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Dr. Ahmed Sayed Khashaba, MD. MSc. PhD.
Assistant Professor-Physiology Medicine (RCsDP)
Sports & Exercise Medicine - University of BATH (UK)
Member of the Education Commission of
the International Federation of Sports Medicine (FIMS)
TRAVELING WITH ATHLETES
AND OVERCOMING
CHALLENGES
Website: https://sites.google.com/a/riyadh.edu.sa/dr-ahmedkhashaba/
Dear respected Chairman, respected Professors and
Colleagues,
First of all, I would like to thank the organizing
committee for inviting and giving me the opportunity
to share my practical experience with all of you.
Despite my academic commitment in doing research
and teaching physiology to medical students, I really
enjoy serving as a team physician to various national
teams for fifteen years. Working as a team physician
actually provided me an immense benefit for being
able to bridge the gap between theory and practice.
Copy right Dr. Ahmed Khashaba, 2015
Outlines:
Knowledge base of the team physician.
Responsibilities of the team physician.
Travelling with the team.
Overcoming common traveling challenges.
Copy right Dr. Ahmed Khashaba, 2015
Knowledge base of team physician
1- (M.B.,B.Ch.) in Medicine and Surgery in good standing, with an unrestricted license.
Musculoskeletal system (Traumatology)
Growth and development
Emergency care & Advanced life support
Internal Medicine
Physical Medicine
Pharmacology (Doping substances)
4
Copy right Dr. Ahmed Khashaba, 2015
Knowledge base of team physician (continued)
2- Exercise science Exercise Physiology Sports Nutrition Applied Biomechanics Sports Psychology Sports Ethics Specific sports-terminology
5
Copy right Dr. Ahmed Khashaba, 2015
Knowledge base of team physician (continued) “PREVENTION IS BETTER THAN CURE”
(Desiderius Erasmus, 1500)
Intrinsic risk factors
Previous injury.
Poor conditioning/muscular imbalances.
Anatomical abnormalities.
Nutritional factors.
Growth (in children).
Extrinsic risk factors
Training errors, including abrupt increases in intensity, duration, or frequency of training.
Inappropriate workout structure.
Improper floors or footwear.
Copy right Dr. Ahmed Khashaba, 2015
Responsibilities of team physician include:
Pre-participation health screening and examination.
Assessment and management of athletic injuries both on the field and field side; triage.
Supervision of athlete’s rehabilitation and return to play.
Participating in a sports medicine society.
Teaching and publishing research papers in the field of sports medicine.
Condemning the use of artificial performance enhancement and counselling the athletes on substance abuse.
Preparation for traveling with the team.
7
Copy right Dr. Ahmed Khashaba, 2015
Traveling with the team
Traveling with the team
Pre-event
Visit site in advance to avoid any potential hazards facing the team.
Clarify roles and responsibilities of the medical team members.
Clarify IMMUNIZATION, INSSURANCE and DOPING PASSPORT issues in advance.
Educational activities are organized in relation to nutrition, doping, jet lag, travelling, rest and recovery, environmental aspects, sexually transmitted diseases, injury prevention etc.. An information kit for the athletes is recommended.
Copy right Dr. Ahmed Khashaba, 2015
Traveling with the team (continued)
During traveling
Medical care of athletes and delegation during travelling is
generally neglected. However, especially during long air
travels, there could be health issues like motion sickness,
anxiety, sleep disturbance, gastrointestinal complaints,
headache. Travel medical bag should contain necessary
medications for all these problems and the physician should
be well prepared for such complaints.
Banned medications should be separated from the medical
bag.
Copy right Dr. Ahmed Khashaba, 2015
Traveling with the team (continued)
During the games Effective communication with all medical staff,
coaches, athletes, and team officials is paramount during the excitement of competition. Be prepared to treat, educate, advocate for, and listen to athletes during their highest highs (victory) and lowest lows (defeat or injury).
Be prepared for drug testing asked for any athlete at any time by thorough understanding of the WADA policies and procedures, and being aware of the team physician role in the proceedings.
(FIMS Team Physician Manual, 2013)
Copy right Dr. Ahmed Khashaba, 2015
Professionalism
The conduct and dress of a team
physician should reflect that of a medical professional rather than a teammate.
Confidentiality of the athlete must always be respected and preserved in front of the media. No medical details to be provided to the media without explicit consent from the athlete.
Copy right Dr. Ahmed Khashaba, 2015
Code of ethics
Always make the health of the athlete a priority.
Never do harm.
Never impose your authority in a way that impinges on the individual right of the athlete to make his/her own decisions.
“Do not sacrifice the welfare of the athlete to the welfare of the team”
Do not allow medical decisions to be influenced by third parties.
Copy right Dr. Ahmed Khashaba, 2015
OVERCOMING COMMON TRAVELING CHALLENGES
A conscientious, well-prepared team physician can provide a healthy environment, which may increase the confidence of the athletes in their performance and reduce the consequences of sports injuries if they occur.
In the following slides, I am going to focus on common environmental challenges that might face the athletes and how it could be managed by the team physician.
Copy right Dr. Ahmed Khashaba, 2015
JET LAG
Recent well conduced scientific studies showed that
west-east travel across 6 time zones result in a
decrease in athletic performance of approximately 10%.
(FIMS Team Physician Manual, 2013)
It is important for the team physician traveling with
athletes to be aware of the detrimental effect of jet lag
on sports performance, and how to minimize its effect
in athletes.
Copy right Dr. Ahmed Khashaba, 2015
Practical guidelines to minimize the
effects of Jet lag on athletes
Arrive at the destination at least one day early for each time
zone crossed. However, allow14 days for resynchronization
if the time zone difference is greater than 6 hours.
Attempt to partially synchronize sleep/wake cycles and
meals a few days before departing ( for East-West flights this
means going to bed later).
Indulge in social and exercise activity (training sessions)
immediately after arriving at the destination.
Avoid alcohol during flights.
Copy right Dr. Ahmed Khashaba, 2015
Practical guidelines to minimize the effect of Jet lag on
athletes (continued)
Travel in one direction when competing at different venues on
an extended trip.
Chronobiotic drugs such as Melatonin may be used.
Melatonin capsules taken in the evening for a few days before
departing (at local time) and after arrival (at local time) may well
facilitate resynchronization. When administrated under this
schedule, melatonin has been shown to reduce the symptoms of
jet lag in both west-east and east-west travel directions.
(FIMS Team Physician Manual, 2013)
Copy right Dr. Ahmed Khashaba, 2015
HEAT ACCLIMATIZATION
Only ~20% of the oxygen consumption during
exercise is converted to mechanical work, whereas
~80% ends up as heat, the major metabolic by
product of strenuous exercise. While much of this
heat is dissipated, at high intensities of exercise and
when the environmental temperature and/or
humidity are elevated, there can be a significant
increase in body core temperature (hyperthermia)
that can cause fatigue and, in extreme cases, death.
Copy right Dr. Ahmed Khashaba, 2015
Preventing strategies for reducing heat injuries
Identify the athletes who are at risk of heat illnesses.
The acclimatization procedure should be settled
gradually for the athletes over 10-14 days.
Check environmental conditions before and during the
activity by monitoring the wet bulb and globe
temperature (WBGT), and modify activity accordingly.
For example: if the (WBGT) index is above 32.2 ºC all
activities should be stopped, while distance running
may not be allowed when the (WBGT) index exceeds
27.8 ºC. (FIMS Team Physician Manual, 2013)
Copy right Dr. Ahmed Khashaba, 2015
Weight loss should not be more than 2-3% of body
weight during exercise and it is recommended that the
athlete consume 1 to 1.5 liters of fluid for each
Kilogram weight loss.
Athletes should drink about 500ml of fluid about 2
hours before exercise.
Inclusion of sodium and carbohydrates (6%) in the
rehydration fluid is recommended for exercise events of
duration greater than one hour.
Cooling therapy in case of mild or severe heat illnesses.
Preventing strategies for reducing heat injuries
(continued)
Copy right Dr. Ahmed Khashaba, 2015
ACCLIMATIZAION TO ALTITUDE
Sleep High and Train Low
Living (or sleeping) high and training low appears to be an
effective way to enhance performance in elite athletes. It is
legal in the context of rules relating to doping and
support. The changes in hemoglobin, red blood cell count
and hematocrit are modest and unlikely to exceed the
absolute standards for hemoglobin (16.0 g/100 ml) and
hematocrit (50%) permitted in international competition.
An alternative to residing at high altitude may be provided
by the use of commercially available "altitude tents".
These allow individuals to sleep in a decompressed or
hypoxic environment while continuing to train in the
daytime at low altitude..
Copy right Dr. Ahmed Khashaba, 2015
Prevention Strategies for Air Pollution
Prevention Strategies for Air Pollution
Training should be scheduled at times associated with the
least air pollution by following the air quality meteorological
news.
When ambient Ozone level is high, do exercise in the
morning or at night. The peak ozone level is around 3 PM.
Activated carbon face masks can be used in urban
environment.
Do exercise preferably in parks or along the ocean.
Copy right Dr. Ahmed Khashaba, 2015
Prevention Strategies for Air Pollution
(continued)
Consider wind direction and run or ride on the
up-wind side.
Keep 10-15 meters distance away of the
exhaust pipes of cars during highway training.
Ingesting some antioxidants such as vitamin C
and E are recommended.
(FIMS Team Physician Manual, 2013)
Copy right Dr. Ahmed Khashaba, 2015
Finally, the team physician has a very
important responsibility to the athletes under
his/her care. Proper training, preparation,
and behavior are fundamental to the task for
the caring and successful team physician.
(FIMS Team Physician Manual, 2013)
Copy right Dr. Ahmed Khashaba, 2015
Thank You For Your Attention!