Sports Med
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The sport of boxing has been the source of much debate, with concerns about the neurological risks of participating having led to many calls to ban the sport. This review seeks to establish an evidence base for the development of boxing-related chronic traumatic encephalopathy (CTE) and to determine the relevance of this information to the modern day sport. The clinical features of CTE include various symptoms affecting the pyramidal and extrapyramidal systems, which manifest most often as disturbed gait and coordination, slurred speech and tremors, as well as cerebral dysfunction causing cognitive impairments and neurobehavioural disturbances. ⋯ No current epidemiological evidence exists to determine the prevalence of this condition in modern day boxing, despite 17% of professional boxers in Britain with careers in the 1930-50s having clinical evidence of CTE. As medical presence within the sport increases and with modern boxers likely to have shorter careers, a reduced exposure to repetitive head trauma, and improved treatment and understanding of the development of CTE will occur. This should lead to the incidence of CTE diminishing in boxing populations.
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There are few data on youth marathon runners and the most commonly asked questions of "can children run marathons?" and "what are the health consequences?" remain unanswered. Expert opinion is split with regard to running this distance at a young age. There have been many thousands of finishers <18 years old at the Los Angeles Marathon in an organised programme for youth running and nearly 300 finishers in at the Twin Cities Marathon. ⋯ There has not been any significant medical injury at these events. Children who choose of their own accord to participate in marathon training should be allowed to do so as long as their social, academic, psychological and physiological development is not disrupted. Follow-up studies of these young runners would help evaluate the long-term health consequences of long distance running and shape future recommendations.
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Exertional heat stroke (EHS) during or following a marathon race can be fatal if not promptly recognised and treated. EHS is a true medical emergency and immediate cooling markedly improves the outcomes. It is critical to recognise EHS and stop the cell damage before the cascade of heat-induced tissue changes becomes irreversible. ⋯ The field treatment of EHS is immediate, total-body cooling with ice-water tub immersion or rapidly rotating ice-water towels to the trunk, extremities and head, combined with ice packing of the neck, axillae and groin. Any combination of delayed recognition or cooling increases the potential for morbidity and mortality. For optimal outcomes, it is best to treat immediately with on-site whole-body cooling if cardiorespiratory status is 'stable' and then to transfer the runner for additional evaluation and care.