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THE CITY REBORN FROM THE ASHES OF AMERICA'S MOST DISASTROUS FOREST FIRE
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WIAA Sport Medical Advisory Committee Updates Posted

Issue Date: August 9, 2017

At the May, 2017 WIAA Sport Medical Advisory Committee meeting, information relating to the Disordered Eating/Relative Deficiency in Sport (RED-S) guidelines were updated. The concussion information was updated to reflect the latest information from the 2017 Concussion in Sport Group in Berlin. Mental Health/Wellness was also added to the WIAA web site.

RED-S has supplemented and replaced the Female Athlete Triad. More information may be found on the WIAA web site: https://www.wiaawi.org/Health DisorderedEatingRelativeEnergyDeficiencySport.aspx.

The new Berlin guidelines allow for exercise prior to recovery when evaluating athlete who may be returning to play after being diagnosed with a concussion.

If you suspect a player may have a concussion, that athlete should be immediately removed from play. The injured athlete should be kept out of play until they are cleared to return by an appropriate health care provider. If the athlete has a concussion, that athlete should never be allowed to return to activity (conditioning, practice or competition) that day.

All athletes are individually assessed and some athletes may be able to begin gentle, non-contact aerobic exercise prior to full recovery. The level of exercise should not cause an increase of symptoms. The athlete should do this exercise under the guidance of the treating healthcare provider (who has experience with concussion management). The athlete should be at full academics (full days of school and doing homework/tests) before allowing this degree of exercise and the exercise should not be associated with practice, but instead independent aerobic fitness. No weight lifting/resistance training until medical clearance. No return to practice without medical clearance.

Relative rest remains an essential component of concussion treatment. Further contact is to be avoided at all costs due to risk of repeat concussion and Second Impact Syndrome. Physical exertion can also worsen symptoms and prolong concussion recovery- this includes aerobic conditioning and resistance training. Physical activity should not be started without authorization by an appropriate health care provider. More information on concussion can be found on the WIAA web site: https://www.wiaawi.org/Health/Concussions.aspx.

Involvement in sports can have a very positive effect on the mental health of high school students. However, mental illnesses, such as depression, anxiety, and others, occur in athletes just like they do in everyone else. Mental illness may not be detected in athletes as easily as in others, though. This is for a number of reasons, including:

Athletes may have a tendency to deny signs of "weakness". Athletes may be afraid of not being allowed to play.

Athlete behaviors may resemble symptoms of mental illness, but can be chalked up to being a normal part of being a good athlete. This might include careful attention to diet, which may actually be part of an eating disorder.

Mental illness in athletes may relate directly to the athlete's sport, or it may have nothing to do with the sport. There are 3 possible relationships between the athlete's sport and his/her mental illness:

The illness is caused or worsened by the sport (for example, an athlete who develops an eating disorder directly related to wanting to be thin for her/his sport).

The athlete chooses the sport as a way to cope with the mental illness (for example, the athlete with anxiety who finds that running helps him/her to feel less anxious).

The sport and the mental illness are completely coincidental and have nothing to do with each other.



While athletes are probably at similar risk for most mental illnesses compared to the general population, there are several unique factors that may especially put athletes at risk for these conditions. These include:

Injuries (including concussion),

Lack of balance in life (no free time, including time with friends)

Pressure of competition,

Overtraining (training too hard for too long without enough time for recovery),

Failure in sport,

Harassment and discrimination related to personal characteristics such as race/ethnicity or sexual orientation Coaching styles that do not match up with how the athlete performs best.

Like most other mental illnesses, depression probably occurs in athletes at the same rate as in the general population. Symptoms of depression include (and note a person does not need ALL of these symptoms in order to have depression):

Feeling sad, down, hopeless, or tearful on most days,

Feeling irritable on most days,

Not looking forward to or enjoying things that used to make the person happy, Feeling worthless,

Lower energy than usual,

Worse concentration than usual

Appetite changes (either much lower or much higher than usual),

Sleep changes (either trouble falling or staying asleep or sleeping more than usual),

Thoughts of death or dying, including suicidal thoughts.

On rare occasion, someone who has times of feeling depressed may have a condition called bipolar disorder. This is a disorder in which they not only may have times of depression, but they also have times of abnormally elevated mood (called mania or hypomania). In this condition, they have multiple days or weeks on end of feeling euphoric, not needing very much sleep and still feeling rested and very energetic (this is different than simple insomnia in which they wish they could sleep but can't), feelings of being better than everyone around them, talking much more quickly than usual, engaging in uncharacteristically risky behaviors without thinking through the consequences, engaging in much more activity than usual, seeming more sexual than usual, and reckless spending of relatively large amounts of money. Importantly, this is not just feeling better than they feel compared to when they are depressed. It is a dramatic state of elevated mood in which people around them notice they are not their usual selves, and the behaviors and symptoms create problems in their lives.

Student athletes with depression, bipolar disorder, or any number of other psychiatric disorders may be at risk for suicide. A large study that compiled the results of numerous smaller studies found no significant difference in the rates of suicide attempts between athletes and non-athletes. However, risk factors for suicide may be different for athletes compared to non-athletes. Sometimes, suicide in athletes may be related to acute, sudden events or changes that are specific to an athlete (e.g., failing to make a team or get a starting spot, or perceived rejection by a coach).

Anxiety may also occur in athletes at the same rates as in the general population. Some symptoms of anxiety are similar to those of depression. It is possible that athletes can have both depression and anxiety. Symptoms of anxiety may include (and note a person does not need ALL of these symptoms in order to have anxiety):Worry about many things (for example, sports, school, friends, family, day to day obligations) in a way that feels difficult to control and happening on most days,

Trouble sleeping (especially falling asleep),

Lower energy than usual,

Worse concentration than usual,

Muscle tension,

Feeling fidgety or restless Feeling irritable much of the time.

There are also specific types of anxiety that can occur, including:

Social anxiety disorder: This is a condition in which someone has significant fear and anxiety about being negatively judged and evaluated by others. People with this condition may be viewed as extremely shy or unfriendly, but in actuality, these people would like to be able to make friends. They dislike being the center of attention and being observed while doing something, and this can make it hard for some people to participate in certain sports, especially individual sports.

Panic disorder: This is a condition in which someone has sudden, severe attacks of intense anxiety and fear lasting several minutes. They usually involve physical symptoms such as feeling short of breath, feeling one's heart beat hard in the chest, or feeling dizzy. Sometimes the symptoms can feel similar to how people feel when they exercise intensely, and that can make an athlete with panic disorder start to avoid his/her sport out of fear that exercise will bring on an actual panic attack.

Obsessive-compulsive disorder (OCD): This is a condition in which someone has repeated, unwanted thoughts that come into his/her mind that they have difficulty controlling (obsessions) and/or behaviors that he/she feels must be performed over and over (compulsions). Examples include intense fear of germs and associated washing of hands over and over, or ordering things "just so" or symmetrically to an extreme degree. OCD is different than superstitious rituals. Rituals are common among athletes, and examples include wearing the same pair of socks for every game or eating the same meal before each race.

Posttraumatic stress disorder: This is a condition in which someone has suffered any sort of trauma (for example, physical, verbal, or sexual abuse, assault, major accidents or illnesses). Associated with that trauma, they have symptoms that may include: nightmares or flashbacks about it, avoidance of anything that reminds them of the trauma, increased startle response, and any of a number of symptoms of depression and anxiety. Traumas unique to athletes may include "out of the ordinary" sportspecific adverse events, such as severe injuries (especially if they involve threats to physical integrity), lethal accidents, loss of a crucial game, public cheating scandal, or teammate suicide.

Athletes should be referred to health care providers who are familiar with mental illness if it is suspected that they might be suffering from such a condition. These providers include pediatricians, family medicine physicians, internal medicine physicians, sports medicine physicians, psychiatrists, psychologists, or other counselors/therapists. Early signs that an athlete might be suffering from mental illness include changes in personality, demeanor, interactions with peers, and general behavior.

Treatment may include talk therapy (psychotherapy), medications, or changes in the environment. If at all possible, the athlete may be allowed to continue to participate in the sport. However, if the sport itself is significantly contributing to the symptoms, then a break from sport may be necessary.

For crisis situations or any question about someone possibly being suicidal, athletes in the U.S. and those who work with them may call the National Suicide Prevention Lifeline at 1-800-273-8255.

The National Federation of State High School Associations (NFHS) has developed a document entitled "Addressing Mental-health Issues in Student-Athletes" that is available here: https://www.nfhs.org/articles/addressing-mental-health-issues-in-student-athletes/.


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