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With star names like 49ers defensive back Darryl Pollard and Pittsburgh Steelers line backer Michael Merriweather one might easily mistake this event for a kick-off party for the new season.

by Kori Graddy

With names like 49ers defensive back Darryl Pollard, Pittsburgh Steelers line backer Michael Merriweather, Dallas Cowboys cornerback Benny Barnes and over 60 other National Football League (NFL) players one would think this is a kick off party for the 2008 NFL season.

Getting ready for the play Photo: istockphoto.com

Taking place at the University California San Francisco Medical Center in what looked to be an event for ESPN; UCSF cardiovascular, radiological and other healthcare teams along with over 60 former players from the NFL took part in cardiac screening studies that included CT calcium scoring, electrocardiograms, carotid artery ultrasounds, blood tests and other cardiac analyses.

The event, in conjunction with a national program by the Living Heart Foundation (LHF) aims to bring awareness to heart disease in the general population as well as the specific cardiovascular challenges found in professional athletes, particularly football players with large body mass.

The Living Heart Foundation was founded by former NFL quarter back and heart surgeon Arthur ‘Archie’ Roberts, M.D. The program, supported by the NFL players association is part of a three-year study of 1200 former football players to examine the rate of heart disease in that population.

In previous studies it was found that compared to non-linemen; retired NFL linemen may be at greater risk for cardiovascular diseases.

An explanation to these findings may be that NFL linemen have a larger body mass index, providing them with a pre-established risk factor for multiple cardiovascular diseases and challenges.

Former NFL players have a history of vigorous strength training from early adolescent years through the professional ranks of their careers. In particular NFL linemen are required to increase and sustain their size and strength to remain competitive. "These retired linemen were ranging in weights between 280lbs - 300+ lbs", says Karen Rago, Administrative Director UCSF Heart and Vascular Center, Heart and Lung Transplant Program.

Researchers found in the past that NFL lineman have a greater prevalence of metabolic syndrome which is characterized and includes such risk factors and components as an enlarged heart, sleep apnea, abdominal obesity, high blood pressure, atherogenic dyslipidemia , insulin resistance or glucose intolerance, prothrombotic state and proinflammatory state. A person must have three or more of these risk factors to have metabolic syndrome.

Thus far, study results show more than half of retired NFL linemen (52.5 per cent) have metabolic syndrome, compared to a little more than one in five (22.2 per cent) retired football players who played other positions, and (21.8 per cent) of the general US population. Linemen also had a higher rate of diabetes, thicker heart walls and a greater rate of obesity and high blood pressure.

Researchers have also discovered that retired NFL linemen are 54 per cent more likely to have enlarged hearts than non-linemen retired NFL players: 36.9 per cent of linemen had enlarged hearts compared to 24.5 per cent of non-linemen. In this assessment, the definition of an enlarged heart is a left ventricular mass of more than 125g/meter squared.

Athletes typically have enlarged hearts due to intense conditioning, but it is thought their hearts return to normal size after their playing days are over. This new research suggests otherwise. An enlarged heart may persist and be a risk factor for cardiovascular disease.

NFL players play an extreme contact sport that leaves them with many chronic musculoskeletal injuries, which make exercise increasingly challenging, if not impossible post retirement. However, the problem isn't confined to professional football. As the demand for bigger, heavier players continues to grow, 50 per cent of high school football linemen are now overweight, and one in 10 are severely obese, according to a study in the January 25 issue of the Journal of the American Medical Association.

Football is a dangerous game

The knee injury most common in football is a sprained medial collateral ligament, or MCL, one of four ligaments that support the knee joint. MCL injuries, which usually occur during a tackle or block -- sometimes because of an illegal hit -- heal on their own without surgery.

Less common, but more serious is a torn anterial cruciate ligament, described as unraveling like a braided rope. A torn ACL happens most often during a quick change of direction, requires surgery and takes the player out for the season, states Marc Fineberg, M.D., chief of sports medicine in the University at Buffalo School of Medicine and Biomedical Sciences.

How to prevent knee injuries? "MCL injuries may be reduced by wearing a double-hinged knee brace," he says. "Using them remains controversial, but we think they provide added protection against MCL injuries. On the other hand, no brace has been proven to protect the ACL."

Conditioning players to be stronger, more flexible and more agile may help to reduce ACL injuries, along with replacing old Astroturf with newer, more forgiving surfaces and wearing the right shoes, notes Fineberg. "Shoes with really long cleats grip better for increased performance, but may also put a player at greater risk of tearing an ACL."

Concussion is gaining recognition as a serious injury, particularly at the professional level. Concussions remain under-reported, however, especially at the high-school level, where they are most frequent and potentially fatal, Fineberg says. Prevention, by not tackling head-on and wearing properly fitted helmets, is the best way to 'treat' this injury.

With few outward signs of injury -- no swelling or broken bones -- identifying the subtle signs of concussion is crucial, because a high school player who has an undiagnosed concussion and sustains a second blow to the head is at risk of second-impact syndrome, which studies have shown can result in sudden death.

"If a coach or trainer suspects a player has had a concussion, he or she should take the helmet away, and put that player on the 'doctor's team,'" states Fineberg. "There must be complete resolution of the injury before the athlete is allowed to play again, and that decision is not the player's, not the parents', not the coach's; it's the physician's."

Signs to look for include dizziness, headache, aversion to light, nausea and a dazed or blank stare. If one pupil is dilated, the player needs to get to the emergency room pronto, he says.

Shoulder injuries, the third most common group of orthopedic injuries in football, occur most often to backs and receivers. Quarterbacks are usually 'off-limits' in practice, but are particularly vulnerable in games if they get slammed to the ground. Wide receivers are at risk when they go up for a pass and come down shoulder-first, usually hitting the turf under a much bigger and heavier player.

Common shoulder injuries include 'AC joint' sprains -- a separation at the bump on top of the shoulder which marks the junction between the shoulder blade and the collarbone. Proper-fitting shoulder pads may help avoid these injuries, which rarely require surgery.

Another common problem is a dislocated shoulder, which occurs when the labrum, the cartilage around the socket, tears. Training focusing on rotator cuff conditioning may help prevent these tears. Players other than quarterbacks can wear a harness to support a shoulder weakened by a labral tear. These tears often require arthroscopic surgery to eliminate the painful episodes of instability, says Fineberg.

Everyday maladies aside, the most catastrophic injury a young football player can sustain is to the neck or spine. "We saw a rapid decline in neck injuries when spearing -- using the head as a weapon -- was outlawed [it now garners a 15-yard penalty]," he says. "Players now are trained to tackle with the head up." Improving neck strength and flexibility may help protect against this type of injury, along with good coaching, he notes.

"Football is a dangerous game," comments Fineberg. "The only thing we can do is try to minimize the risks by providing the safest environment possible. That involves the players, coaches, officials, parents, trainers, doctors, even the people who maintain the field. It's everyone's responsibility."

A study by the University of North Carolina found that 300,000 American athletes suffer a concussion each year. Surprisingly, players in the National Football League have seen their head injury rate decrease in recent years, thanks to improved safety measures with head and shoulder protection.

The work of the LHF

The LHF, a non-profit entity, founded by Archie in 2001, uses its established nationwide healthcare network to provide technically advanced, voluntary, health screenings for active and retired professional football players at regional participating medical facilities within major geographical areas around the US. The LHF works closely with the NFL Players Association to plan and deliver the health screening program.

The American College of Cardiology (ACC) and its Chapters, as well as the American Association for Respiratory Care (AARC) assist the LHF by providing skilled personnel to assist at the screenings and expert medical planning to strengthen program content. A program goal is to offer a CV health screening program designed to improve the early identification of health risk in these former elite athletes, without a financial charge to the players for the screenings.

CV Health Screening Program poster Photo: Living Heart Foundation

An example of a category of football players who might benefit most from our health screening would include players of very large body mass who would be expected to have, or soon develop, a variety of co-morbidities including hypertension, diabetes, and elevated cholesterol. Such conditions are highly associated with heart disease and stroke. It will also be interesting to correlate such medical co-morbidities and specific health screening findings with the extent of athletic injuries encountered during their careers.

Regularly scheduled repeat screening tests will provide the LHF with the ability to define health risk stratification for the players. This knowledge will empower them to learn about ways to limit the impact of evolving health problems that may occur as they actively complete and subsequently age in their lives after football. In some ways, the transitional time from active to retired player, and the subsequent several year period, may be a particularly vulnerable period for many former elite football players.

Sources: University California San Francisco Medical Center/Buffalo School of Medicine and Biomedical Sciences/Living Heart Foundation.

Click here for the Living Heart Foundation site.