,hold the player out of practice or play. An athlete whosuffers from suspected heat illness should not engage inpractice or competition for the remainder of the dayand until the athlete is fully hydrated.


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The first step in avoiding heat illness is adjusting prac-tice or game length and intensity to the environmen-tal conditions. It is equally important to maintain ade-quate hydration before, during, and after physicalactivity. Temperature and humidity combine to createconditions that can produce heat illness and dehydra-tion. For example, an air temperature of 90 degreesFahrenheit combined with a relative humidity of only30 percent can result in heat illness with prolongedphysical activity. Temperature and humidity chartsshould be used (available on the Internet) to modifyactivity in hot conditions to protect the player. As ageneral rule, an air temperature of 95 degreesFahrenheit is high risk regardless of the humidity.When the air temperature is 85 degrees, high risk isassociated when the humidity reaches 60 percent. At75 degrees, high risk is associated with 90 percenthumidity.

Hydration GuidelinesIdeally, a player should be fully hydrated beforebeginning practice or competition. Generally, 7 to 9cups, or 56 to 72 ounces, of fluid are required forchildren and adolescents every 24 hours to meetthe bodys daily needs. However, an additional 12-16 ounces (112 to 2 cups) should be consumedapproximately two hours prior to activity. Fluids lostthrough sweat and breathing should be replaced byfluid consumption. Youth football players will

require 3 to 4 ounces every 15 to 20 minutes dur-ing activity for players weighing less than 100pounds; 4 to 5 ounces every 15 to 20 minutes forheavier players. Fluids should be made availablebetween quarters and during timeouts. Followingbouts of physical activity, players should drink atleast 12-16 ounces of fluid per pound of bodyweight lost during the activity.

Thirst is not a good indicator of the need tohydrate. It takes up to 16 ounces of fluid to replaceeach pound of body weight lost during activity. It is a

good idea, particularly in hot environments, to weighplayers each day to help determine adequate fluidreplacement needs.

Flavored, cold, lightly salted, and/or sweetenedcommercial drinks may improve voluntary fluidreplacement by players, especially the younger ath-letes. Drinks sweetened with a carbohydrate such asglucose or sucrose (sugar) may help a player maintainenergy during activities that last more than one hour.In addition, fluids containing the electrolytes sodium,potassium, and chloride can promote fluid retention.

Salt tablets are not required, but players should beencouraged to salt their food at meal times.

In hot seasons, allow for acclimatization by buildingexercise intensity and hydration throughout a periodof about 10 to 14 days. When exercising in the sunor heat, players should wear light-colored clothingmade of fibers that absorb sweat. In addition, whencoaching young players, it is important to rememberthat prepubescent children sweat less than adultsand have a much lower heat tolerance. Frequentbreaks (10-15 minutes) per hour in cool or shadedareas with helmets removed, sufficient time to drinkwater, and removal and replacement of sweat-satu-rated uniforms and clothing are helpful strategies fora coach to minimize the risk of heat illness amongplayers. Reducing the intensity and length of prac-tices is strongly recommended on hot days.

Warning SignsThe acute warning signs of exertional heat stroke,exercise heat exhaustion, and dehydration includenausea, headache, weakness, fainting, poor concen-tration, flushed skin, light headedness, loss of mus-cle coordination, fatigue, nausea, and vomiting.Prolonged dehydration can lead to loss of appetite,production of dark yellow urine, and muscle cramps.

Certain types of players may be at a higher risk forheat-related illness and should be monitored closely.These types of players include those with a prior his-

tory of heat illness, overweight or obese players, orthose with a medical history of gastrointestinal, dia-betic, kidney, or heart problems. These types of play-ers require special attention by coaches and quickaction if any symptom of heat illness is noticed.

Players suffering from heat exhaustion often showheat-illness symptoms. These players should beremoved from activity, rehydrated in a shaded area,and monitored closely for worsening of symptoms.A player who may be experiencing heat-related ill-ness should not be returned to play for at least the

remainder of the day and should be fully rehydratedprior to return. If the player does not improve orbegins to show any signs of more serious illness(including disorientation, hot and dry skin, highbody temperature, nausea, and seizures), emer-gency medical personnel should be contactedimmediately. Every attempt should be made toreduce the players body temperature immediatelyusing whole body cooling techniques, such asimmersion in cool water or the application of wettowels with fanning of the body.

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Athletes often were advised in the past to consumelarge amounts of carbohydrates the night before agame and to forgo eating prior to competition. It isimportant to replace these half-truths with practical

guidance.A pregame meal should give nourishment thatprovides energy for the muscles, reduces distractingfeelings of hunger, and prevents hypoglycemia, orlow blood sugar, symptoms of which includefatigue, lightheadedness, and blurred vision. Thefoods consumed should be familiar to the athleteand should take into account the potentially highstress level experienced prior to competition. Insimple words, they should eat what their familynormally cooks.

Ingested carbohydrates are stored in the muscleas glycogen, which later becomes a primary fuel forexercise. Therefore, young athletes should maintaina diet rich in carbohydrates such as rice, pasta,

potatoes, breads, and cereals. A wide variety ofvegetables and fruits should also be consumed inaddition to a moderate amount of protein and asampling of fats and sugars.

The evening before a game, a players mealshould consist of about 60 to 70 percent carbohy-drates and 10 to 15 percent proteins. Spaghettiwith tomato sauce, or lean meat with rice or pota-toes and vegetables, are good choices. Players alsoshould drink plenty of fluids, including juices andwater.

14

Youth coaches should be aware of the facts and guidelines regarding pregammeals for players.


PREGAME MEALS

On the night preceding competition, playersshould consume a full meal, with more emphasis oncarbohydrates.

Two to four hours before competition, players should eata light meal consisting primarily of carbohydrates.

All pregame meals should be familiar to the athlete andeasily digested.

Sugary, fatty, or heavy foods are not advised prior tocompetition.

Fluids are one of the most important components ofpregame meals; adequate hydration is essential to goodhealth and performance.

To help refuel muscles after an intense practice or game,players should be encouraged to eat carbohydrate-richfoods (such as pasta and vegetables) within the first twohours after the event.


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On game day, athletes should refrain from eatingheavy meals close to game time. However, two tofour hours before competition, light meals consist-ing primarily of carbohydrates are ideal. It takesabout three to four hours for a heavy meal to bedigested, two to three hours for a lighter meal, andless than an hour for most light snacks.

An ideal pregame meal: pasta with meat or toma-to sauce, cooked vegetables or a salad, bread, non-caffeinated beverage, and cookies or fruit salad fordessert. Another example: baked, grilled, or broiledchicken; mashed or baked potatoes; cooked greenbeans; rolls; noncaffeinated beverage; cake, cook-ies, or fruit salad for dessert. If an athlete is hungryclose to game time, try sports drinks or sports barsthat are high in carbohydrates.

It is not advisable to consume high-fat or sugar-laden foods (pizza, hamburgers, and soda for exam-ple) prior to competition. These foods may providea temporary energy burst followed by a drop inblood sugar that leads to fatigue. In addition, heavyor hard-to-digest foods (meats, nuts, beans) maycause gastrointestinal distress during a game.

Players should be advised to drink plenty of fluidsbefore, during, and after practice and competition.Sports drinks containing carbohydrates can provideadditional energy.

Finally, muscle is more receptive to refueling for thefirst two hours after athletic activity. Encourage play-

ers to eat healthful, carbohydrate-rich foods such aspasta, to replenish muscle glycogen stores, alongwith drinking plenty of fluids. Regular consumptionof carbohydrates (e.g. fruit, fruit yogurt, bagels, drycereal) will facilitate recovery from practice.

Coaches should take an active role in educatingyoung athletes about sound nutritional principles.They should encourage athletes to consume lightpregame meals that are rich in carbohydrates, mod-erate in protein, and low in sugars and fats. Pasta,vegetables, and salad are good examples. Hydration

is equally important to athletic performance andshould become a requirement for participation.

15

GO ONLINE AT WWW.NFLHS.COM/HEALTHMORE READINGACSMS Handbook for the Team Physician, Williams & Wilkins, 1996. pp. 442-451.

ACSM brochure: Eating Smart, Even When Youre Pressed for Time 1-317-637-9200.

ACSM brochure: Nutrition and Sports Performance, 1-317-637-9200.

ACSM Current Comment: Vitamin and Mineral Supplements http://www.acsm.org/comments.htm.

PET

ER

NEWCOMB


17/6516

Although weight loss is not a primary concern of most football players,some young athletes may wish to lose weight, or fat mass, for athletic oraesthetic reasons. Others may be intentionally trying to make weight forcompetition and meet divisional weight requirements. Youth coaches needto know the dos and donts of weight loss.

WEIGHT LOSS IN YOUNG ATHLETES


Coaches should provide practical guidance for youngplayers who wish to lose weight.

Young athletes wishing to lose weight should focus onchanges in body composition (i.e., loss of fat mass with-out compromising lean muscle mass or bone density).

Players can lose fat mass by decreasing their caloricintake by 500 calories per day while increasing theirenergy expenditure by a similar amount. A cutback of1,000 calories per day will roughly correspond to twopounds per week.

Regardless of diet, players should consume at leastthree healthy meals a day consisting of a variety ofcarbohydrates, lean meats, and vegetables.

Young athletes should not consume fewer than 2,000calories per day.

Players wishing to lose weight should gradually increasethe frequency of aerobic exercise and low-intensity,high-repetition strength training.

Coaches should be aware of young players attempts tolose weight and should discourage fad diets, intentionaldehydration, and overtraining by recommending apractical diet and exercise methods centered on losingfat mass while retaining lean muscle and bone density.


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If a player desires to lose weight, a coach shouldattempt to refocus the athletes attention onchanges in body composition versus loss of scaleweight. In particular, players should strive fordecreases in fat mass without compromising leanmuscle or bone density. In addition, coaches shouldemphasize that gradual changes are healthier and,more often, longer lasting. Weight loss programsshould begin well before the competitive seasonbegins.

Based on calculations that 3,500 calories corre-sponds to one pound of body weight, players canlose about two pounds per week by creating adeficit of 1,000 calories per day. More practically, aplayer can decrease his caloric intake by about 500calories per day and burn off another 500 caloriesthrough aerobic exercise and low intensity circuittraining.

A simple approach to calorie reduction that willhelp with weight loss and is also heart healthy is tolimit saturated fat to less than 30 grams per day. Ifthat is not a successful strategy, limit it to less than20 grams per day. In addition, athletes can decreaseserving sizes; however, it is important to maintain adiet consisting of at least three healthy meals perday to provide adequate energy for growth andexercise. A variety of carbohydrates, lean meats, andvegetables will ensure adequate nutrition and elimi-nate the need for dietary supplements. In addition,

no young athlete should consume fewer than 2,000calories per day, and coaches should watch for signsthat players are experimenting with fad diets or havedeveloped an eating disorder.

In order to lose fat, players should graduallyincrease the frequency and intensity of aerobic exer-cise along with low-intensity, high-repetitionstrength training. For example, running or jogging 2to 3 miles can burn up to 500 calories in some ath-letes. Coaches should monitor a dieting playersactivity level to avoid overtraining injuries and burn

out. Finally, if at all possible, weight loss programsshould be undertaken as a team effort between aplayer, his family, the coach, and a physician ornutritionist.

Intentional dehydration (losing water weight bysweating, spitting, or other methods) in order tomake weight is extremely dangerous and should bediscouraged at all times.

Coaches should be able and prepared to provide

practical guidance for young football players desiringto lose weight. Specifically, coaches should promotelong-term reductions of fat mass without a simulta-neous loss of lean muscle or bone density.

17

GO ONLINE AT WWW.NFLHS.COM/HEALTHMORE READINGDyment, Jr., P.G. (Ed.). Sports Medicine: Health Care for the Young Athlete, 2nd Ed., American Academy of Pediatrics 1991,

pp. 99, 137.


AL

MESSERSCH

MIDT


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Although it is difficult for a coach to control a play-ers eating habits, several important guidelines canand should be discussed with players who areattempting to gain weight. Doubling up on mealservings, selecting higher-calorie foods (such asmultigrain breads, low-fat dairy products, beans,

baked chicken, dried fruits, and nuts), and drinkingmilk or juice with meals will increase a playersoverall caloric intake.

Based on calculations that 3,500 calories equalsapproximately one pound of body weight, mealsand snacks should provide an extra 1,000 calories

18

Young football players may wish to gain weight or bulk up to improveathletic performance and create a more imposing figure on the footballfield. Coaches should know the body mechanics of weight gain.

YOUNG ATHLETES AND WEIGHT GAIN


Coaches should provide practical guidance for youngplayers who wish to gain weight.

Advise players to eat larger serving sizes of healthyfoods at least three times a day and to supplement mealswith snacks, milk, and juice throughout the day.

Based on calculations that 3,500 calories equalsapproximately one pound of weight, players must consumean extra 1,000 calories per day to gain 1 t0 2 pounds perweek.

Strength training exercises also will help a player gainweight. However, increases in the frequency, duration,and intensity of training should be undertaken graduallyand with the players safety in mind. Although there is no

magic age when children can begin weight trainingsafely, resistance exercise in younger children shouldconsist primarily of pushups, situps, and pullups.

Proper nutrition and exercise habits are preferable topotentially dangerous ergogenic aids.


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per day in order for a player to gain from 1 to 2pounds per week. Coaches must caution players,that it is not advisable to consume great amountsof fat-laden foods (such as fried foods, fatty meats,or full-fat dairy products) to gain weight; largerand more frequent servings of healthy foods are abetter choice for optimal athletic performance.

Exercise is the second component of healthyweight gain; athletes with this goal should beadvised to increase the frequency, duration, andintensity of strength training, or resistance exercise.Resistance exercises can involve traditionalweightlifting equipment (appropriately sized andsupervised) for older children or simple exercisesthat rely on body weight (pushups, pullups, situps)for younger children.

Players desiring to gain weight sometimes tryprotein powders, amino acid supplements, crea-tine, and even hormones such as androstenedione.All these types of products are available on theInternet and elsewhere. Counsel athletes that eventhe safest supplement carries possible risks thatmay outweigh the advertised benefits. Promotesound nutrition and exercise over the doping men-tality by opposing the use of ergogenic aids byyoung athletes.

All children develop and mature at different rates.It is a coachs responsibility to provide practicalguidelines for safe, healthy weight gain, which

includes increased caloric consumption andstrength exercise training.

19



ACSM Current Comment Youth Strength Training: http://www.acsm.org.

MIC

HAEL

ZAGARIS


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Substance Abuse


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Even episodic drug use can affect performance inyoung players. A change in performance and moti-vation may be the only clue a coach will have thata player is using drugs.

The most widely abused drug by both youths and

adults is alcohol. In children, even very smallamounts of alcohol can cause impaired motor per-formance, which includes reduced hand-eye coor-dination, grip strength, and jumping ability. In addi-tion, players who have consumed alcohol may tire

21

Many coaches are trained to recognize a players use of ergogenic drugs,such as anabolic steroids, that are used to enhance a players strength andendurance. However, young athletes are much more likely to abuse alcohol,

marijuana, cocaine, ecstasy, and other recreational drugs. Youth coachesneed to know the symptoms of substance abuse and how to assist in securingtreatment.

SUBSTANCE ABUSE


Young football players are at risk of using and abusingalcohol and illicit drugs.

Coaches should educate players about the dangers ofdrug abuse and should always be conscious of being apositive role model.

Preventing young players from abusing drugs increasestheir chances of becoming healthier athletes andadults.

Effective approaches include:

Speak to athletes about drug abuse and ask themquestions in a personal and direct manner.

Find and be prepared to recommend a local programthat is experienced in assisting young people withdrug addiction.

Work with the team health-care professional(s) todiscourage drug use by discussing the consequencesof use, effective methods to overcome common barri-

ers to quitting, and techniques to prevent relapse. Prohibit alcohol use by parents at team events.


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more quickly during high-intensity exercise.Coaches should watch for slurred speech, tremors,and decreased physical performance.

Experimentation with marijuana also is prevalent

among young athletes. The signs of marijuana useinclude red eyes, dry mouth, excessive giddiness,and the inability to concentrate. Reaction timescan be slowed, reducing a players level ofperformance.

Cocaine abuse, in contrast, is characterized byincreased rates of speech, hyperactivity, and agita-tion. Physiologically, the player may experienceshortness of breath, heart palpitations, and highblood pressure. The sudden deaths of nationally-known athletes can be cited when discussing

cocaine abuse with players.All players should be informed of the risks asso-ciated with drug and alcohol abuse, especially as

it relates to physical activity. Any athlete who hasrecently used drugsor is suspected of chronicabuseshould be removed from play and referredfor counseling. However, the most effective deter-

rent a coach can provide is to act as a role modelfor positive behavior. Coaches should not con-sume alcohol in the presence of players, and alco-hol use among parents at team hotels or partiesshould be prohibited.

All youth coaches should be aware of the warn-ing signs of alcohol and drug abuse. Coaches andhealth-care professionals should speak to playersabout drug abuse and ask questions in a personaland direct manner. Coaches should also rememberthat they and the athletes parents act as role

models for young players and should refrain fromsuch negative behaviors as alcohol, tobacco, anddrug use.

22

GO ONLINE AT WWW.NFLHS.COM/HEALTHMORE READINGACSM Current Comment: Alcohol and Athletic Performance http://www.acsm.org.

ACSM Current Comment: Cocaine Abuse in Sports http://www.acsm.org.

ACSMS Handbook for the Team Physician, Williams & Wilkins, 1996. pp. 470-482.

NCAA Minimum Guidelines for Institutional Alcohol, Tobacco and Other Drug Education Programs

http://www.ncaa.org/sports_sciences/education/minimum_guidelines.html.

The National Center for Drug Free Sport http://www.drugfreesport.com/home.htm.

GREG

TROTT


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From a childs first participation in sport until theend of his/her athletic career, many individuals,teams, and organizations are in a position to act as

agents of drug-abuse prevention, recognition, andearly intervention. The coach is central to the sportsexperience and should be aware of possible sub-stance abuse by athletes.

The symptoms of drug abuse can be subtle, par-ticularly in fit and accomplished athletes. Coachesoften are in the best position to detect drug abusebecause they constantly observe the athletesappearance and behavior. Unexplained changes inphysical appearance, behavior, mood, performance,or concentration may be symptoms of drug abuse.

Arguments with teammates, inappropriate chal-lenges to authority figures, lying, routinely showingup late to practice, increased injury rate, and/or

excessive reliance on medications for the treatmentof minor injuries should raise suspicions of drugabuse.

The attitude and behavior of the coach can influ-ence the attitudes and actions of athletes. Thecoach should be able to discuss openly the ethicsand dangers of drug abuse, provide appropriateguidance, and stress proper training methods toavoid injury. The coach should help the athlete setgoals that are achievable through hard work anddeveloped talent andwithout the use of drugs.

23

Drugs used by young athletes may be legal or illicit, recreational orperformance enhancing, or they may be therapeutic and necessary.

It is important that the youth coach can recognize drug abuse.

SUSPECTING DRUG ABUSE


Be knowledgeable about the danger signals that mayindicate signs of drugs abuse.

If an athlete is suspected of drug use, talk to him whereprivacy and confidentiality are assured.

Consider initially discussing commonly used substancessuch as over-the-counter medications and their effectson performance as an icebreaker.

Be informed about material on the topic available fromcommunity resources.

Stay informed about new drugs that are known to beabused.

When possible, a coach may want to share his suspicionswith a team physician who can decide whether to discussthe subject with the athlete and/or his parents, in thecase of a minor.


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Smoking and the use of smokeless tobacco are common even in young athletes.Youth coaches need to know the dangers of tobacco use and its effect onathletic performance.

TOBACCO USE


Young athletes are at high risk for developing a smoking orsmokeless tobacco habit.

Tobacco use impairs athletic performance, may increase therisk of injury, and slows the rate at which injuries heal.

Nicotine is a highly addictive and dangerous drug in anyform.

Smoking and smokeless tobacco are responsible forrespiratory and oral cancers, increases in blood pressure,vascular damage, heart attack, and receding gums.

Coaches should educate players about the dangers oftobacco and should serve as positive role models byrefraining from tobacco use.

Preventing young players from using tobacco increasestheir chances of becoming healthier athletes and adults.

Effective approaches include:

Treat the absence of tobacco use as a healthy vital signand a key to enhanced performance.

Ask athletes not to start, or to quit, using tobacco in adirect and personal manner.

Find and be prepared to recommend local treatmentprograms experienced in youth tobacco addiction.

Work with the team health-care professional(s) todiscourage tobacco use by discussing the consequences,recommending effective methods to overcome commonbarriers to quitting, and using techniques to preventrelapse.

Be a role model for athletes. Do not use tobacco.


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Smoking and smokeless tobacco use still are consid-ered socially acceptable, despite nicotine beingidentified as a highly addictive and dangerous drug.While smoking rates have decreased in the pasttwo decades, smokeless tobacco use in youngmales and females is on the rise. This trend may beeven more prevalent in young male athletes, whooften use chewing tobacco during practice andsporting events.

The dangers of smoking tobacco have beenwidely reported in the media. Tobacco smoke con-tains more than 4,000 chemicals, including carbonmonoxide and nicotine, which cause cardiorespira-tory toxicity and addiction. Smoking can impairathletic performance by reducing the ability of thelungs to deliver oxygen to the blood, causingdiminished muscular performance. Nicotine causesa narrowing of blood vessels, and puts an addition-al strain on an athletes heart, making it work hard-er to achieve optimum performance.

The addictive and adverse effects of smokelesstobacco are well documented. Oral tobacco usecauses a significant increase in oral lesions and gumrecession, and can cause elevations in heart rateand blood pressure. The primary causes of oral can-cer are smoking and smokeless tobacco use. Thenicotine in smokeless tobacco, like in that of ciga-rettes, puts added strain on the heart and bloodvessels, significantly reducing optimal performance.

In addition, tobacco users take a significantly longertime to heal after a musculoskeletal injury.The NCAA Guidelines for institutional alcohol,

tobacco, and other drug education programs sug-gest that each player should sign a form consent-ing to a drug test, and each athletic departmentshould conduct a drug and alcohol education pro-gram once a semester. This message, translated foryouth and high school football, suggests thatcoaches take an active role in preventing playersfrom smoking and using smokeless tobacco

through education and disciplinary action.Adolescence is a critical time for learning these

life lessons, and the youth coach can be a respect-

ed role model for avoiding nicotine addiction andsubsequent health concerns.

25

GO ONLINE AT WWW.NFLHS.COM/HEALTHMORE READINGACSM Current Comment: The Use of Smokeless Tobacco Products by Athletes http://www.acsm.org.NCAA Minimum Guidelines for Institutional Alcohol, Tobacco and Other Drug Education Programs

http://www.ncaa.org/sports_sciences/education/minimum_guidelines.html.The National Center for Drug Free Sport http://www.drugfreesport.com/home.htm.National Center for Chronic Disease Prevention and Health PromotionOral Cancer Resource

http://www.cdc.gov/nccdphp/oh/oc-home.htm.American Dental Hygienists AssociationOral Health Online http://www.adha.org/oralhealth/oralcancer.htm.

M.

REIBEL


27/6526

Young athletes often feel pressure to improve their athletic performance,and may attempt to do so through the use of ergogenic aids and dietarysupplements. Youth football coaches need to be aware of various nutritionalergogenic aids, risks and benefits of use, and signs of use and abuse.Youth and high school football coaches should promote proper training andnutritional habits to improve the athletic performance of young players.

DIETARY AND SUPPLEMENT PERFORMANCE ENHANCEMENT


Although caffeine is a legal and socially acceptable drugthat can increase endurance and short-term performancein small doses, it can also produce many negative sideeffects. Although coaches cannot restrict normalconsumption, the use of caffeine as an ergogenic aidshould be strongly discouraged.

Other stimulants, such as ephedrine (ephedra), have beenbanned by bodies that govern athletic activity because oftheir link to sudden death in athletes. Young footballplayers should be monitored for stimulant abuse, andstimulant users should be removed from play and referred

to counseling. Nutritional ergogenic aids are substances that are

ingested to improve athletic performance.

The dietary supplement industry is unregulated and, thus,no standards for production and packaging have beenestablished. Product safety is not guaranteed, and falseand misleading claims abound.

Claims made by the manufacturers of protein and amino

acid supplements have not been confirmed in scientificstudies. Ingestion of large quantities of supplementalamino acids may affect the natural absorption of aminoacids.

Although creatine and androstenedione are naturallyproduced in the body, the safety and efficacy of thesesupplements has not yet been proven scientifically. Coachesshould prohibit their use and the use of all ergogenic aidsby young players.


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It has been estimated that 1 million Americansages 12-17 take one or more sports supplements.The supplements most widely used by teensinclude: creatine for increasing muscle mass; over-the-counter decongestants such as ephedrine orphenylpropanolamine for energy, weight loss, andincreased strength (particularly if taken with caf-feine); and steroid precursors such as androstene-dione (andro) to increase testosterone levels. Theeffects of dietary supplements, as with regulardrugs, are a function of dose, frequency, andduration of use.

Sports supplements are cleverly marketed toappeal to adolescents. They are featured in manymagazines and are widely advertised on theInternet. Alluring nonscientific and nonmedicalclaims are featured in advertisements for these sup-plements such as: more energy or increasedstrength. No prescriptions are required to purchasethese products because they are classified as dietarysupplements.

Nutritional ergogenic aids aresubstances that are ingested to improve athleticperformance. Some are claimed to enhanceendurance, while others supposedly increasestrength. For example:

Caffeine is a legal drug that is widely used insociety and can act as an ergogenic aid, although ithas no nutritional value. Moderate doses (1-3 cups

of coffee, equaling three to nine mg/kg) taken onehour before exercise can enhance endurance andshort-term athletic performance. The benefit maybe exerted through the release of adrenalin into theblood stream, which in turn stimulates free fattyacid release from both fat and skeletal muscle tis-sues, sparing muscle carbohydrate (glycogen).However, caffeine is a controlled or restricted sub-stance as defined by the International OlympicCommittee (IOC) and the NCAA. It is unlikely thatan athlete will reach the illegal limits as defined by

these organizations through normal caffeine con-sumption. However, even low levels of caffeine inthe body, especially a childs body, can cause anxi-ety, jitters, inability to focus, gastrointestinal unrest,insomnia, and irritability. Higher doses can causeheart arrhythmias and mild hallucinations. Giventhese considerations, coaches should discourage theuse of caffeine as an ergogenic aid. However, it isnot necessary at this time for players to abstainfrom normal consumption.

Ephedrine (ephedra) and its herbal counter-

part, ma huang, are dangerous stimulants that aresold over the counter as cold medications. Thesestimulants cause an increase in metabolic rate andheart rate, much like adrenalin, and share manyadverse side effects with caffeine, such as dizziness,dryness of the mouth, elevated blood pressure, andpossibly blurred vision. However, unlike caffeine,ephedrine has been banned at any level by the NFL,NCAA, and the IOC. Reports link ephedrine withsudden death in athletes using the substance.

Protein and amino acid supplementsare popular with young football players eventhough a healthy diet contains a sufficientamount of protein (at least 1 gram per pound ofbody weight for football activity). Although man-ufacturers advertise that certain amino acid sup-plements increase growth hormones, scientificstudies have not confirmed these claims. In con-trast to improving athletic performance, ingestinglarge amounts of certain amino acids can affectthe natural absorption of other amino acids, pro-ducing gastrointestinal distress that reduces ath-letic performance.

Creatine is naturally produced by the kidneys,liver, and pancreas, and is also present in meatsand fish that should be a part of an athletes nor-mal diet. A synthetic version can be taken as a toolfor building muscle mass because of its effect onpostexercise muscle regeneration and energy

stores. A dosage of 3-5 mg a day is adequate formaintaining muscle creatine, and ingestion of 20-25 mg for 5-7 days decreases the normal decline inforce or power produced during short durationmaximal bouts of exercise, though increases aresmall. However, this supplement has not beenshown to improve longer duration, aerobic exer-cise. The side effects of creatine use can include:gastrointestinal distress, muscle cramping, strainsand sprains caused by overexertion, and a reduc-tion in the bodys natural ability to produce crea-

tine. Over time, creatine use may place an extraload on the kidneys and other organs, and in skele-tally immature players, creatine may affect muscu-loskeletal junctions. There is no research that sup-ports the safety of creatine use in child and adoles-cent athletes.

Andro (Androstenedione) is a naturallyoccurring adrenal hormone that is a precursor forboth testosterone and estrogen in the body.Structurally, it is similar to anabolic steroids and ispromoted to produce the same effects on the body.

27


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However, scientific evidence does not support theanecdotal reports of enhanced performance orbody composition. Furthermore, andro does havesteroid-like side effects, including liver damage,heart disease, shrunken testes, low sperm count,and violent mood swings.

Other supplements that are marketed as beingable to boost energy and increase muscle include:herbs and herbal extracts (ginseng, gingko biloba),bee pollen and derivatives (royal jelly), and aminoacid-like compounds (l-carnitine). It is extremely dif-ficult to keep up with each of these types of sup-plements, and there is little scientific evidence sup-porting their effectiveness. A coach is advised tocounsel his athletes to avoid such products at alltimes.

Heres a suggested check list for making nutritionand substance recommendations to high school andyouth athletes: Research scientific evidence to support the use

of the substance or diet modification. Establish safety profiles for athletes at the youth

and high school level. Address gender-specific risks. Inform the administration of your

recommendations. Ensure that school board policies permit your

recommendation. Encourage your assistant coaches to use the

same guidelines. Ensure that parents are informed before theminor athlete is presented the material.

Ensure that informed consent is documentedand signed by parents and athlete.

The use of any ergogenic aid, regardless of itspotential risks and benefits, fosters the doping mentality that can lead to abuse and safety issues.Youth and high school football coaches should pro-mote proper training and nutritional habits to

improve the athletic performance of young playerswithout the use of ergogenic aids.

28


ACSM Current Comment: Caffeine and Exercise Performance http://www.acsm.org.

ACSM Current Comment: Creatine Supplementation http://www.acsm.org.

The physiological and health effects of creatine supplementation, ACSM Roundtable 2000

http://www.acsm.org.

United States National Institutes of Health (NIH) Office of Dietary Supplements http://ods.od.nih.gov/.

CAP

PY

JACKSON


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The use of anabolic-androgenic steroids has plagued sports for morethan a half century. There should not be a controversy about steroiduse in sports; nonmedical use is illegal and banned by most, if not all,major sports organizations.

ANABOLIC-ANDROGENIC STEROIDS


Anabolic-androgenic steroids are synthetic derivativesof the naturally occurring male hormone testosterone.

Anabolic means to build, and refers to the muscle-building effects of these hormones.

Androgenic refers to their masculinizing effects such astriggering the maturing of the male reproductive systemin puberty, including the growth of body hair and thedeepening of the voice.

No anabolic-androgenic steroid is 100 percent anabolicor 100 percent androgenic; all possess a combination ofthe two.

The use of anabolic-androgenic steroids to enhanceperformance is not only illegal, it is dangerous.

Using steroids often results in dangerous personalitychanges including exaggerated aggression anddepression.

Anabolic-androgenic steroids can retard growth andmaturation.

Abused steroids are often obtained from clandestine

laboratories or are smuggled into the United States, andalso include veterinary steroids.

The abuse of these substances is readily determined byurine drug tests.


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Recent evidence suggests that steroid use amongadolescents is on the rise. The 1999 Monitoring theFuture survey (conducted by the National Institute ofDrug Abuse) of drug abuse among adolescents inmiddle schools and high schools across the UnitedStates estimated that 2.7 percent of eighth andtenth graders and 2.9 percent of twelfth gradershad taken anabolic-androgenic steroids at least oncein their lives. This represented a significant increasesince 1991. Although the abuse is higher among

boys, the rate of increase among girls is rising.Athletes primarily abuse steroids in an attempt to

increase muscle size/strength and to reduce bodyfat. Some have used steroids to reduce recovery timeafter workouts, others to increase aggressiveness. Itis not surprising that they have been especially pop-ular in competitive sports in which strength is a fac-tor, or in sports such as weightlifting. Some adoles-cents abuse steroids as part of a pattern of high-riskbehavior such as drinking and driving, not wearingseatbelts, and abusing other illicit drugs.

Anabolic-androgenic steroids can be taken orally,injected, or applied to the skin in the form of patch-es, gels, or creams. Typically, they are taken in dosesmarkedly in excess of the amounts prescribed forlegitimate medical purposes. Frequently they arestacked, which means that a variety of steroids aretaken at once. They also are pyramided and cycledover 6-12 weeks. In such a regimen, the steroids arestarted at a low dose, gradually increased to a peakin the middle of the cycle, then gradually reduced tolow doses at the end of a cycle. Typically, the abuserwill not use steroids for many weeks in an effort tohave the body return to normal.

There are numerous side effects associated withanabolic-androgenic steroid abuse, including majorpersonality changes, heart attacks, strokes, and sud-den death. Some of the side effects are obvious, suchas males developing a high-pitched voice, enlargedbreasts, severe acne, and shrunken testicles. Some ofthe side effects depend on how the drug was taken.

For example, oral forms can result in liver disease,while the use of needles for injections can result ininfections such as HIV and hepatitis.

Steroid use in adolescents can retard growth anddevelopment. It is particularly important to remem-ber that unlike most other drugs, the negativeeffects of steroids may not be apparent for monthsor years.

Nonmedical use of steroids is dangerous and ille-gal. The negative effects of anabolic-androgenicsteroids are not just physical. Abusers can be

depressed, irritable, and very aggressive (roid rage).There also is evidence that they can be addictive.

30


Wadler, G.I. & Hainline B. Drugs and the Athlete. F.A. Davis, Phila. 1989.

www.steroidabuse.org Information on Anabolic Steroids. A service of the National Institute of Drug Abuse.

www.drugabuse.gov Website of the National Institute of Drug Abuse.

ACSMS Handbook for the Team Physician, Williams and Wilkins, Baltimore, 1996.

Yesalis, C.E. (Ed.). Anabolic Steroids and Sports and Exercise, Human Kinetics, Champaign, 1993.

J.

D.

RIDLEY


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Medical Issues


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There are several objectives in requiring a prepartici-pation examination for all youth and high schoolathletes. The examining health-care professionalseeks to detect conditions that may predispose theathlete to sudden death, illness, or injury. An exami-nation should be performed by a physician prior toa players initial football season, and repeated atleast at two year intervals.

The preparticipation examination should include acomplete medical history detailing past injuries, ill-

nesses, and surgeries; use of supplements and med-ications; drug and other allergies; and signs orsymptoms of problems that can be affected byexertion. The physical exam should measure height,

weight, visual acuity, and vital signs, and examineall systems affected by exercise. The final dispositiondetermines clearance for participation and considersthe following questions: Does participation placethe athlete or another participant at risk for injury?Can the athlete safely participate with treatment(medication, rehabilitation, braces, or padding)?Can limited participation be allowed while evalua-tion and treatment is conducted? Are there otheractivities in which the athlete can safely participate?

If clearance for participation is denied, the physi-cian should make recommendations for treatmentor alternative participation based on the athleteshealth and safety.

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Prior to participation in youth and high school football, all playersshould be required to undergo a medical examination by a physician.The purpose of this examination is to detect pre-existing conditions tobetter insure safe participation during training and competition.

PREPARTICIPATION EXAMINATIONS


Prior to initial participation in youth or high schoolfootball, each player should be examined by a qualifiedphysician at least every two years.

The examination should be performed to detectconditions that predispose a player to sudden death,injury, or illness.

If clearance for participation is denied by a physician,the physician should recommend alternate activities asthe athletes condition permits.


ACSM Current Comment: Pre-participation Examinations http://www.acsm.org.

Pre-participation Physical Evaluation (Second Edition): AAFP, AAP, AMSSM, AOSSM, AOASM; McGraw-Hill, 1996.


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As a child grows, the heart becomes stronger andthe lungs larger. A young athlete also experiences anincrease in stamina, or endurance, during adoles-cence. It is important that coaches be mindful thatas some players heart and lungs become morephysically fit, they may unknowingly push a less-developed skeletal or muscular system to the pointof injury. The consequences of overuse include stressfractures and muscle strains. Psychologically, a rapidincrease in endurance leading to more time spent insport and exercise may also result in player burnout.

Around age 12, most boys undergo what is com-monly called a growth spurt, lasting 2-4 years. Asthe skeleton elongates and a player grows strongerand faster, the growth plates become a weak link inthe skeletal system, and are susceptible to injury. Leftuntreated, growth plate injuries can arrest bonegrowth and cause long-term orthopedic difficulties.In addition, the muscles and other soft tissue of arapidly growing child do not keep up with the bonegrowth. This can result in a lowered flexibility ormuscle tightness in these athletes. Coaches should

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Physiological and psychological changes can greatly affect athletes in youtor high school football. Youth coaches need to know how to deal with keygrowth and development milestones that may affect participation.

GROWTH AND DEVELOPMENT


Adolescence is characterized by many physiological andpsychological changes that may affect a players healthand performance.

A youth or high school football coach must be awareof each players developmental status and any potentialinjuries or health issues that might occur because ofskeletal or muscle growth, increases in endurance,and emotional turmoil.

Engaging in rigorous sporting activities duringadolescent skeletal growth may result in dangerous growthplate injuries. Preventive measures include use of properprotective gear and warm-up and stretching instruction.

Increases in endurance and duration of time in practicemay predispose a player to overuse injuries.

In addition to monitoring a players physicaldevelopment, a coachs responsibilities include beinga positive role model for healthy emotional andintellectual maturation.

The youth coach must recognize the difference inmaturation rates among athletes and be mindful of size,coordination, and strength differences among athletes.


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develop a stretching and flexibility regimen in whichall players participate regularly.

Physical characteristics of a male adolescentsgrowth spurt include a large increase in muscle massand some body fat (up to 40 pounds) and growth inheight of up to 12 inches. An adolescents growthspurt is more closely tied to the skeletal age or mat-uration than it is to the chronological age. Facial

hair, pubic hair, and underarm hairas well as thepossible appearance of acneare all physical indica-tors of the onset of puberty.

Puberty can also be an emotional roller coasterfueled by the pressures of school and fluctuatingsocial status. Puberty can interfere with a playersability to maintain attention on the field, thusincreasing the chance of injury. A good coach servesas a liaison between the adult and adolescentworlds, bridging the communication gap by becom-ing a positive role model.

Because athletes mature at different rates, someplayers on a youth football team will be develop-mentally behind others. Body size, coordination, andmuscular strength are three key physical factors thatwill differ. These differences can result in anincreased risk of injury in the less-developed child,particularly in a contact sport. Coaches should beaware of these developmental differences when

matching players in one-on-one drills.A coach must be aware of the overall and individ-ual development status of all players on the team.Considerations should be given to the risk of growthplate and overuse injuries. A muscle stretching pro-gram, consistently used, can help alleviate muscletightness associated with periods of rapid skeletalgrowth and development. Open communicationcoupled with positive role modeling will help coach-es guide players through their psychological andemotional maturation.

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MIK

E

MOORE


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Team physicians must be qualified medical doctors(M.D.) or doctors of osteopathy (D.O.) who possessan extensive knowledge of emergency care as itrelates to sports injury and illness. The physicianshould be trained in basic cardiopulmonary resusci-tation and be knowledgeable about childhood ill-nesses and conditions related to sport and exercise.

When dealing with prepubescent and teenage

athletes, it is also important that the physician andcoach maintain open communication with playersregarding other health issues, including nutrition,substance abuse, and sexual matters.

The team physician should be responsible formanaging injuries that occur on the field and ill-nesses that arise during the playing season. He orshe should also be used as a consultant, and shouldmaintain communication with each athletes pri-mary care physician. In the case of injury or illness,the physician should counsel the coach, the player,and the parents regarding rehabilitation and make

the final determination regarding return to play.In addition, a physician and coach should worktogether to coordinate preparticipation examinations.

A good working relationship between a coach and team physician willimprove the health and safety of the football team.

WORKING WITH A TEAM PHYSICIAN


A coach and team physician should form a partnership forthe medical care of young athletes.

The duties of a team physician include managinginjuries, illnesses, and medical emergencies; makingreturn-to-play decisions; performing preparticipationexaminations; and knowing players medical records.

Coaches should defer to the judgement and experience ofteam physicians when discussing a players rehabilitationand return to play. However, because the coach andphysician each has a different relationship with and rolein a players health and safety, the two should consulteach other when making recommendations to the athleteand family.


The ACSM Team Physician Consensus Statement, 1999 http://www.acsm.org.

Dyment, P.G. (Ed.). Sports Medicine: Health Care for the Young Athlete. American Academy of Pediatrics 1991, p. 188.

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Athletic trainers should be nationally certified withinstruction in the prevention, recognition, evalua-tion, management, and treatment of sports-relatedinjuries. Specifically, an athletic trainer should pre-pare athletes for practice and competition throughtaping, bandaging, and bracing; monitoring thefield of play for safety concerns; and ensuring thatfluids are available for the athletes. When an injury

occurs, an athletic trainer can provide immediatefirst aid and evaluate the need for further medicaltreatment. Trainers work under state laws and maybe required to have a physician supervise their

activities and approve evaluation and treatmentprotocols. In addition to sports injuries, an athletictrainer should be certified in basic cardiopul-monary resuscitation (CPR) and be prepared tohandle administrative duties such as medicalrecord keeping.

Athletic trainers can be extremely helpful inadvising a coach on appropriate muscular

strength, conditioning, and stretching programsfor youth football players. A trainer also ensuresthat first-aid supplies, tools kits, and emergencysupply kits are constantly well stocked.

GO ONLINE AT WWW.NFLHS.COM/HEALTHMORE READINGNational Athletic Trainers Association website, http://www.nata.org.

National Council of Athletic Training website, http://www.ncat.org.

The Conditioning of Athletes for Sport: A Consensus Statement, 2001, http://www.acsm.org.

Dyment, P.G. (Ed.). Sports Medicine: Health Care for the Young Athlete, American Academy of Pediatrics 1991, p. 201.

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An athletic trainer is often the first, and perhaps the only, health-careprofessional with regular access to youth athletes. A coach should know howto work with an athletic trainer to provide the best on-site preventive careand practical first aid for young football players.

WORKING WITH AN ATHLETIC TRAINER


A youth or high school football team should take fulladvantage of the skilled professional services afforded byan athletic trainer.

A coach of young athletes should look to an athletictrainer to provide on-site preventive care, evaluation,and management of sports-related injuries.

Athletic trainers can serve as liaisons between the coachand the physician by providing information on the causeand type of injury incurred, and by assisting with on-siterehabilitation.

Athletic trainers can take on administrative responsibil-ities such as medical record keeping as well as ensuring a

constant supply of medical and first-aid equipment.


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Viral illnesses such as the common cold or flu can greatly affect aplayers health and performance. Athletes spend a good deal of time inclose contact with one another, so it is important to reduce the riskof viral transmission.

COLDS AND FLU IN ATHLETIC COMPETITION


Players and team personnel involved in youth or highschool football should maintain good hygienic practices,such as frequent hand washing, and should avoid sharingwater bottles, cups, mouth guards, or other personalitems.

Exercising in the cold or damp does not increase the riskof viral infection.

Regular exercise is one of the best ways to reduce a youthsrisk of developing viral infections and other illnesses.

If symptoms of a common cold (runny nose or sore throatwithout fever or body aches) are present above the level ofthe neck only, moderate intensity participation may be

allowed. If symptoms, including fever, are present belowthe neck, or are associated with muscle cramping, partic-ipation should not be allowed until the symptoms haveended.

Players exhibiting symptoms of a viral infection shouldtake care to limit the amount of infected particles trans-mitted into the air via coughing and sneezing.

If a coach is in doubt about the type of infection a playeris carrying, if a player does not appear to be improving

from an infection, or if symptoms last longer than fivedays, a physician should examine the player to determinethe type of infection and make return-to-play suggestions.


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Basic hygiene practices can greatly reduce the riskof viral transmission on a team. Players and teampersonnel should adopt frequent hand washing,maintain cleanliness of equipment and lockerrooms, and never share personal items such astoothbrushes, mouthguards, cups, water bottles,utensils, eye drops, towels, combs, or brushes.

Players experiencing symptoms of a serious infec-tionfever, coughing, sneezing, extreme tiredness,body aches, or swollen glandsshould be removedfrom activity at least until the symptoms subside.Viruses are generally transmitted from person toperson by the inhalation of airborne particles ordirect contact with saliva or body fluids. Athleteswith cold and flu symptoms should be careful tocough or sneeze into clean, disposable tissues andto wash their hands often.

If symptoms of a common cold (runny nose or

sore throat without fever or body aches) are presentabove the level of the neck only, the player shouldbe removed from play until the major symptomssubside, and care should be taken to limit exposure

to other players. Moderate intensity participationmay be allowed once the symptoms have lessened.A return to full intensity can be allowed two orthree days after the symptoms have ended. If symp-toms including fever are present below the neck orare associated with muscle cramping, participationshould not be allowed until the symptoms haveended. Athletes should gradually be allowed to par-ticipate up to full speed. If cold-like symptoms lastfor more than five days, particularly if there is nonoticeable improvement, the athlete should see aphysician to determine the type of infection pres-ent. Viral infections other than colds and flu(mononucleosis, for example) are possible and mustbe treated by a physician.

If allowed to participate during or shortly after aserious vir

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