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The article reports on the weight cutting rules for wrestlers as finalized by the National Federation of State High School Associations (NFHS). The new rules, approved by the NFHS board of directors in April 2005, establish a minimum weight certification program at the national level. The most significant rule change outlines a weight management program. Beginning in the 2006-2007 session, a wrestler's hydration level should not exceed 1.025, body fat percentage must not fall below 7% for boys or 12% for girls, and weight loss is limited to 1.5% of body weight per week. Another rule revision limits the amount of weight a wrestler can gain during consecutive days of competition. Wrestlers can now gain no more than 2 pound; the previous rule allowed them to gain 1 pound for each consecutive day of competition, regardless of the number of days. Among other safety-related rule changes that do not relate to weight cutting, all pads worn by wrestlers must fit snugly against the body to avoid an opponent's hand getting caught between the pad and the wrestler.

The article presents brief news related to the happenings at the 2004 Boston Marathon Race. The racecourse starts on the town green of a small rural village and then spills through bigger towns until it reaches the finish line in downtown Boston, Massachusetts. Healthcare professionals who have an interest in covering marathons often look to the Boston event, the oldest and largest of its kind in the United States, for guidance and inspiration. So when 87 degree Fahrenheit temperatures at the 2004 race nearly overwhelmed the medical system, the medical community took notice, hoping to learn from challenges the medical team faced and the adaptations planned for next year's race.

This article reports that obstacles such as cost, staffing, and the likelihood of false-positives have prevented cardiac diagnostic tests such as 12-lead electrocardiography (ECG) from becoming a routine part of the preparticipation examination (PPE) in most countries, including the United States. Two international medical groups, however, have recently endorsed the inclusion of the 12-lead ECG in the PPE. In December 2004, the International Olympic Committee (IOC) medical commission released a consensus statement that outlines standards for the cardiac PPE, which includes 12-lead ECG testing. The IOC statement, commonly referred to as the Lausanne recommendations, advises that participants in competitive sports who are younger than age 35 undergo a preparticipation cardiovascular screening at least every other year.

This article focuses on acute and chronic pain,which characterize most conditions that sports medicine physicians treat. Though cyclooxygenase-2 (COX-2) inhibitors are no more effective for the treatment of pain and inflammation than other nonsteroidal anti-inflammatory drugs, their gastroprotective effects have made them an attractive option for patients who are at risk for gastrointestinal bleeding, particularly those who are on longterm pain medication for conditions such as osteoarthritis and rheumatoid arthritis. The US Food and Drug Administration approved the first COX-2 inhibitor in 1998, followed by rofecoxib and valdecoxib.

This article reports that as football, wrestling and other contact sports seasons get underway, physicians are bracing for more waves of methicillin-resistant Staphylococeus aureus (MRSA) infections. David D. Cosca, MD, a family practice physician in the sports medicine department at the University of California, Davis, says the UC-Davis football team has had several occurrences of MRSA infection, and that many players required hospitalization for intravenous (IV) antibiotics, surgical incision and drainage. Once associated only with nosocomial outbreaks, MRSA skin and soft-tissue infections among athletes appear to be part of a trend toward wider community emergence.

Recent, high-profile heat illness deaths in professional sports have heightened interest in technological tools that can prevent future fatalities. Other examples of research applications have included tracking circadian rhythm over phases of the menstrual cycle,¹ recording the core temperatures of search and rescue divers during extreme conditions,² and determining core body temperature in patients who have chronic fatigue syndrome. Wireless temperature monitoring is most likely to be used during activities that involve great heat exposure.

Despite rising obesity rates, fewer healthcare professionals are counseling patients about weight loss, according to recent findings from the U.S. Centers for Disease Control and Prevention. The data come from the Behavioral Risk Factor Surveillance System, a state-based telephone survey of adults ages 18 and older. Among the respondents who were categorized as obese according to their body mass index. 42% in 1994 had been advised by a health professional to lose weight. In 2000, however, the percent advised to lose weight decreased to 40%. The decrease is statistically significant. The researchers also explored whether patients attempted to lose weight after having been counseled by a healthcare professional.

Few topics in sports medicine generate as much passion as the word "specialty." The topic has risen to the forefront of discussions in sports medicine circles recently in response to the United States-based American Board of Medical Specialties' March 2003 approval of an orthopedic sports medicine subspecialty. Currently, there is no sports medicine subspecialty for physiatrists, though plans are underway to allow physiatrists to sit for the primary care sports medicine subspecialty exam or to pursue their own subspecialty certification, says Michael Fredericson, physical medicine personnel. Primary care personnels see the new orthopedic sports medicine subspecialty as a benefit for the wider sports medicine community.

Public health efforts have successfully reduced the burden of osteoporosis on women, and now experts — who anticipate an epidemic of the disease in men in the coming decades — say it's time to do the same for men. Many men, and perhaps even some of their healthcare providers, might be surprised to know that a man's risk of an osteoporosis-related fracture is greater than his risk of prostate cancer. Primary causes of osteoporosis in men are related to aging or genetic factors.

Focuses on the motivation of patients to exercise using pedometers. Description of a pedometer; Measurement of the walking distance using the pedometer; Significance of the pedometer on the '10,000' step concept; Technology involved in exercise gadgets. INSET: Heart Rate Monitors: Advances and Practical Points..

Reveals the symptoms of muscle dysmorphia. Unhealthy practices stemming from changing images of the 'ideal' male physique; Insights from the book 'The Adonis Complex: The Secret Crisis of the Male Body Obsession,' by Roberto Olivardia; Treatment steps.

Discusses ways by which physicians could counsel patients about the health benefits of exercise. Importance of physician counseling about exercise to improving patients' health status and to the success of several activity recommendations contained in the United States government's Healthy People 2010 initiative; Effectiveness of exercise counseling; Advice on how to bring up the exercise issue with patients.

Focuses on the emergence of diverse philosophies on healthy aging. Principles of anti-aging medicine; Foundations of successful aging; Similarities of anti-aging medicine to sports medicine; Implications of aging-related demographic trends.

Reports on the benefits and pitfalls of physician referral of patients to personal exercise trainers. Increasing number of aged with chronic conditions; How personal trainers help; Referral tips; Certification of personal trainers; Insurance and cost. INSET: Finding personal trainers and certification information..

Reports on the role of school physical education in curbing the increasing obesity and inactivity among children. Emphasis on lifetime physical activity and fitness; Need for children to be physically active; Amount of PE recommended for children; Long-term health effects of PE; Tips for physicians who want to promote and support PE programs.

Looks at the debate on the use of softer baseballs in an effort to reduce the severity of impact injuries to the brain, face and heart. Information on commotio cordis; Study on the use of softer baseballs in reducing the risk of commotio cordis; Suggested preventive measures. INSET: Researchers weigh in on eye issues..

Reveals that bicycling can lead to temporary or permanent impotence among men. Focusing of body weight on the pudendal nerves and artery, cavernosal artery, surrounding soft tissues, bony structures and associated sexual organs; Prevention of injury through the use of an ergonomic bicycle seat.

Focuses on the use of nonprescription drugs, such as androstenedione, to enhance the performance of sportsmen, while looking at drug use of baseball player Mark McGwire. Classification of androstendione as an anabolic steroid; Name given by bodybuilders to anabolic steroids; Comments from Lewis G. Maharam, medical doctor and sports medicine specialist in private practice in New York City, New York; Details on androstenedione.

Focuses on the use of the drug creatine monohydrate supplements by athletes, while questioning the safety of the drug. Reference to three college wrestlers who died last fall; Expected increase of creatine sales for 1998; Information on creatine; Normal daily requirements for creatine; What several studies have shown; Effects of creatine supplementation on athletes.

The article reports that clearance issues for patients who have cardiovascular conditions are some of the most difficult and sometimes contentious decisions that sports medicine physicians make, and since 1985 various iterations of the Bethesda Conference recommendations have played a vital role. To keep pace with how advances in the diagnosis and management of cardiac conditions might influence clearance decisions, physicians eagerly anticipate the release of new Bethesda recommendations, which occurred in March 2005 when the American College of Cardiology posted the document on its Web site 1 in advance of the April 19th print publication in its journal. The consensus group for the 36th Bethesda Conference, which met in New Orleans in November 2004, did not just address the clearance issues for each condition, they also provided guidance on a wide range of related topics such as preparticipation screening, the use of automated external defibrillators, drugs and dietary supplements in sports, medicolegal considerations, and commotio cordis.

The article reports that healthcare professionals who work with athletes often struggle with concussion management decisions, because symptoms vary so widely and so little clinical research exists to guide treatment. The authors urge baseline testing for athletes in high-risk sports, and that all athletes who sustain head injuries undergo serial neuropsychological and postural-stability testing along with a thorough clinical evaluation. Neuropsychological testing, once only available to elite athletes, has become more accessible to mainstream sports medicine, thanks to the wide availability of reasonably priced computerized testing programs such as CogSport, Headminder, and Impact. Though many sports medicine physicians and athletic trainers routinely use the computerized neuropsychological testing programs, some physicians say it's too soon for such testing to be recommended by sports medicine organizations, because such recognition may imply that neuropsychological testing is a standard of care.

Exercise and sports participation are gauges that many transplant patients use to measure their return to a more normal, active life. For other patients, a transplant enables them to become well enough to seek the benefits of exercise— for the first time in their lives. A Showcase for Transplant Athletes. Though there are limited data on the number of transplant recipients who exercise or play sports, the increased participation in transplant sports events may provide one snapshot of activity in this group. Though she eagerly anticipated being active, Marcy Weiner said she was surprised when her transplant physician recommended exercise as part of her post-transplant health plan.

On the heels of professional football player Korey Stringer's death in 2001 from heatstroke, there was a 2-year lull in football heat illness deaths. Two recent heat illness deaths in high school football, however, has alarmed sports medicine physicians, who are questioning current preventive efforts and discussing what more needs to be done to prevent such deaths. According to its annual survey of football injuries, released in February 2004, the National Center for Catastrophic Sport Injury Research reported that no heat illness deaths were recorded in football in 2002 or 2003.

Several studies have illustrated that exercise has a wide variety of benefits for breast cancer patients, from improving immune functioning to alleviating depression. However, a new study presented in April 2004, at the American Association for Cancer Research annual meeting in Orlando recently made health headlines because it was the first to suggest that physical activity may improve survival. The study, conducted by researchers at Harvard University, evaluated participants in the Nurses' Health Study who were diagnosed as having stage 1 to 3 breast cancer between 1984 and 1996. To avoid assessment during women's breast cancer treatment period, researchers began tracking subjects' exercise exposure at least 2 years after diagnosis. Researchers identified 2,296 women who reported physical activity after breast cancer diagnosis and 230 breast cancer deaths. Researchers concluded that even modest amounts of physical activity after breast cancer treatment may promote survival.

Paintball has moved from extreme to the mainstream, participation in the sport now numbers more than 8 million, according to the most recent estimate from the Sporting Goods Manufacturers Association. The popularity of the sport and the growing accessibility of paintball parks present a fitness option that may appeal to some patients who aren't regularly active. An analysis of the aerobic demands of the sport and advice from a paintball safety expert helps physicians make appropriate recommendations to patients.

The article focuses on the rise in children's distal forearm fractures. Physicians anticipate distal forearm fractures among young adolescents, because growing bones are more porous at a time when children are active in sports and recreational activities. Nearly all medical care delivered around Rochester, Minnesota, is available for study because medical care is centralized among a few providers and linked through the Rochester Epidemiology Project. Sundeep Khosla, MD, lead author of the study and professor of medicine in the Endocrine Research Unit at the Mayo Clinic in Rochester, says researchers were surprised by the size of the increase in distal forearm fractures.

Surgical advances and a potential new drug treatment are promising new therapies for stress incontinence. Stress incontinence — a well-known exercise obstacle — is the most common cause of urine leakage in younger women. The study group included 200 ambulatory community-dwelling women aged 40 to 78 years who had stress incontinence or mixed incontinence with stress as the primary pattern. At the end of the trial, researchers found that behavioral training plus PFES was not more effective for reducing incontinence episodes than clinic-based behavioral therapy alone.

Focuses on some devices that have made their foray into the field of physician and sportsmedicine. Way in which 'Game Ready' system, helps in preventing heat related illness among athletes; Method by which 'RTX,' from AVAcore Technologies Inc. lowers core body temperature of athletes.

Concerns about overhydration and hyponatremia among endurance athletes were once discussed only in sports medicine circles. In May, USA Track & Field, the national governing body for track and field and race walking, issued new hydration recommendations that urge runners to hydrate based on individual needs, rather than drinking as much as they can tolerate. Experts agree that successful identification and treatment of hyponatremia depends on distinguishing the condition from heat illness and other diagnoses, disagreements are about what level of hydration is optimal for the health and performance of athletes. Hyponatremia has become more common as greater numbers of less competitive athletes participate in endurance events.

Debate on the key to effective, long-term weight loss has pitted proponents of low-carbohydrate, high-protein diets against those who back low-fat diets. Research findings on the safety and efficacy of these diets and the accidental death of one of the low-carbohydrate diet proponents have renewed the focus on the diet debate. Though the study supports greater weight-loss benefits of low-carbohydrate diets, the authors pointed out several safety concerns. Guidance from physicians and dietitians are also presented.

The war in Iraq and other world events have directly and indirectly affected many military sports medicine physicians, from those stationed in battlefield medical hospitals to those in homeland clinics covering for deployed colleagues. The war setting provides an opportunity to highlight the contributions of military medicine to the treatment of civilians. World events have dramatically altered what would otherwise be routine assignments for some military physicians. Sports medicine and military medicine have become increasingly complementary disciplines, because both have a strong musculoskeletal component.

Focuses on the introduction of a laundering service for sports equipment by Kelowna, British Columbia-based Esporta Wash Systems, Inc. to reduce rashes and skin infections. Information on the availability of the services in various province in Canada; Web site address; Process of the system; Benefits of the services.

Focuses on the regulation of weight cutting practices in U.S. wrestlers. Body fat minimum weight limit set by the U.S. National Collegiate Athletic Association; Doubts expressed by members of the sports medicine community regarding the validity and fairness of minimum weight recommendation for high school students; Skinfold testing technique used by state athletic associations to help determine weight of wrestlers.

Examines the neuropsychological performance in soccer players in the U.S. Comparison of neuropsychological impairments between players and nonathletic controls; Reasons for failing to compare the U.S. and the European neuropsychological studies; Safety measures to prevent impairments.

Focuses on the plans of medical professionals for marathons and other endurance events in Boston, Massachusetts. Aim of the events; Design of the walk-in clinic; Operation of the clinic; Location.

Focuses on the impact of cycling on the health of athletes in Washington, D.C. Indication of arthritic knees; Observation of traumatic brain injury; Identification of traffic congestion.

Examines the use of portable echocardiography screening for the preparticipation physical examination of athletes in the United States. Benefits of echocardiography; Detection of identifiable conditions causing sudden cardiac death; Limitations of echocardiography screenings.

Reports on the automation of neuropsychological testing in assessing head injuries among athletes sustained with concussions. Significance of return-to-play decisions among athletes with sustained concussions; Features and functions of the healthcare tools intended for athletes; Benefits of concussion guidelines regarding head injuries diagnosis.

Examines the use of body fat testing in sports medicine. Validation of underwater weighing and dual-energy x-ray absorptiometry as body fat testing methods; Tips for physicians who want to incorporate body fat testing into their diet and activity assessments; Waist-to-hip ratio as general measures of facy distribution.

Focuses on the connection between sports training and growth delay. Evidence on sports and prepubertal growth.

Reports on the development of a lighter-weight helmet aimed at preventing cervical spine injuries among football players. Helmets and injury reduction; Design of the helmet; Warning labels that appear on the redesigned helmet models.

Reports on the status of sports medicine as a specialty in Australia. Membership rules of the Australian College of Sports Physicians; Role of the National Specialist Qualification Advisory Committee; Factors blamed for the delay of the accreditation process. INSET: What Is sports medicine? International views..

Provides information on prolotherapy, an alternative therapy used in mainstream sports medicine. American Association of Orthopaedic Medicine's offer of physicians workshops on how to perform prolotherapy and other alternative methods of treating pain.

Reports that years of analyzing crash and injury data have enabled motor sports physicians to closely predict how severe a driver's injuries will be as a crash occurs. Allure of the sports to fans; Prevention of catastrophic injuries; Connections with traditional sports medicine.

Focuses on research efforts to test athletes for growth hormone doping. Emphasis on developing tests to protect athletes from the side effects of drugs; Recognition among researchers of why testing for growth hormone abuse is more difficult.

Discusses promising breakthroughs in osteoporosis management. Ultrasound for bone density assessment; Parathyroid hormone (PTH) for treatment; Limitations of ultrasound diagnosis; Comparison of ultrasound diagnosis with dual-energy x-ray absorptiometry, the gold standard in diagnosing osteoporosis; Role played by PTH in calcium homeostasis; Self-administration of PTH with a subcutaneous injection pen.

Focuses on a class of medication for treating influenza. Ability of neuraminidase inhibitors to shorten the duration of the illness; Increase in viral inactivation by respiratory mucus; Therapeutic indications; Management of influenza in sports.

Discusses noncontact anterior cruciate ligament (ACL) injury in women. Reasons why ACL injuries are more common in women than in men; Neuromuscular differences between men and women; Training programs formulated to prevent ACL injuries in women athletes; ACL injury prevention pamphlet and video available for skiers.

Highlights a study from the Iowa State University in Ames, on the muscle-building supplement, androstenedione. Short-term effects of androstenedione in serum hormone levels and its muscle development effect; Clinical interpretations; Questions raised over the study's outcomes.

Examines the effectiveness of Lyme disease vaccination. Mechanism of action of SmithKline Beecham's Lyme disease vaccine, Lymerix; Patient risk factors; Clinical opinions on who should use the vaccine; Efforts of pharmaceutical companies to improve the dosing schedules; Dependence of the vaccine's efficacy on individual risk and geographic risk. INSET: New in-office test speeds Lyme disease detection..