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Selected Issues in Sport-Related Concussion (SRC|Mild Traumatic Brain Injury) for the Team Physician: A Consensus Statement is title 22 in a series of annual consensus documents written for the practicing team physician. This document provides an overview of selected medical issues important to team physicians who are responsible for athletes with sports-related concussion (SRC). This statement was developed by the Team Physician Consensus Conference (TPCC), an annual project-based alliance of six major professional associations. The goal of this TPCC statement is to assist the team physician in providing optimal medical care for the athlete with SRC.

In January 2012, the National Athletic Trainers' Association, along with the National Strength and Conditioning Association, convened a meeting in Colorado Springs, Colorado. Its purpose was to hold an interdisciplinary forum and gather input to address sudden death in collegiate conditioning sessions. Based on these discussions, a writing group drafted the following recommendations. To date, these best practices have been endorsed by the American College of Emergency Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, American Osteopathic Academy of Sports Medicine, Canadian Athletic Therapists' Association, Collegiate Strength and Conditioning Coaches association, Gatorade Sports Science Institute, Korey Stringer Institute, National Academy of Sports Medicine, National Athletic Trainers' Association, and National Strength and Conditioning Association. Other reviewers and meeting participants are listed with the professional organizations they represent at the end of this article. Maximizing strength and conditioning sessions has become fundamental to sport. The right combination of strength, speed, cardiorespiratory fitness, and other components of athletic capacity can complement skill and enhance performance for all athletes. A sound and effective training program that relies on scientific principles of exercise physiology and biomechanics intended to produce outcomes that are sensitive and specific to the sport should be the goals. Unfortunately, the athlete's development, health, and safety are sometimes overshadowed by a culture that values making athletes tough, instilling discipline, and focusing on success at all costs. This ill-conceived philosophy has been a contributor to the alarming increase in collegiate athlete deaths and serious injuries during conditioning sessions. A total of 21 National Collegiate Athletic Association (NCAA) football players have died during conditioning workouts since 2000.1 The 3 most common causes of the fatalities were (in order) exercise-related sudden death associated with sickle cell trait (SCT), exertional heat stroke, and cardiac conditions.1 Seventy-five percent of the fatalities (n = 16) were Division I football players. Also, the incidence of exertional rhabdomyolysis in collegiate athletes appears to be increasing. Excesses in strength training and conditioning—workouts that are too novel, too much, too soon, or too intense (or a combination of these)—have a strong connection to exertional rhabdomyolysis. Introducing full-intensity workouts too quickly is especially high risk: 11 of the 21 deaths occurred during day 1 or day 2 workouts. Rule changes enacted in 2003 related to heat acclimatization procedures during August football practices have been extremely effective. In the NCAA Division I Football Bowl Subdivision, no player died from practicing or playing in a game between 2000 and 2011. However, conditioning workouts continue to be a catalyst for catastrophic outcomes. It is imperative that similar guidelines be implemented to improve the safety of conditioning sessions. This consensus statement provides specific conditioning recommendations with the intent of ending conditioning-related morbidity and deaths of collegiate athletes.

Studies in our laboratory and elsewhere require the analyses of stable lead (Pb) isotopes at sub-ppb levels as tracers of lead metabolism and therapeutic chelation treatment in animal models and humans. While analytical alternatives such as thermal ionization mass spectrometry (TIMS) provide excellent isotope measurement sensitivity and precision, TIMS is not well-suited for rapid throughput of large numbers of biological samples. Here we report the development of an inductively coupled plasma magnetic sector mass spectrometry (Finnigan MAT Element) method, possessing suitable lead isotope measurement sensitivity and precision for use in biologically stable lead isotope tracer studies in which the natural relative abundance of one or more isotopes (i.e., 204Pb, 206Pb, 207Pb, or 208Pb) has been enriched by >5%. Standard reference materials (SRMs) NBS 981 lead isotope standard and four different NIST biological SRM materials were spiked with bismuth-209 as an internal standard, and analyzed at lead concentrations of 1–10 ppb. The method consisted of 300 passes per sample for masses 201, 204, 206, 207, 208 and 209, with a total analysis time of about five minutes per sample. Concentrations for 204Pb, 206Pb, 207Pb, and 208Pb were determined by comparison to a certified lead concentration standard that had been isotopically characterized by TIMS. Analyses of lead concentrations in the NIST biological SRMs yielded a measurement accuracy (recoveries) of 96–101%, with a detection limit of 0.013 ppb total lead. Accuracy of isotope abundance analyses of NBS SRM 981 (n=12) was 99.92–99.99% of that expected for all four isotopes, with a measurement precision of 0.07–0.22% RSD. Thus, this method is ideally suited for the rapid, accurate, and precise measurements of lead concentrations and stable isotope abundances in lead isotope tracer studies in animals and humans, where one or more lead isotopes are enriched above natural levels.

ObjectivesTo help athletic trainers promote a “food-first” philosophy to support health and performance, understand federal and sport governing body rules and regulations regarding dietary supplements and banned substances, and become familiar with reliable resources for evaluating the safety, purity, and efficacy of dietary supplements.BackgroundThe dietary supplement industry is poorly regulated and takes in billions of dollars per year. Uneducated athletes need to gain a better understanding of the safety, eligibility, and efficacy concerns associated with choosing to take dietary supplements. The athletic trainer is a valuable athletic team member who can help in the educational process. In many cases, athletic trainers are asked to help evaluate the legality, safety, and efficacy of dietary supplements. For this position statement, our mission is to provide the athletic trainer with the necessary resources for these tasks.RecommendationsProper nutrition and changes in the athlete's habitual diet should be considered first when improved performance is the goal. Athletes need to understand the level of regulation (or lack thereof) governing the dietary supplement industry at the international, federal, state, and individual sport-participation levels. Athletes should not assume a product is safe simply because it is marketed over the counter. All products athletes are considering using should be evaluated for purity (ie, truth in labeling), safety, and efficacy.

Douglas J. Casa, PhD, ATC, FNATA, FACSM (Chair)*†; Jon Almquist, VATL, ATC*; Scott A. Anderson, ATC*; Lindsay Baker, PhD‡; Michael F. Bergeron, PhD, FACSM§; Brian Biagioli, EdD||; Barry Boden, MD¶; Joel S. Brenner, MD, MPH, FAAP#; Michael Carroll, MEd, LAT, ATC*; Bob Colgate**; Larry Cooper, MS, LAT, ATC*; Ron Courson, PT, ATC, NREMT-I, CSCS*; David Csillan, MS, LAT, ATC*; Julie K. DeMartini, MA, ATC†; Jonathan A. Drezner, MD††; Tim Erickson, CAA‡‡; Michael S. Ferrara, PhD, ATC, FNATA*; Steven J. Fleck, PhD, CSCS, FNSCA, FACSM§§; Rob Franks, DO, FAOASM||||; Kevin M. Guskiewicz, PhD, ATC, FNATA, FACSM*; William R. Holcomb, PhD, LAT, ATC, CSCS*D, FNATA, FNSCA§§; Robert A. Huggins, MEd, ATC†; Rebecca M. Lopez, PhD, ATC, CSCS†; Thom Mayer, MD, FACEP¶¶; Patrick McHenry, MA, CSCS*D, RSCC§§; Jason P. Mihalik, PhD, CAT(C), ATC##; Francis G. O’Connor, MD, MPH, FACSM††; Kelly D. Pagnotta, MA, ATC, PES†; Riana R. Pryor, MS, ATC†; John Reynolds, MS, VATL, ATC*; Rebecca L. Stearns, PhD, ATC†; Verle Valentine, MD††