Sports Medical Conditions

Medical conditions have a relationship to two related, but distinct, sport issues—the ability of an individual athlete to generally participate in sport, and the more refined pursuit of sporting excellence. Depending on the nature of the condition, medical circumstances will either influence or dictate sport outcomes.

The consideration of medical conditions that affect sport is not made in a uniform manner. Child and adolescent athletes are subject to different considerations than are adults, particularly with respect to the general musculoskeletal development of young persons, and with regard to growth plate considerations in particular. Conditions that are directly related to the aging process such as osteoarthritis and other physiological considerations will influence the relationship between medical conditions and sport participation for older persons.

The determination of what effect, if any, a medical condition may have on the performance of a prospective sport by an athlete will first require an assessment of the relative risk posed by participation to the athlete. The American Pediatrics Association developed a useful categorization formula in 1994 that is now widely employed in pre-participation sport assessments made by physicians. In this method, the risk of participation is examined with reference to the degree of physical contact in the activity. Sports are classified as contact or collision sports, limited/incidental contact sports, and non-contact sports.

Contact or collision sports include ice hockey, American football, rugby, and Alpine skiing (due to the risk of high speed falls or collisions with fixed objects on the ski hill). Limited or incidental contact sports include basketball, soccer, cycling (risk of falls), inline skating (risk of falls), baseball and softball (base runner collisions), and various athletics field events where contact is made with a landing area, such as the high jump. Sports that are of limited risk to the athlete when performed in isolation may present a more significant risk where there are repetitions required in training.

Non-contact sports include all running disciplines, volleyball, sailing, athletics field events such as the shotput, and archery.

In any circumstance where there is an issue as to the physical durability of the person proposing to participate in a particular sport, these classifications are useful. However, the degree of risk to a particular participant is not limited to the degree of physical contact created in the sport. An equally important consideration is the level of physical intensity with which the participant is expected to perform in the sport. Intensity can be weighed in most sports through the impact that participation imposes on the cardiovascular and cardiorespiratory systems and their related functions.

Intensity is a measure that itself has a number of different dimensions. Intensity has been defined as a combination of the dynamic demands on the cardiovascular system, or the volume of work imposed on it by a sport activity, and the static demands, the pressure placed on these systems. Intensity is also affected by the related factors of training levels and the emotional level of the competitive environment and those required of the athlete to compete. A sport that places the athlete at moderate risk of injury caused by physical contact, such as volleyball, places significant mental and emotional demands on the competitor when the venue is a state championship or an international tournament. Emotional considerations apart, high-intensity sports include running, rowing, cycling, cross-country skiing, and lacrosse. Moderate-intensity sports include volleyball, sailing, baseball, and cricket. Curling, golf, and archery are examples of low-intensity sports,

With the two different methods of defining the relationship between sport and a known medical condition, the athlete can be cross-referenced against two valid standards. Some common medical conditions have two means of comparison to explain how the impact of a medical condition can be assessed in a particular sport. Skeletal and structural conditions are often revealed through sport participation and not before. Factors such as uneven leg length, a congenital weakness in a bone formation or reduced bone density, the onset of osteoarthritis, and similar medical conditions are made apparent through sport when they were not necessarily apparent in daily life. The assessment of these conditions from a contact/collision perspective is very important; in some high-intensity sports, the stress of repetitive action may pose significant problems for the athlete. When the preexisting skeletal condition is known, sports posing physical risk should be avoided. In some cases, when the assessment reveals a structural imbalance, the athlete will be encouraged to obtain an orthotic or other corrective device.

Identified cardiovascular system problems will require an intense physical assessment as a part of the participation analysis. Potential cardiovascular conditions that have a significant impact on athletic participation include self-induced conditions such as hypertension and arteriosclerosis, usually precipitated by poor dietary practices, as well as congenital problems such as a heart murmur, heart arrhythmia, and various types of irregularities in the heart muscle wall. The true extent of these conditions is sometimes impossible to define; common tools to assist in the determination are stress tests involving heart monitors and related assessments.

Eating disorders such as anorexia nervosa and bulimia often occur among young female athletes in sports where there exists considerable pressure, both among peers and coaches, as well as that imposed by the nature of the sport itself to possess a particular body type. When such disorders are identified, the athlete should be removed from the competitive and training environment in which the disorder arose until the disorder has been entirely resolved. An eating disorder is well recognized in the medical community as a serious mental illness that requires thorough medical attention; sport participation should not be renewed until the athlete is well.

Diabetes is increasingly common in both adolescents and adults; in most circumstances, a diabetic condition can be properly controlled through diet. Many athletes have succeeded in high-intensity settings with a diabetic condition with proper monitoring and support.

Neurological conditions, such as a history of concussion caused by blows to the head or jaw, can produced cumulative effects; each successive blow to the head represents a progressively greater risk of permanent brain injury than the previous incident. The athlete must be assessed not only from the perspective of the general risks of the particular sport, but what level of risk within the sport remains for the particularly vulnerable athlete, if the maximum amount of protection were available.

In most cases, the safety of the athlete is of lesser consideration when a partial loss of vision will be primarily a performance issue. An example is American ice hockey player Bryan Berard, who lost all of the sight in one eye playing in a National Hockey League (NHL) game in 2000. Berard continued his career after satisfying league officials that he could perform at a professional level with one fully functional eye.

As a neurological condition, epileptic seizures will require a careful assessment of the seizure history of the athlete and the effect of available anti-seizure medication on different types of sport-imposed physical stress.

People who are either clinically obese or who are significantly overweight must proceed with a physical training program with considerable caution. The chief risks associated with sport in these circumstances are the additional stresses placed on the joints of the body, as well as the pressures created for the cardiovascular system.

People who have had a kidney removed must approach sports involving significant fluid losses and rehydration with caution; warm weather and endurance exercise require the kidneys to operate at maximum capacity in the maintenance of optimal sodium/fluid balance. On the other hand, damaged internal organs, such as a damaged kidney or an enlarged spleen, are almost always a condition that will exclude participation in sports that involve even a slight risk of physical contact. Further assessment must be made of the organ capacity in relation to its function relative to the demands of the relevant non-contact sport.

Existing skin disorders, such as herpes simplex I, are contagious. Sports where the athlete will have significant skin contact with apparatus or floor mats, such as gymnastics, or where there is significant skin-to-skin contact required in the sport, such as wrestling and boxing, should be those where participation is excluded until the skin condition is definitively cleared.

Asthma and related breathing conditions are among the most common of medical conditions that affect sports participation. The cause of asthma, which is an inflammation and a consequent narrowing of the bronchial passages and airways leading to the lungs, is both hereditary and environmental in nature. Certain types of people have a predisposition to asthma; other persons are susceptible to a condition known as sport-induced asthma. Almost all forms of asthma can be treated for the purpose of permitting an athlete to fully participate in any sport with appropriate and carefully monitored medical support. Other asthma conditions are those that the young athlete tends to outgrow. The most common medication used to treat asthmatic conditions are inhaled corticosteroids, which are generally taken on a daily basis. When the athlete feels the distress from the onset of an asthma attack during competition or training, a bronchodilator is employed, such as Albuterol, a beta2 agonist (a chemical that mimics the effect of adrenaline and tends to work to open the affected passages).

SEE ALSO Eating disorders in athletes; Health; Psychological disorders; Sport psychology; Sports medicine education.