COACHING THE ATHLETE WITH SICKLE CELL TRAIT

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Sickle Cell Trait In AthletesREAL LIFEA
Common Sense Approach
Chris A. Gillespie, MEd, ATC, LAT
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THE FACTS

• Since 2000 exertional sickling is the leading
  cause of non-traumatic death in NCAA Football
  All Divisions.
• In FBS --- if you add heat, heart, and asthma ---
  Combined, match the total dead from sickling.  
• In the last 12 years there have been NO traumatic
  deaths in FBS no catastrophic head injury no
  catastrophic neck injury no comotio cordis. 
  (although three deaths in non FBS schools One
  cardiac non-trauma related AND two head injury
  related)
• Not one single FBS football player in the last
  12 years has died playing football.  
• Not one single FBS football player in the last
  12 years has died practicing football. 
• They have ALL died PREPARING to play football 4
  in winter workouts, 4 in summer workouts, and 2
  in September conditioning drills ALL in
  STRENGTH/CONDITIONING SESSIONS!

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NOT JUST COLLEGE or FOOTBALL

• 2000 - 12 y/o male football, conditioning, Ohio
• 2002 - 14 y/o female basketball, conditioning,
  Texas
• 2004 - 15 y/o male football, pre-season practice,
  Texas
• 2006 - 12 y/o male football, conditioning,
  Florida
• 2009 - 16 y/o male football, conditioning,
  Maryland
• 2010 - 15 y/o male football, pre-season practice,
  Florida
• 2011 - 14 y/o male football, conditioning, South
  Carolina
• 15 y/o male football, conditioning, Texas
• 16 y/o male football, conditioning, Florida

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HIGH SCHOOL FOOTBALL 2011

• 7 non-traumatic practice deaths
• 5 were African-American
• 3 deaths attributed to exertional sickling
• 4th is suspected exertional sickling
• 60-80 of African-American high school football
  players who collapsed and died in summer
  practices had SCT/sickling as a COD

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Case Study

• 1990 football season
• 19 year old black male football player
• Collapsed after running one and one half mile
  distance run
• Complained of leg pain and mid low back ache
• Sickle cell crisis with acute exercise related
  rhabdomyolysis
• Increased Creatine Kinase level (CK)

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Rhabdomyolysis
Definition A disorder involving injury to the
kidney caused by toxic effects of the contents of
muscle cells.
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Rhabdomyolysis
Causes Incidence Myoglobin is an oxygen binding
protein pigment found in skeletal muscle. When
skeletal muscle is damaged, myoglobin is released
into the bloodstream. It is filtered out of the
bloodstream by the kidneys. Myoglobin may
occlude the structures of the kidney, causing
damage such as acute tubular necrosis or kidney
failure. Myoglobin breaks down into potentially
toxic compounds, which will also cause kidney
failure. Necrotic (dead tissue) skeletal muscle
may cause massive fluid shifts from the
bloodstream into the muscle, reducing the
relative fluid volume of the body and leading to
shock and reduced blood flow to the kidneys.
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Creatine Kinase (CK)orCreatine Photokinase (CPK)
An enzyme found predominantly in the heart,
brain, and skeletal muscle. When the total CPK
level is substantially elevated, it usually
indicates injury or stress to one or more of
these areas.
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Normal Creatine Kinase (CK) Values
Male 38 - 174 units/L
Female 96 140 units/L
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CK Levels
A high CK, or one that goes up from the first to
the second or later samples, generally
indicates that there has been some damage to the
heart or other muscle. It can
also indicate that your muscles have experienced
heavy use.
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CK Levels
People who have greater muscle mass have higher
CK levels than those who dont,
and African-Americans may have higher CK levels
than other ethnic groups. Very heavy exercise
(such as in weight lifting, contact sports, or
long exercise sessions) can also increase CK.
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What is Sickle Cell Trait?

• Not itself a disease
• Hereditary condition
• One abnormal gene for hemoglobin (S)
• Genetic type AS
• Sickle Cell Anemia Disease is SS

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Who has Sickle Cell Trait?

• About 8-10 of the U.S. black population has
  sickle cell trait
• Only about 1 have the disease
• SCT is also found in non-blacks as well, but less
  frequently

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For Many YearsAthletic Organizations

• Characterized SCT as a benign condition that does
  not affect the longevity of the individual

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Genetics
Education is the Key
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Testing for Sickle Cell Trait?

• Simple blood test
• Mandatory vs. voluntary (changes)
• What do we do if the test is positive?
• Genetic Counseling
• Health care issues
• Work-out adaptation

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Sickle Cell Trait Medical Problems

• Inability to concentrate urine normally
• Blood in the urine
• Spleen problems especially at high altitudes
• Exercise related rhabdomyolysis
• Exercise associated sudden death

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Warning Signs

• Leg pain
• Back pain
• Hematuria
• Dehydration
• Fatigue
• A positive SCT test
• When in doubt..

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Crisis Time is of the Essence!

• Must seek timely and appropriate medical care for
  the athlete who is potentially suffering from
  sickle cell crisis.This is a TRUE medical
  emergency !

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Proper Hydration Hot Weather

• Avoid dehydration
• Acclimatization is key
• Condition before athletic bouts begin
• Do not exercise in a dehydrated state or during
  acute illness
• Drink fluids all day
• Know your athletes

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Exercise and Work-Out Routine

• CONTROVERSIAL
• No running over 100 yards at any time!
• Increased rest periods between bouts of exercise
• Unlimited hydration before, during, and after
  exercise
• Performance levels increase with these changes

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Precautions per the Inter-Association Consensus
Statement

• Exclude from Day-1 conditioning tests
• Slow, paced progressions of training
• Allowing longer periods of rest and recovery
  between repetitions
• Heat stress, dehydration, asthma, illness, and
  altitude create additional risk
• Stop activity with onset of symptoms
• Set a tone that encourages consideration for the
  athlete with sickle cell trait

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Selectively Opting Out of Sports

• All SCT positive athletes at Samford University
  since 1990 have been football players
• In interviews with these athletes, we have
  hypothesized that athletes choose sports where
  they will excel
• Athletes with SCT most likely cannot excel in
  sports with high aerobic demand so they opt out
  of these sports at an early age

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Medical History Questions

• Do any of your close relatives suffer from SCD or
  SCT?
• Have you ever been tested for SCT?
• If yes, was the test positive?
• If yes, what have you done differently?
• Do you fatigue more than your peers in aerobic
  related activities?
• If yes, explain?
• Have you ever selectively opted out of a sport or
  activity because of fatigue?
• If yes, explain why and list the types of
  symptoms that you have had during these
  situations.

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CONCLUSION

• Most of the studies in this area have been done
  in the military setting
• Most of the knowledge that we have gained in
  athletics is gained from anecdotal information
• More studies regarding the risk involved in
  athletics must be done
• An Inter-Associational SCT Task Force met in
  February 2007 to discuss ways to prevent the
  senseless deaths of athletes with Sickle Cell
  Trait. As a result the NCAA took some corrective
  action but its not enough!

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THE FACTS

• Since 2000 exertional sickling is the leading
  cause of non-traumatic death in NCAA Football
  All Divisions.
• In FBS --- if you add heat, heart, and asthma ---
  Combined, match the total dead from sickling.  
• In the last 12 years there have been NO traumatic
  deaths in FBS no catastrophic head injury no
  catastrophic neck injury no comotio cordis. 
  (although three deaths in non FBS schools One
  cardiac non-trauma related AND two head injury
  related)
• Not one single FBS football player in the last
  12 years has died playing football.  
• Not one single FBS football player in the last
  12 years has died practicing football. 
• They have ALL died PREPARING to play football 4
  in winter workouts, 4 in summer workouts, and 2
  in September conditioning drills ALL in
  STRENGTH/CONDITIONING SESSIONS!

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Thank Youfor yourtime attention!