Youth sports in the United States has become so commoditized, ultra-competitive and micromanaged by adults, that many young people literally have the soccer life and joy sucked out of them by the time they reach middle or high school.  

Although often with the best of intentions, adults create confining environments that are emotionally unhealthy and undermine the development that the environment is intended to foster.  

Much of this dysfunction comes as a result of creating a training atmosphere that fuels the development of the fixed-mindset that focuses on 'now' development & results.  

What I mean by that is that success and failures become the barometer that youth players are taught to read with the tangible evidence of development measured in wins, losses and awards.  Additionally, ‘losses’ are taught to be associated with failure.

The reality is that all athletes developed at their own pace and from early-prodgys to ‘late-bloomers’ failures and mistakes are often very impactful ‘teachers’.

The fixed mindset often ‘coaches’ youth athletes to view their development and their success in black-and-white, while sports development, like life, is more about learning from and navigating the 'grey'.

The fixed mindset discourages conflict, often leading to surrender when obstacles arise and overcoming them is too difficult.  As a result of the constant toggle of attempt followed by failure, fix-minded youth athletes will often abandon that which they joined out of interest and love, because participation becomes a series of absolute 'pass' or 'fail' moments.  

Tragically, many of these youth athletes carry this frustration into other non-athletic endeavors, often finding themselves frustrated and viewing failure as confirmation that growth and development are fruitless and therefore a waste of time.  

In the absence of joy, and flanked by perceived repetitive moments of failure, fixed minded athletes rarely accept constructive criticism and rarely are able to find joy in celebrating the successes of others.

The growth mindset views development as a journey such that moments pose challenges that should be embraced.  

Because success and failure are not measured in the 'now' moment, the growth mindset lends itself to persistent diligence, even in the face of setbacks and challenges.  This is because the growth mindset sees challenges as part of the process-- a means to an end-- on the road to mastery.  

The training environment where the growth mindset prevails is one where creativity is encouraged and failures are celebrated as an integral part of the journey.  In this space, unlike in the fix mindset space, coaches and parents approach moments of failure with individuals and teams as essential teaching tools.

Framed with the knowledge that almost all youth athletes and teams ‘keep score’ and ‘seek stats’ (neither of which are to ever be discouraged); youth athletes ‘learn’ how to navigate and process all of that data through ‘vibing’ off the adults.  When they learn that a game/match result is but one datapoint, it helps to better frame and cultivate growth-mindedness.

Growth-mindedness also has room for the success of other athletes; enabling youth athletes not only to learn from the successes of others, but to also find fuel and inspiration from them.  

The relationships between player and coach and between players and parents are tremendously impactful.  

As we look to determine what those relationships 'look like', perhaps we need be more mindful of the fact that how we frame the training space will determine the attitudes of our players on game day and even well beyond the pitch.  

Questions to Ask
   - Are we creating a space that emotionally inspires or one that fatigues?  
   - Are we establishing a training environment that leads to joy and satisfaction even in the face of defeat?
   - Are we teaching our young players that both ‘good’ and ‘bad’ results are fuel?
   - Are we investing time in promoting well-being and ‘balance’ or are we simply creating a space where athletes learn to ‘play and compete’ at all costs?

Ultimately, less than 2% of youth athletes will ever play in their sport’s ‘big show’  which means that the time spent training and competing is shaping the future for these young athletes long after their competitive days are in the past.  It also means that, like it or not, the stewardship responsibilities of the adults (parents/guardians, referees and coaches) is far greater than the sport.  

These eager minds and malleable brains are craving opportunities that create safe venues for growth, learning and fun.

Christopher T. Conti, MD is the Founder and Owner of Steel City Direct Care, LLC., a Pittsburgh, PA-based medical practice specializing in the care of athletes and aviators.  He is an emergency medicine physician with additional training in sports and concussion health.  He is currently a Team Physician for the US Soccer Federation (USSF), U14-U17 Youth National Team player pools, Medical Advisor for the PA West Soccer Association, a local affiliate of the United States Youth Soccer Association and the Medical Advisor for the Woodland Hills School District in suburban Pittsburgh, PA.  Dr. Conti serves as Medical Advisory Board Member for  SportGait and is also a Credentialed ImPACT Consultant (CIC) for sports concussion care.  Dr. Conti is a designated Senior Aviation Medical Examiner (AME) for the Federal Aviation Administration (FAA)

Disclaimer
The information, opinions and content presented do not necessarily represent the policies or opinions of USSF, the FAA, PA West Soccer, USYS, FIFA, ImPACT, SportGait, the Woodland Hills School District or Steel City Direct Care, LLC.  
None of the information presented should be construed as formal medical advice, nor should it be considered an acceptable substitute for a formal virtual or in-person encounter with an appropriately trained and licensed healthcare professional.  None of the above-listed entities, including Steel City Direct Care, LCC, are responsible for any adverse outcome associated with this content.  

If you would like to schedule a virtual or in-person visit with Dr. Conti, please contact Steel City Direct Care

Steel City Direct Care is a Direct Patient Care (DPC) practice that provides targeted & specialized in-person and virtual care for aviators and athletes of every age and level of skill and participation.

Pilots and other aviation professionals are very familiar with checklists—organized and systematic processes that minimize the chances of mishaps.

And while it can be argued that a checklist is only as good as its ease of use, the relevance of the information/task being ‘checked’, they still remain a vital component in supporting aviation safety.

Pilot readiness and fitness for flight are critical, rate-limiting elements in the flight safety dynamic, so it would make sense that there would be a checklist to help pilots self-assess prior to manning the controls of an aircraft.

In the mid-1980’s the FAA developed the IM SAFE Checklist as a tool to help pilots determine assess whether there might be any potential barriers to focused and safe aircraft operation.  Each letter in the IMSAFE acronym represents a potential hazard or barrier to safe flight.

I = ILLNESS
This category is the pilot’s reminder that any level of physical illness, dis-ease (un-wellness) can impact safe and focused aircraft operation and overall flight safety.  

Upper respiratory symptoms can sometimes cause excessive drowsiness (even when not treated with medication), equilibrium disturbance.  

Infectious diseases may cause distraction with uncontrolled bouts of coughing, shortness of breath, fever, chills or distracting headache and/or muscle/joint pain.  

A seemingly innocent ‘stomach flu’ might cause intermittent debilitating gastrointestinal pain or uncontrolled vomiting and/or diarrhea.  

The FAA guidance is that pilots should not fly if they are feeling any sort of illness, since this may affect a pilot’s ability to fly due to the distracting nature of the symptoms themselves or the impact of the symptoms on memory, judgement, alertness, concentration, task accuracy, cognitive function (calculation and problem solving) and mood.  

 
M = MEDICATION
All medications are chemical compounds that impact physiological processes within the body.  Additionally, all medications have the potential to produce both common/expected and uncommon or unexpected side effects.  Both normal medication effects and side effects can alter a pilot’s capacity to safely fly.  

Even if a pilot is medicated for an illness, it still may be unwise for them to fly, since medications can cause changes in performance, especially if they interfere with a pilot’s alertness, responsiveness, task accuracy and problem-solving ability.  

The relationship between medications and flying is more complex than many pilots realize. While pilots frequently seek definitive lists of approved medications, there is no universal lists.  It is important to understand that sometimes the medication may present the risk while in other circumstances it is the medical condition that the medication is treating that is the concern.  

The FAA has a list of ‘NO FLY’ medications which allude to that fact.  Some medications are on that list because of their chemical composition and the effects of those chemicals on organs and tissues while other medications are on the list because the condition being treated by the medication is disqualifying.
 
The intent of aviation safety professionals is to optimize safe flight conditions—not to ‘ground’ pilots.  With that said, however, the general principle still holds true with respect to acute illness—in most instances if a pilot requires medication for acute symptoms of illness, then they’re likely too ill to fly safely.

There are some medications that are ‘NO FLY – NEVER FLY’, meaning that the FAA will likely never medically qualify an airman who is taking that medication.
 
Other medications are ‘NO FLY’ without approval and surveillance, while others still, are ‘NO FLY- WHILE UNDER THE INFLUENCE’.  These are typically OVER-THE-COUNTER medications.   And even if these medications are approved, the FAA recommends the ‘RULE OF FIVE’S” which requires the pilot take the longest dosing interval for a medication and multiply that number by 5.

     RULE-OF-FIVE’S FOR BENADRYL
     Dosing Interval:  Every 4 to 6 hours
     Calculation:  6 hours x 5 = 30 hours between last dose and resuming flight duties

Additionally, if after 30-hours the pilot still believes that he/she is symptomatic, continue to self-ground.

There is other FAA guidance regarding specific medications and classes of medications where a ‘ground trial’ is required for 14 or more days before resuming flight duties.

Remember also that medication approvals may vary internationally, with drugs permitted by the FAA potentially being prohibited in Europe and vice versa.

The bottom line— pilots that require any medical treatment or medications should consult both their general practitioner and Aviation Medical Examiner before flying.


S = STRESS
The third element of the IMSAFE checklist refers to a pilot’s response to events or factors known as “stressors,” which can often lead to overwhelming feelings that can produce impaired problem-solving, task accuracy and other important elements of decision-making in flight.

Stressors can take on many forms, such as those that stem from work, finances, and health. Stress is unavoidable, however, all stressors have the potential to create distraction. 

It is important for pilots to be able to compartmentalize stress in moments during flight in order to remain singularly focused on safe aircraft operation.  Pre-flight delays, ground stops, disagreements with ATC personnel are examples of unexpected stressors just prior to flight that, if not managed, could impact aircraft safety.

The skills to manage stress are born from a variety of stress management practices and a strong emotional support structure beyond the flight deck.
 

A = ALCOHOL
Pilots should be wary when consuming alcohol and how long the effects will last.  There are a number of often overlooked factors that impact the effects of alcohol beyond the alcohol content:
   - pilot weight
   - pilot's general and acute health status (I= ILLNESS)
   - nutrition
   - hydration
   - volume of alcohol consumed and/or speed of consumption
   - alcohol use frequency
   - alcohol use with prescribe and over-the-counter medications

The FAA prohibits pilots from flying within eight hours of alcohol consumption, although they recommend that a pilot waits at least 12 to 24 hours after consumption to fly.
 

F = FATIGUE
Fatigue can be categorized as both acute and chronic, and many pilots report both.  Data consistently show that between 50% and 90% of professional pilots report ‘significant fatigue’.  

More alarming, 60% of professional aviators surveyed reported falling asleep involuntarily while in-flight.  

Over 40% of professional pilots self-report that their ability to operate and aircraft safely is compromised by fatigue/tiredness at least once a month.

Flying while fatigued and flying while sleep/rest-deprived produces impairment, no different than being under the influence of alcohol.  Tired pilots should not fly and it is up to each pilot to determine whether they are getting adequate rest and what they need to do to prevent prolonged periods of fatigue.  

You should have the type of relationship with your AME that allows for open discussion about fatigue and strategies to get adequate rest.


E = EMOTION, ‘ENOUGH’
Emotion is different than stress.  While stress and stressors are external ‘things’ emotion refers to a pilot’s feelings at any given moment in time that might influence their ability to make decisions in the areas of aircraft operation.  Stress and emotion can be related but some elements of emotion are linked to other chronic conditions and even to brain chemistry.  

For example, a stressor can make a pilot angry and the pilot’s anger response can impact safe flight operations.
 
However, a pilot may also have a previously disclosed behavioral health diagnosis for which he/she is being treated that has now suddenly worsened.

Pilots must be able to conduct regular-interval and ‘in-the-moment’ self-checks when he/she feels that they are becoming emotionally triggered in order to determine if overall flight safety might be better served by not flying.   Flying while impaired by feelings that cannot be managed is a risk to flight safety.

‘Enough’ refers to hydration and nutrition-- having enough water and calories for proper body/brain function.  

Perhaps the most common but often overlooked impactors of pilot fitness for flight are calories and hydration.  The brain is the largest consumer of both water and glucose.

Unlike other body organs, the brain cannot manufacture glucose.  Both water and glucose must be contantly supplied meaning that pilots should be adequately hydrated and fed before, during and after flight.


THE FINAL ANALYSIS
The IMSAFE checklist is a guide.  It is a quick, simple, user-friendly self-check mechanism that pilots can use to ‘screen’ themselves for flight fitness, readiness and safety.
You should always feel comfortable connecting with your AME about any questions that you might have as it relates to aviation health and your fitness for flight.  We are here to help.

At Steel City Direct Care, LLC, pilots are our business and we exist to keep you in the sky and at the controls.  We’d love to connect with you!


Christopher T. Conti, MD is the Founder and Owner of Steel City Direct Care, LLC., a Pittsburgh, PA-based medical practice specializing in the care of athletes and aviators.  He is an emergency medicine physician with additional training in sports and concussion health.  He is currently a Team Physician for the US Soccer Federation (USSF), U14-U17 Youth National Team player pools, Medical Advisor for the PA West Soccer Association, a local affiliate of the United States Youth Soccer Association and the Medical Advisor for the Woodland Hills School District in suburban Pittsburgh, PA.  Dr. Conti serves as Medical Advisory Board Member for  SportGait and is also a Credentialed ImPACT Consultant (CIC) for sports concussion care.  Dr. Conti is a designated Senior Aviation Medical Examiner (AME) for the Federal Aviation Administration (FAA)

Disclaimer
The information, opinions and content presented do not necessarily represent the policies or opinions of USSF, the FAA, PA West Soccer, USYS, FIFA, ImPACT, SportGait, the Woodland Hills School District or Steel City Direct Care, LLC.  
None of the information presented should be construed as formal medical advice, nor should it be considered an acceptable substitute for a formal virtual or in-person encounter with an appropriately trained and licensed healthcare professional.  None of the above-listed entities, including Steel City Direct Care, LCC, are responsible for any adverse outcome associated with this content.  

If you would like to schedule a virtual or in-person visit with Dr. Conti, please contact Steel City Direct Care

Steel City Direct Care is a Direct Patient Care (DPC) practice that provides targeted & specialized in-person and virtual care for aviators and athletes of every age and level of skill and participation.

If you are an athlete, it is very likely that this has happened to you before in sports…

While training or competing and subjecting your body to the many 'load' demands and stresses of highly dynamic sports movements you, "tweaked” something.

The result was possibly:
     - an ache in your foot or ankle
     - soreness in your knee or hip
     - a 'pulling' or 'jabbing' sensation in your mid- or lower back

Something happened that made you 'pay attention' in the moment though it was not enough to make you stop participating.

So you shrugged-off the moment of pain and decided to press-on, remembering somewhere it the recesses of your sports mind that someone once told you that there's a difference between being 'sore' and being 'injured'.

But in this moment of discomfort, you chalked it up to 'soreness' and you finished-out the training session or competitive event.

The next day, you soreness persisted, perhaps now with some swelling, and after talking to a teammate or other well-intentioned untrained consultant, you diagnosed yourself as simply being "a little stiff“ prompting you to opt for 'recovery' without evaluation and maybe a quick check-in with the Medscape University of Online Medical Science or the Google Virtual College of Sports Medicine.

Of course, I am joking because neither of these entities exist nor do their information platforms present themselves as medical institutions of higher learning.
.
In your mind, you’re thinking that the discomfort, decreased mobility and feeling of dis-ease (un-wellness) will pass, but they don't.

Now, weeks later, you are still “not back to normal“ and “not 100%“ and more concerning, still not able to return to full participation.

You start with a your primary care provider, local urgent care or emergency department only to be told to 'rest' and 'be patient'.

You finally connect with a sports health professional and after a number of sports-specific 'provocative' tests where simulated sports-specific movements and stress to the injured body part produce tell-tale discomfort, and a definitive culprit.

The diagnosis, a significant, performance-altering injury to a bone, ligament or tendon followed by a prolonged recovery that has now been delayed by a month or more, leaving
you wondering, how did this happen, how did I get here?

ATHLETES MUST UNDERSTAND THAT THEY ARE BUILT DIFFERENT
If you are participating in a any highly dynamic sports activity at the elite or sub-elite training and competitive level, or are participating at an intensity level or frequency that higher than normal, you are subjected to repetitive and incredible dynamic forces.

Even if highly trained and optimally physically fit-- even with honed sports-specific movement mechanics, better-than-average nutrition and hydration and an attention to and appreciation for wellness and self-care, we can often talk ourselves out of seeking the care we need after injury or illness.

For some of the hesitancy comes from a place of fear and anxiety regarding the potetial diagnosis.

For others, culture and 'coaching' has encouraged stoicism, implying that pain and discomfort are obstacles to be overcome rather than 'signals' from the body that should not be ignored.

High performing athletes have to understand that they are different and that the physics of their movement is not on their side.  

The physical forces being placed on muscles and joints are enormous and over time, the cumulative effect of these repetitive high velocity/loading forces can compromise joints and tissues.  

The are times where the 'tweak' or the 'pull' is just a 'tweak' or a 'pull', but sometimes the symptoms are a sign of the actual or impending failure of these tissues and structures under the enormous stress of repeated high-velocity movement.

And the answer can rarely be uncovered through an internet search alone.

WHAT ATHLETES CAN AND SHOULD DO
'Listen' to your body within the context of your status as a high-performance athlete-- understanding that the dynamics and circumstances are different because missed or delayed diagnosis can impact your ability to train and compete.    

Any one or combination of the following may be a sign symptoms of a deeper injury that warrants prompt attention from a trained sports health professional:

   - pain that persists or worsens over time
   - discomfort that produces unusual selling or bruising
   - any swelling or bruising while on a 'blood thinning medication as warfarin (Coumadin, Plavix, Xarelto)
   - discomfort that significantly impacts normal movement and/or joint function
   - discomfort associated with numbness/tingling
   - discomfort that produces weakness of an extremity
   - discomfort or un-wellness that is associated with a previous similar injury
   -any illness/injury that may exacerbate (make worse) a current chronic medical condition (like asthma/COPD, irregular heart rhythm, kidney disease, diabetes, seizure disorder)

And perhaps the most important consideration is if you feel unsure or in any way unwell to the point of distraction, seek care-- again from a trained clinical sports health professional.

WHERE SHOULD I GO TO SEEK EVALUATION?
If you believe that your injury/illness requires “now” evaluation, you may opt to visit an emergency department or urgent care center.

If you believe your injury can 'wait', you should attempt to promptly contact a trained and credentialed sports health professional.  

If you are participating at a level where you have access to a sports health support team (athletic trainer, physiatrist, team clinician),  a member of that team can help coordinate the 'next steps'.

When in doubt, utilize emergency care options and move forward from there.  Do not hesitate to seek care if you feel that you need it urgently or emergently.

THE ROLE OF THE EMERGENCY ROOM
From contusions (bruises) to concussion, emergency departments exist to evaluate, rule out and provide stabilizing care for acute life or limb, threatening injury/ill illness.   In the US, they are open 24/7/365 and must provide all patients with a medical screening examination regardless of insurance, financial or immigration status, etc.

Emergency department staff are highly trained clinical professional with a wealth of clinical knowledge on a wide variety of conditions.  Emergency department staff, in general, are not specifically trained in the care and management of the high performance athlete.

The emergency department can absolutely assess and even diagnose a wide variety of sports-related conditions and provide pain relief, immobilization through splinting, weight-bearing assistance with crutches, and perhaps preliminary imaging if clinically indicated.

Even if you are evaluated and treated by an emergency department clinician with additional sports-specific training, all emergency department visits for all complaints will end with discharge instructions that include a follow-up interval and a recommended follow-up provider/specialty.

For the high performance athlete, if an injury or illness warrants evaluation in the emergency department, the next step is to coordinate care with a properly trained and licensed sports health provider.

If you are 'attached' to a team with sports health and performance support, your follow-up will start there.  Those with health insurance may need to check their insurance network's directory of providers.

When in doubt, before you leave the emergency department, ask for information about sports-specific services that might be available at the hospital/health system where you are being treated.

This is important because sports-focused evaluation and treatment plans can improve recovery time and outcomes for injuries as well as illnesses.

Additionally, in the case of treatment plans that require medication, it is important to involve sports-focused clinical providers to ensure that you are not receiving medication’s that are banned or restricted.

In those cases, depending on your level of participation and/or the organization governing competitive participation, you may require a Therapeutic Use Exemption in order to utilize those medication‘s.

THE SPORTS-SPECIFIC CARE DIFFERENCE
The post-COVID availability of telemedicine and virtual care has expanded the accessibility of all clinical services including sports health related care.

Despite increased access, many athletes still appear reluctant to seek sports-related health services.

Interestingly, data suggest that within youth sports in the United States, less than 5% of total participation-related expenditures are related to health, wellness, and performance.

The bulk of that 5% is spent in the evaluation, diagnosis and treatment of acute illness and injury with very little investment in comprehensive, proactive, prevent preventative, whole athlete care or recovery/rehabilitation.

At the elite performance level, the degree of investment has been studied across many sports, particularly as it relates to injury-reduction and overall player and team performance.

The data suggest that teams that have a more robust investment in these support services, in general, tend to be more successful.

The relationship between the health and wellness of the athlete and performance success is being studied but logically, healthier athletes are better positioned for success in competition.

The estimates suggest that most elite-level/professional teams invest somewhere between 15% and 35% of budgeted expenses on health, wellness and performance support.

Furthermore, this investment has been shown to have a 3 to 6-fold return on investment as measured by both revenue and winss-and-losses.

THE BIRMINGHAM CITY FC STORY
Birmingham City FC competes in The Championship, which is the second tier of English Football).  During the 2024 season, club leadership made a considerable investment of time and capital on improved emphasis in the areas of performance and recovery.  

Using an innovative, evidence-driven platform, the work of the physio team led by Dr. Pete Cummings led to:

   - earlier detect neurocognitive and neuromuscular fatigue
   - prevention of injuries that could player availability and overall team performance
   - personalized, player-specific recovery plans

The result was real time data that staff could use to reduce injury risk and improve recovery.  

The result was a 'breakout season' and the resurgence of a storied English football franchise.


FOLLOW-UP CARE AFTER INITAL EVALUATION
all sports related injuries in high performance athletes require follow up!

One of the primary goals of this follow-up is to ensure that your recovery returns you to full, competition-level, strength, agility and function.

Some injuries and illnesses that do not impact the non-athlete can still produce subtle changes in movement mechanics, stamina, etc that keep the injured athlete at risk.

Additionally, even small changes and overall movement mechanics in response to an isolated injury can put other joints and muscular systems at risk.

For example, a right ankle injury that is not fully recovered could put unnecessary stress on the hips, lower back or joints of the opposite leg. This would likely go unnoticed in a non-athlete but could manifest as an overuse injury in the high performance athlete— further prolonging recovery, and return to full participation.

IMPORTANCE OF THE “RECOVERY PARTNERSHIP”
Interaction between the athlete and the members of his/her health, wellness and performance support team is best described as a partnership.

The athlete brings personal goals and objectives and an honest self-assessment of strengths, weaknesses, and commitment.

The trained professionals that make up the support team bring knowledge of science and data driven best-practices along with sports health-specific clinical experience.

Within the framework of that partnership, there must also be transparency, open/honest communication and trust.

When the partnership is firing on all cylinders, it produces powerful and performance shifting results.


FINAL ANALYSIS
The human body is incredibly strong and resilient. Trillions of cells under highly complex, physiological and neurological oversight, working together, just to maintain “normal” daily function.

Now insert the intense demands of high performance sports participation.   High performance athletes are 'built' different.

The ability of the body to meet/exceed the demands of these complex, high demand movement mechanics are to be marveled as extraordinary.

Nonetheless, injuries and illnesses do occur and athletes at any level of skill or participation are not exempt.

As a high performance athlete, your body is your instrument that, when finely tuned and functioning, will allow you to separate yourself from teammates with whom you may be competing for match minutes as well as competitors.

Do not underestimate or undervalue the importance of remaining tuned-in to your own body and staying connected to the health and wellness support resources to keep you “in the game” and at your best.

With the amount of time, energy and finance that millions invest each year in high performance sports participation, perhaps athletes should consider leveraging some of that expenditure in a way that encourages health, wellness, well-being and self-care.

At the organized sports level, particularly among youth sports, coaches and organizational boards that desire to create market separation between their “brand” and the competition should consider the role and benefit of a more robust health, wellness, and performance focus.

In the end, where there are sports, there will be competitors and where there are competitors there will be injury.

Perhaps some of this information may help to shape your approach in a way that improves competitive success as well as your level of joy and longevity.

Christopher T. Conti, MD is the Founder and Owner of Steel City Direct Care, LLC., a Pittsburgh, PA-based medical practice specializing in the care of athletes and aviators.  He is an emergency medicine physician with additional training in sports and concussion health.  He is currently a Team Physician for the US Soccer Federation (USSF), U14-U17 Youth National Team player pools, Medical Advisor for the PA West Soccer Association, a local affiliate of the United States Youth Soccer Association and the Medical Advisor for the Woodland Hills School District in suburban Pittsburgh, PA.  Dr. Conti serves as Medical Advisory Board Member for  SportGait and is also a Credentialed ImPACT Consultant (CIC) for sports concussion care.  Dr. Conti is a designated Senior Aviation Medical Examiner (AME) for the Federal Aviation Administration (FAA)

Disclaimer
The information, opinions and content presented do not necessarily represent the policies or opinions of USSF, the FAA, PA West Soccer, USYS, FIFA, ImPACT, SportGait, the Woodland Hills School District or Steel City Direct Care, LLC.  
None of the information presented should be construed as formal medical advice, nor should it be considered an acceptable substitute for a formal virtual or in-person encounter with an appropriately trained and licensed healthcare professional.  None of the above-listed entities, including Steel City Direct Care, LCC, are responsible for any adverse outcome associated with this content.  
If you would like to schedule a virtual or in-person visit with Dr. Conti, please contact Steel City Direct Care

Steel City Direct Care is a Direct Patient Care (DPC) practice that provides targeted & specialized in-person and virtual care for aviators and athletes of every age and level of skill and participation.

Soccer is classified as a dynamic, aerobic, impact sport.  Injuries are inevitable and lower extremity injuries are the most common musculoskeletal injuries reported among male and female soccer players of all ages and levels of competition and participation.

Ankle sprains are one of the most common musculoskeletal injuries in the United States among both athletes and non-athletes and the disability caused by these injuries and the time spent recovering can impact both work and sports/recreation participation.  

Approximately 10% of all ankle injuries are recurrent injuries.

Medically speaking, ankle injuries can be classified in many ways.  In general, ankle injuries can be described as ‘common’ or ‘high’ ankle injuries.  

This blog helps athletes better understand the general difference between the two and focuses attention on the mechanism, symptoms and recovery associated with the ‘high’ ankle sprain among footballers—though most of this information can be applied to any sport.


The Lower Leg
Below the knee joint, the lower leg is composed of two long bones—the tibia which is the strong, thick ‘shin’ bone and the thinner, largely non-weight-bearing bone on the outer aspect of the lower leg called the fibula.   Even though the fibula does not 'do' much in terms of supporting body weight, it plays an important role in stabilizing the lower leg and the ankle.  These two bones are kept in close proximity to one another by a series of ligaments that make up a tough band of tissue called the syndesmosis.  

The syndesmosis is the site of injury in ‘high ankle’ sprains.

The Ankle Joint
The ankle is not a bone, but it is an anatomical location where 3 bones come together (articulate) and are stabilized and held together by tendons (the ends of muscle that connect to bone) and ligaments (tissue that connects bones to one another).  These bones are the tibia, the fibula, and the talus.  When the joint is functioning properly, the ankle is able to move dynamically and withstand forces 3 or more-times a footballers’ total body weight.


Common Ankle Injuries
The ankle cannot be ‘broken’ per se, and medically, ankle fractures are described in terms of the bone(s) involved as well as other grading systems and descriptive terms.   Ankle fractures are far less common than tendon (strains) and ligament (sprains) injuries.  

Common ankle sprains most often involve inversion injuries where the ankle suddenly ‘twists’ inwardly.  Athletes often call this ‘rolling’ their ankle.  The most common ligament injured in the common ankle sprain is the anterior talofibular ligament (ATFL), though sprains can involve one or more ligaments.  It is also important to note that virtually all ankle sprains also involve an element of tendon (strain) injury.

It is just a a lot to say "I sprain-strained my ankle", so we typically simply call it a sprain.  

Some injuries that produce discomfort in or around the ankle joint aren't ankle injuries at all.  

One of the most common examples is an injury to the Achille's tendon which is actually a lower leg injury that involves the foot because the gastrocnemius (calf) muscle originates in the lower leg and attaches to the back of the heal.


Common Ankle Injuries | Symptoms & Findings
   - account for about 85% – 90% of ankle sprains
   - pain, swelling, bruising and pain involving the ankle joint and foot
   - pain is often worsened with attempting to walk, step, run or hop
   - athlete recovery and full return to unrestricted participation typically takes 6 to 12 weeks with a structured rehabilitation program—longer without


‘High’ Ankle Injuries
Because ‘high’ ankle injuries involve different lower leg structures, the signs, symptoms and examination findings are different.  ‘High’ ankle injuries involve the syndesmosis of the lower leg—the strong ligamentous band of tissue between the tibia (shin) and fibula).  

While the ATFL is an important stabilizing ligament of the ankle joint, the syndesmosis is an important stabilizer of the shin and fibula.  Walking, running, twisting, jumping and sudden changes in direction exert tremendous force on the lower leg and the syndesmosis helps keep the tibia and fibula from being spread apart too far.  When you bear weight on the leg, the tibia and fibula experience high forces that spread them apart.

While common ankle sprains involve ‘rolling’ the ankle, ‘high’ ankle sprains more commonly involve eversion (outward movement) or a movement called dorsi-flexion—where the foot bends suddenly and forcefully toward the shin.  


 'High' Ankle Injuries | Symptoms & Findings
   - account for up to 5% to15% of ankle sprains
   - pain and swelling to the ankle joint is far less common, often sparing the foot entirely
   - pain that radiates upward towards the shin, particularly when attempting to weight-bear or pivot on the foot


The Lower Leg Examination
A proper examination of an injured ankle will start with obtaining a history from the patient of how the injury occurred (timing and mechanism), initial symptoms, home care and treatment and any other clinical evaluation (from a primary care physician, emergency department, urgent care or athletic trainer).  

Next, the examiner will perform a complete evaluation of the knee, lower leg, ankle and foot.  

The exam will start with a general inspection—looking for deformity, bruising, swelling, warmth and other wounds such as lacerations (cuts) or abrasions (scrapes) and previous surgical scars.

Next, the function and stability of the muscles, tendons and ligaments and joints will be evaluated—including assessing the range-of-motion and the ability to bear-weight (stand and move on the injured leg).  Both restricted and abnormally-increased range of motion (called joint laxity) may be an indication of injury.

The examination will also include an evaluation of the circulation (blood flow) and pulses as well as an assessment of the nerve function.

After the physical examination, the examiner may decide to obtain imaging (plain xrays, CT imaging or MRI)


Diagnosis of ‘High’ Ankle Sprain
   - History and mechanism of injury
   - Physical Exam findings including a fibular compression test also called the high ankle sprain test or the syndesmosis squeeze test
   - many times, particularly in elite-level athletes or in those with persistent symptoms or significant deformity or exam findings, imaging studies (X-ray, CT, MRI) may help in diagnosis and treatment decisions


Treatment of ‘High’ Ankle Sprain
   - Initial treatment typically includes ‘PRICER’ (Protect, Rest, Ice Compress, Elevate, Re-evaluate), modified weight-bearing
          - Protect & Rest:  limit use/weight-bearing, crutches, walking boot, splinting
          - Ice:  apply ice to injured area to reduce pain and/or inflammation
          - Compress:  appropriate use of ace bandage wrap for comfort and inflammation
          - Elevate:  at rest, elevating the injured ankle will reduce pain/swelling
          - Re-evaluate:  follow-up evaluation prior to resuming unrestricted activities
   - Early, limited weight-bearing—evidence suggests that the duration of immobilization and/or limited weight-bearing may be twice as long as that for common ankle sprains.  


Recovery Timeline
Every footballer is different and thus there is no specific, hard-and-fast rule for the recovery duration from a ‘high’ ankle sprain.  

In general, however, the recovery time for ‘high’ ankle sprains that do not require surgery is 6-8 weeks, though as many as half of athletes will reports symptoms for as long as 6 months following injury.

Guided rehabilitation from trained athletic trainer or physical therapist has been clearly shown to improve recovery and in some cases, shorten recovery time

Advanced imaging my be required in athletes where there is any evidence of potential ligament instability

A small percentage of lower extremity injuries (including common and 'high' ankle injuries) may require surgery to fix which will impact recovery time.

Elements that Impact Recovery & May Reduce Injury Risk
   - Neuromuscular activation training which ‘connects’ the brain to the musculoskeletal system and focuses on balance, coordination and sport-specific movement patterns
   - Evidence suggests that regular, proper neuromusculoskeletal activation may reduce the rate of ankle injuries by as much as 30%
   - Proper movement mechanics are essential to an optimally stable joint
   - Sleep, adequate recovery between training and competitive events, hydration and balanced nutrition all can positively impact musculoskeletal function
   - injuries that impact participation and performance may also impact mood which, in turn, can negatively impact healing and recovery

Athletes may struggle socially-emotionally while recovering from injury.  Part of the recovery process should include creating 'safe' spaces for open communication about these elements no different than conversations about physical pain/discomfort.

It is important for footballers to be properly evaluated following any musculoskeletal injury—particularly those that require removal from training or competition.  

Early and proper diagnosis and the initiation of guided rehabilitation are important to getting the injured footballer back on the pitch safely.

Christopher T. Conti, MD is the Founder and Owner of Steel City Direct Care, LLC., a Pittsburgh, PA-based medical practice specializing in the care of athletes and aviators.  He is an emergency medicine physician with additional training in sports and concussion health.  He is currently a Team Physician for the US Soccer Federation (USSF), U14-U17 Youth National Team player pools, Medical Advisor for the PA West Soccer Association, a local affiliate of the United States Youth Soccer Association and the Medical Advisor for the Woodland Hills School District in suburban Pittsburgh, PA.  Dr. Conti serves as Medical Advisory Board Member for  SportGait and is also a Credentialed ImPACT Consultant (CIC) for sports concussion care.  Dr. Conti is a designated Senior Aviation Medical Examiner (AME) for the Federal Aviation Administration (FAA)

Disclaimer
The information, opinions and content presented do not necessarily represent the policies or opinions of USSF, the FAA, PA West Soccer, USYS, FIFA, ImPACT, SportGait, the Woodland Hills School District or Steel City Direct Care, LLC.  
None of the information presented should be construed as formal medical advice, nor should it be considered an acceptable substitute for a formal virtual or in-person encounter with an appropriately trained and licensed healthcare professional.  None of the above-listed entities, including Steel City Direct Care, LCC, are responsible for any adverse outcome associated with this content.  
If you would like to schedule a virtual or in-person visit with Dr. Conti, please contact Steel City Direct Care

Steel City Direct Care is a Direct Patient Care (DPC) practice that provides targeted & specialized in-person and virtual care for aviators and athletes of every age and level of skill and participation.

Obstructive sleep apnea is the most common sleep-related breathing disorder.  The term sleep apnea means ‘without respiration’ and people with obstructive sleep apnea repeatedly stop and start breathing multiple times each night while they sleep.

Obstructive sleep apnea occurs when the throat muscles relax and block the airway.  The result is that breathing stops during sleep often for prolonged periods of time throughout the night.  The person sleeping almost never notices and it is often reported to them by others who observe the events.

The statistics are alarming:
   - 10-15% of females and 20-30% of males have OSA; with up to 90% undiagnosed

Additionally, an OSA diagnosis is found in:
   - 70% of all morbidly obese patients
   - 70% of patients with Type II diabetes
   - 40% of patients with hypertension

What’s Going On In the Body With OSA
OSA is characterized by repetitive upper airway obstruction during sleep, causing a cascade of repetitive physiologic responses to these ‘breathing arrest’ episodes.  At the root of these changes is the decrease in blood oxygen levels that accompany these events.

When these events happen repeatedly, every night, over time:
   - blood pressure rises; ultimately remaining chronically elevated (hypertension)
   - the heart muscle is subjected to a chronic and abnormal workload leading to heart failure
   - the circulatory system responds to decreased oxygen levels in a way that increases risk of heart attack, stroke
   - chronic decreased oxygen to the brain increases risk of neurocognitive decline
   - diabetes risk increases while those who are already diabetic find it more difficult to control their blood glucose levels

Ultimately, untreated OSA can manifest in pilots as:
   - memory loss and task processing difficulties
   - pulmonary (lung) hypertension
   - cerebrovascular events (stroke)
   - cardiovascular events (heart attack, heart failure, heart arrhythmia)
   - hypertension
   - diabetes
   - chronic drowsiness and fatigue
   - excessive daytime sleepiness
   - chronic headache
   - obesity

Symptoms of obstructive sleep apnea during the night include:
   - loud snoring
   - pauses in breathing during sleep, often noticed by a partner.
   - waking during the night gasping or choking.
   - needing to urinate often.

Symptoms of obstructive sleep apnea during the day include:
   - excessive daytime sleepiness.
   - waking in the morning with a dry mouth or sore throat.
   - morning headaches
   - trouble concentrating, focusing and processing
   - mood changes, including depression
   - persistent/uncontrolled high blood pressure
   - decreased libido in men and women, and erectile dysfunction in men

Consult a healthcare professional if you have, or if your partner notices, any one or more of the following:
   - snoring loud enough to disturb your sleep or the sleep of others.
   - waking up gasping or choking.
   - pausing in your breathing during sleep.
   - excessive daytime drowsiness. You may fall asleep while working, watching television, operating heavy machinery, driving a vehicle and operating an aircraft.

OSA and Flight Safety
It is estimated that 2.6% of aircrew have OSA, with the numbers rising considerably to as high as 70% in higher risk cohorts, like those with obesity.

Data also suggest that pilots with untreated OSA have a 6-fold increase in the risk of aircraft crashes and other flight-related mishaps.

In 2008, during a daytime flight, both the Pilot and the First Officer were found to have fallen asleep in the cockpit resulting the aircraft overflying its destination airport.  Though the aircraft did land safely,  the incident was attributed to a combination of sleep-related factors including the Pilot’s undiagnosed OSA.

By 2015, the NTSB identified OSA as one of its ‘Most Wanted’ Transportation Safety Improvements.

In fact, when sleep-related impacts on pilot performance are linked to substance impairment, pilots with mild-to-moderate OSA consistently show performance degradation similar to those operating an aircraft (simulated) with a blood alcohol concentration (BAC) of 0.06% to 0.08%.  

Anyone can develop obstructive sleep apnea. however, certain factors put you at increased risk, including:

   - Excess Weight: Most but not all people with obstructive sleep apnea are overweight. Fat deposits around the upper airway can obstruct breathing. Medical conditions that are associated with obesity, such as hypothyroidism and polycystic ovary syndrome, also can cause obstructive sleep apnea.
   - Older Age:  The risk of obstructive sleep apnea increases as you age but appears to level off after your 60s and 70s.
   - Male Sex: In general, men are 2 to 3 times more likely than premenopausal women to have obstructive sleep apnea. However, the risk of obstructive sleep apnea increases in women after menopause.
   - Family History:  Having family members with obstructive sleep apnea might increase your risk.
   - Narrowed Airway:  Your tonsils or adenoids might become enlarged and block your airway, increasing your risk of obstructive sleep apnea. Enlarged tonsils are an important risk factor for obstructive sleep apnea in children. A narrowed airway also can be passed down in families.
   - Chronic Nasal Congestion:  OSA occurs twice as often in those who have consistent nasal congestion at night, no matter what causes it.
   - Smoking:  People who smoke are more likely to have obstructive sleep apnea.
   - Other Health Conditions:  OSA is associated with other health conditions, including high blood pressure, heart attack, stroke, irregular heartbeat, diabetes, chronic lung disease and depression.

Treatment Options
There are a number of effective treatments for OSA with most medical professionals recommending less invasive and non-surgical interventions as the first-line.

All non-surgical and surgical treatments for OSA must be reported to the FAA in order to maintain lawful medical certification.

Behavioral Changes
   - Change in sleeping position (sleeping on side or stomach)
   - Change in sleep environment (matress type, light level, room temperature)
   - 0% weight loss in obese/morbidly obese patients can reduce risk by up to 25%

Dental Appliances
   - these appliances reposition the mandible (jawbone)

Continuous Positive Airway Pressure (CPAP)
   - considered to be the ‘gold standard’ and most effective non-surgical treatment for OSA
   - found to decrease daytime sleepiness and increase cognitive function
   - CPAP provides continuous positive air pressure by ‘blowing’ air toto the respiratory system through a mask in order to keep the airways open during sleep

Surgical Interventions
   - Surgical interventions include nasal airway procedures, palate implants, uvulopalatopharyngealplasty (UPPP), tongue reduction procedures, genioglossus (tongue) advancement procedures and maxillomandibular (upper and lower jaw) advancement.

OSA and Your Medical Certificate
OSA screening is a part of every aviation medical examination (flight physical)—every time.  

   - Pilots who already have an OSA diagnosis and who have already reported PSA to the FAA, will require regular-interval evaluation of data and will require a Special Issuance.

   - Pilots with known OSA and who have not yet reported their OSA to the FAA and for those pilots at high risk for OSA will be DEFERRED and will be required to undergo additional testing and evaluation before being issued an medical certificate in any class.

The Final Analysis
OSA is a common but highly treatable medical condition.  If left untreated, it can contribute to a host of chronic and potentially dangerous medical conditions.
Untreated and non-monitored OSA is an absolute threat to pilot health and flight safety.

Pilots who fly with untreated, undiagnosed and unmonitored OSA assume an unnecessary risk to self, flight crew, passengers and the general public.

Please contact your Aviation Medical Examiner for more guidance.

You may also want to click HERE to review the current FAA guidance to Aviation Medical Examiners regarding OSA.

Christopher T. Conti, MD is the Founder and Owner of Steel City Direct Care., a Pittsburgh, PA-based medical practice specializing in the care of athletes and aviators.  He is an emergency medicine physician with additional training in sports and concussion health.  He is currently a Team Physician for the US Soccer Federation (USSF), U14-U17 Youth National Team player pools, Medical Advisor for the PA West Soccer Association, a local affiliate of the United States Youth Soccer Association and the Medical Advisor for the Woodland Hills School District in suburban Pittsburgh, PA.  Dr. Conti serves as Medical Advisory Board Member for  SportGait and is also a Credentialed ImPACT Consultant (CIC) for sports concussion care.  Dr. Conti is a designated Senior Aviation Medical Examiner (AME) for the Federal Aviation Administration (FAA)

Disclaimer  
The information, opinions and content presented do not necessarily represent the policies or opinions of USSF, the FAA, PA West Soccer, USYS, FIFA, ImPACT, SportGait, the Woodland Hills School District or Steel City Direct Care, LLC.  

None of the information presented should be construed as formal medical advice, nor should it be considered an acceptable substitute for a formal virtual or in-person encounter with an appropriately trained and licensed healthcare professional.  None of the above-listed entities, including Steel City Direct Care, LCC, are responsible for any adverse outcome associated with this content.  

If you would like to schedule a virtual or in-person visit with Dr. Conti, please contact Steel City Direct Care

Steel City Direct Care is a Direct Patient Care (DPC) practice that provides targeted & specialized in-person and virtual care for aviators and athletes of every age and level of skill and participation.

The hyper-organization and monetization of youth sports has transformed what was once largely community recreation into a multi-billion-dollar industry. It is estimated that at its current trajectory, the youth sports industry could reach $70 billion in the coming years despite a leveling-off and in some sports a decline in participation.

It is clear that ‘pay-to-play’ is here to stay and that the model has a far-reaching impact on participants and families.

Families now invest enormous amounts of time, energy, and money into travel teams, private training, and year-round competition.

Ironically, data suggest that parents spend almost nothing for health, wellness and self-care unless it is linked to evaluation, diagnosis, or treatment of an acute sports-related illness or injury.

Sports/activity related injuries account for a large percentage of pediatric and adolescent medicine emergency department and urgent care visits.

At the same time, research consistently confirms that sports participation provides powerful benefits for children and adolescents.

Organized sports are associated with improved physical health, emotional development, social skills, and self-esteem, and participation in youth sports is linked to better physical and mental health outcomes later in adulthood.

But alongside these benefits sits a statistic that should give parents, coaches, and youth sports organizations pause:

     - Nearly 70% of young athletes stop participating in organized sports by age 13.

     - By mid-adolescence, attrition rates climb even higher to above 80%-- with 8 of every 10 previously engaged participants no longer participating at all by age 15.

These are not children who never enjoyed sports. These are kids who were actively practicing, competing, and enjoying participation—until they suddenly stop.

Parents often describe the moment the same way-- “One day they loved it. The next day they quit.”

But the word “quit” may tell us more about our expectations than about our children.

This is a widespread phenomenon and the young athletes leaving organized sports are not simply the least talented participants on the far edge of the talent curve. This attrition includes elite athletes, average athletes, and everyone in between.

And when parents try to make sense of it, they often view it through the lens of years of financial, emotional, time and logistical investment and sacrifice.

Some coaches offer a different explanation. They argue that young athletes today simply lack the discipline, drive, or commitment necessary to compete.

But if we ask the athletes themselves—many of whom are training more frequently than professional athletes once did at the same age—their answer is remarkably consistent:

Playing/participating stopped being fun.

The Tale of the 13-Year-Old Burnout
When young athletes describe why they step away from sports, they often describe symptoms that mirror classic burnout:

   - Physical exhaustion
   - Decreased motivation
   - Mood changes
   - Sleep disturbance
   - Difficulty concentrating
   - Frequent injuries or illness
   - Persistent pain and discomfort

Burnout in youth sports is now widely recognized in sports medicine literature. 

Studies show that 25–30% of youth athletes in competitive programs demonstrate moderate to high levels of burnout, while more than half report experiencing burnout symptoms at least occasionally.

And these symptoms often appear during early adolescence—often minimized or kept hidden.

It is also important to note that there are very few studies assessing the burnout phenomenon in pre-adolescent children though it can be suggested that the 'seeds' of burnout were planted during the pre-middle school years.

Now consider the environment many young athletes are navigating:

   - training 15–20 hours per week
   - participating in multiple leagues simultaneously
   - attending ‘supplemental’ private or specialized training sessions
   - traveling across states for tournaments
   - spending entire weekends competing
   - mid-season tryouts to maintain a current roster spot

All while navigating:

   - the hormonal and other physical changes of pre-adolescence/adolescence
   - the impact of social media input on perceived performance and unrealistic expectations
   - the fact that brain development and maturation may still be a decade or more away

All before they are even old enough to drive a car.

Pediatric sports medicine specialists increasingly warn that the professionalization of youth sports—year-round training, early specialization, and constant competition—contributes to overuse injuries, overtraining, and burnout.

And yet, despite the growing scale of youth sports participation and investment, one key outcome has not changed.

There is no meaningful increase in the number of athletes reaching elite levels of sport.

The reality is sobering:

   - Only about 7% of high school athletes will play sports at a 4-year college (at any level/division), and fewer than 2% of college athletes will go on to play professionally.

So we now find ourselves facing a troubling picture:

   - Millions of children participating in organized sports, often at professional-style training volumes, while the overwhelming majority will leave the organized sports environment before high school; with the remaining few still having an incredibly small chance of competing beyond high school.

This is not meant to discourage or to dash the hopes and dreams of our youth (or their parents), but to suggest that adults must ‘adult’ in order to add a different lens and perspective and to set healthy limits.

The View From Where I Sit
As a physician focused on the whole-child athlete and a youth soccer coach, I see this dynamic unfold almost daily.

And it is important to say this clearly:
   - Most parents are not acting out of pressure or ego.
   - They are acting out of love.
   - They want their child/ren to have every possible opportunity to both joy and success.

In fact, outside of concerns for player safety, the most important decision-making factor identified by parents across sports and levels of participation is:  is my child having fun.
But we now know that burnout is real—and that burnout rarely happens overnight.
Instead, it develops slowly and quietly, often with subtle warning signs that are easy to overlook.

At first the athlete feels tired.
Then practices feel like obligations rather than joy.  The expectations now become attached to goals, statistics, match outcomes and rosters and not to happiness and fulfillment.
 
Eventually, the motivation disappears.

When that happens, the outcome is predictable.
The athlete walks away— often despite the risk, burden and fear of being labeled as one who “didn’t have what it takes and quit“.

In other words, the young middle/high-schooler decides that it is better to stop playing rather than to continue dealing with the emotional stress and strain of joyless participation.

And the cycle repeats itself in community after community, year after year.

A Framework to Consider: The 1-2-3 Balance Script
There is no single solution to youth sports burnout—but all solutions must start with attentive, informed, engaged and empowered parents

This framework can help create a buffer between participation and overload.

I call it the 1-2-3 Balance Script.

At least ONE DAY OFF Each Week
Young athletes should take at least one full day off from training and competition each week.

This includes sports-related activities such as film study or tactical training.

Rest is not wasted time but it is targeted time for recovery.

Recovery allows the brain and body to adapt, repair tissue, and consolidate learning, which ultimately improves performance and reduces injury risk.
 
At Least TWO MONTHS OFF Each Year
Young athletes should also take two cumulative months (62 days) off organized sports each year.

This period—often called a “true off-season”—helps reduce the risk of overuse injuries, mental/cognitive fatigue, and burnout, which are common in athletes who train year-round.

Note that taking 1-day off per week will account for 52 of the 62 days

At Least THREE DAYS BETWEEN Competitive Events
Whenever possible, athletes should have three days between competitive events— this includes young athletes participating in multiple sports simultaneously and/or across multiple leagues

Parents may not always control tournament schedules, but they do control participation decisions.

This does not mean that the athlete can not train at some level between competitive events, but with the higher physiologic and neurocognitive demands of competition,

Many elite/sub-elite level organizing entities for youth sports, recognizing the many barriers to achieving this target have recommended/required that the competitive length be shortened if the 72-hour threshold cannot be met.  In soccer for example, the recommendation is that every consecutive match played where the 72-hour threshold is not met, should be shortened by 10-15% from the match immediately prior.

Choosing recovery over constant competition can reinforce empowered and self-care driven decision-making and will protect both health and performance.

There’s Still Power in ‘Free Play’—and a Whole Buch of Fun!
Ironically, one of the most powerful tools for long-term athletic development may be the simplest:

Unstructured play.  Kids organizing themselves and playing.
 
No adults making up the rules.  No coaches offering suggestions.  

Unstructured play to start every organized training as well as just kids being kids in the neighborhood and playing whatever sport/activity they choose.
 
   - Free play allows kids to explore movement, creativity, and competition without constant evaluation or pressure.

   - Free play builds self-esteem, encourages confidence and allows for children to even explore approaches to problem solving, confrontational communication and conflict resolution

Research also suggests that multi-sport participation and periods of rest reduce both burnout and injury risk, while early specialization significantly increases those risks.

In other words, the pathway to long-term athletic success may actually look less like specialization and more like exploration.

Perhaps that’s why many organized youth sports entities emphasize FUNdamentals and learning to ‘love to play’ before actually ‘learning to play’.

The Real Superpower: Self-Care
Perhaps the most important skill young athletes can learn is not technical or tactical.
It is self-awareness.

Learning what unwellness and dis-ease ‘look like’ and ‘feel like’ and learning how to communicate those internal inputs to the adult decision-makers.

Self-awareness and self-care are not weaknesses to be hidden but they are superpowers to be recognized, activated and leveraged.

Teaching kids to monitor their energy, mood, and recovery—and to feel empowered to say “no” when necessary may be more important than any specific sports skill.

At the highest levels of sport, this approach is already standard practice.

Many collegiate and professional programs regularly track athlete wellness with easy-to-use/user friendly technology platforms that allow daily check-ins measuring:

   - Sleep quality
   - Hydration
   - Muscle soreness
   - Mood
   - Mental sharpness

These systems help coaches adjust training loads and prevent burnout while creating a culture where athletes can speak openly about wellness.

Healthy, well, ‘balanced’ athletes perform better, sustain fewer illnesses and injuries and recover faster.
 
Parents can adopt a similar approach at home through regular, low-pressure conversations about how their child feels physically and emotionally.

Making 'check-ins' a part of the ‘normal’, regular-interval conversation makes it less awkward and can yield important information to help parents shape schedules and frame expectations—all while teaching the child that it ‘OK’ to not be ‘OK’ and that they should never feel reluctant to share.
 
Your young athlete needs to know that YOU are their ‘safe space’.

Sometimes those conversations will lead to difficult—but healthy—decisions:

   - Skipping a game.

   - Sitting out a tournament.

   - Taking a break.
   - Trying something new

In the end, less than 1% of all youth sports participants will become professionals, but they will all become adults.

The 90+ percent of youth sports participants who don't 'make it' to the 'next level' did not waste their time during those years of practicing, competing, providing team snacks and working at the concession stand to raise money.

Instead, all of that time spent participating help to shape and strengthen a number of core skills and capabilities that will last a lifetime.  

With respect to health, wellness and well-being, this time shaped their concepts of:

   - Self-Care Literacy which is their understanding about how participation in any activity affects their physical and emotional well-being
   - Self-Care Empowerment which is their ability to consistently and confidently advocate for their own physical and emotional health and wellness.

Long after the final whistle blows, those are the skills that will matter most.

The benefits are in the playing and if we want young people to stay in sports, to reap the fullness of those many benefits, we must protect the very thing that brought them there in the first place.

Joy.

At Steel City Direct Care, LLC, we care for the whole athlete... any age, any sport, any level of participation and competition.  We'd love to connect with you!


Christopher T. Conti, MD is the Founder and Owner of Steel City Direct Care, LLC, a Pittsburgh, PA-based medical practice specializing in the care of athletes and aviators.  He is an emergency medicine physician with additional training in sports and concussion health.  He is currently a Team Physician for the US Soccer Federation (USSF), U14-U17 Youth National Team player pools, Medical Advisor for the PA West Soccer Association, a local affiliate of the United States Youth Soccer Association and the Medical Advisor for the Woodland Hills School District in suburban Pittsburgh, PA. Dr. Conti serves as Medical Advisory Board Member for  SportGait and is also a Credentialed ImPACT Consultant (CIC) for sports concussion care.  Dr. Conti is a designated Senior Aviation Medical Examiner (AME) for the Federal Aviation Administration (FAA)

Disclaimer
The information, opinions and content presented do not necessarily represent the policies or opinions of USSF, the FAA, PA West Soccer, USYS, FIFA, ImPACT, SportGait, the Woodland Hills School District or Steel City Direct Care, LLC.

None of the information presented should be construed as formal medical advice, nor should it be considered an acceptable substitute for a formal virtual or in-person encounter with an appropriately trained and licensed healthcare professional.  None of the above-listed entities, including Steel City Direct Care, LCC, are responsible for any adverse outcome associated with this content.
 
If you would like to schedule a virtual or in-person visit with Dr. Conti, please contact Steel City Direct Care

Steel City Direct Care is a Direct Patient Care (DPC) practice that provides targeted & specialized in-person and virtual care for aviators and athletes of every age and level of skill and participation.
 

Whether you are a sports enthusiast, “weekend warrior“ or elite-level competitor, the difference between success and failure is often measured in milliseconds and millimeters.  Athletes are constantly searching for a competitive edge with strategies that often center around consistent practices and habits.   Sleep is an often misunderstood potential game-changer in a young athletes health, wellness and performance toolkits.

With very few exceptions in nature, virtually all mammals, birds, reptiles, amphibians and fish sleep, though some animals can go long periods of time without sleeping.
Sleep discipline describes the practices and habits that enable humans to develop and maintain an appropriate sleep schedule-- allowing for both physiologic and psychological/emotional functioning.  In other words, sleep is a requirement for physical, emotional health, wellness and self-care.

The scientific community has consistently identified sleep deprivation as a leading cause of poor performance in school and in sports; reporting that up to 80% of preteens, teenagers and young adult college athletes self-report sleep practices that meet the definition of sleep deprivation.  

Sleep deprivation is defined as any sleep amount that is insufficient to maintain optimal functioning and productivity during the day.

In fact, both the Federal Aviation Administration (FAA) and the US Department of Transportation (DOT) suggest that sleep deprivation is often identified as a contributory cause in accidents involving pilots and commercial truck drivers.  Data suggest that the negative effects of sleep deprivation on concentration, reaction time and decision-making are equivalent to driving under the influence of alcohol or other impairing drugs.

Many elite-level organized sports organizing bodies have identified sleep disturbances and sleep deprivation as major components that negatively impact the health, wellness and performance and suggest that these sleep-related issues may be particularly damaging to the health and wellness of younger athletes..

Getting enough sleep is an important part of overall well-being. Lack of sleep can make it hard to maintain focus and concentration, regulate mood, and heal/recover from illness and/or injury. In fact, insufficient sleep has even been linked to increased risk of both injury and illness.

Excessive daytime sleepiness (EDS) is a condition defined as an increased and often disabling level of fatigue during daylight hours.  EDS is estimated to affect up to one-third of adults in the United States.  EDS makes it hard to stay awake and focused during daylight hours.  EDS can interfere with your ability to work and get through your day and ironically it can also be disruptive to nighttime sleep.  Though there are some medications and medical conditions that can cause EDS, the vast majority of EDS can be traced back to poor sleep discipline and inconsistent sleep habits and practices.

Here are a few steps you can take to develop and maintain consistent sleep practices and help with your general health, wellness, self-care and performance both in the classroom and in the sport(s) you play:

Set a Timer as a Reminder to ‘Wind Down’ Before Bed
Though the human body is very resilient, it functions best when maintaining routines and rhythm.  That is why it is better for overall health and wellness to attempt to go to bed around the same time every night and wake-up at the same time every morning  regardless of the next day’s schedule.  In other words, whether it is a weekday or a weekend schedule, whether you have work, school, training or competition, your bedtime and wake-up times should remain consistent if at all possible.  A key element to establishing and maintaining a ‘set’ bedtime is to develop a nighttime, pre-sleep routine and one helpful tool is to consider using a pre-sleep timer.  The timer is your signal that it is time to prep the mind, the body and the bedroom for sleep.

Develop and Maintain a Pre-Sleep Routine
Once the timer is set, the activities within that hour should all be intended to prepare the for sleep.  You should have snacked or hydrated before this timer starts because eating or drinking to close to 'sleep-time' can be disruptive to getting to or staying asleep.  Your pre-sleep routine should include:

   - dimming the lights
   - powering-down electronic devices and TVs
   - prepping clothing, meals, snacks, school and sports gear for the next day
   - reviewing the next day’s schedule of activities
   - hygiene elements, body/skin care routines

Your body will follow the natural circadian rhythm without assistance, however, avoiding brightly lit screens and lights in general will help maximize secretion of the ‘sleep hormone’ melatonin.  Some studies even suggest that bright lights and blue-lit screens can reduce melatonin secretion at bedtime and delay the onset of sleep by several hours, meaning that even if you are tired and ‘ready’ for bed, it may be difficult for you to fall asleep.

Your pre-sleep routine should be 'de-stressing’ meaning that activities that might cause anxiety and added stress such as last-minute exam studying or pre-match prep for an important upcoming match might not be helpful in getting ready for a good night’s sleep.  

Some specific pre-sleep activities may include:

   - leisure/recreational reading (not studying)
   - hobbies such a puzzling, knitting, sewing, etc…
   - light stretching that does not involve strenuous exercise
   - yoga
   -  prayer/meditation

Get Your Sleep-Space Ready
Along with getting your body and mind ready for sleep, it is also important to ‘prep’ your sleep-space.  Prepping your bedroom and your bed for sleep can do wonders to help you drift-off into ‘slumber-land’.  

Prepping your sleep-space might include:

   - removing any clutter on the bed and tidying the area around your bed
   - smoothing bed sheets and covers
   - making sure pillows are in the right position
   - getting the lighting right for sleep, including dimming the lights, turning off screens and closing the blinds (if there is distracting light from outside that might disrupt getting to sleep).  
   - cooling the temperature of the room by adjusting the air conditioning, opening a window, or turning on a fan
   - eliminating distracting noise; including considering using ‘white noise’ devices and turning your mobile device to ‘do not disturb’

Hunger (and Thirst) Games
The body perceives hunger and thirst as 'system stressors' that must be managed, which means that going to bed excessively hungry or thirsty can be disruptive to a healthy sleep routine.  If you must snack before bedtime, it should be at least one hour before bedtime and you should avoid foods and liquids that contain stimulants like sugar and caffeine as well as items that will make you feel excessively bloated and “full”.  It should be noted that going to bed excessively hungry is also a 'stressor' so you should be managing your evening meals according to both your morning and afternoon activities (school, work, sports) as well as your pre-sleep schedule/routine.

Consider the ‘90-Minute’ Sleep Interval Rule
The body uses hormones and other chemicals to establish and maintain a level of readiness for sleeping.  Similarly, there are chemicals that are produced by the body to keep us awake and alert.  This process is collectively called the circadian rhythm that establishes a daily ‘internal clock’ that has an approximately 24.2 hour cycle.  In addition, the typical sleep cycle in humans is about 90-minutes.  Disruptions to the circadian rhythm can impact the sleep cycle and disruptions of the sleep cycle can impact the circadian rhythm.  The reason why we should limit nap duration (discussed later), for example, is because the “deep sleep“ parts of the sleep cycle occur approximately 30 to 40 minutes after a sleep-cycle  begins.   Sleep experts suggest that 90-minute sleep intervals is the 'target' for a healthy sleep routine. This is often a difficult concept to understand because the human brain is “hardwired“ to think in terms of whole numbers, which is why we tend to take one hour naps and sleep for eight hours, when we should be taking 20 minute naps and sleeping for 7.5 or 9.0 hours.  Try inserting this 90-minute interval strategy into your sleep practices and you may notice a difference.

Avoid the ‘Nap Trap’
Humans have an ‘internal clock’ that is tied to daylight, sunset and the release of different hormones that either help us sleep, wake us up and keep us awake.  Ideally, proper sleep discipline says that we should be able to go to bed and wake up at the same time every day, regardless of the next days schedule, without help from an alarm clock. As a general rule, daytime napping is an indication of sleep deprivation— meaning that unless we are sick, have some underlying medical condition that makes us excessively tired or under the influence of certain medications, we should not have an urge to take naps during the day.  In other words, generally speaking, napping is a signal that our sleep routine is ‘off’.  

If you feel an unavoidable need to take a daytime nap, you should:

   - Avoid taking naps in our “normal“ sleep-space, meaning we should not take naps in the bed/bedroom where we normally sleep at night because the brain has established that space for nighttime sleep
   - Limit nap time to 20 minutes or less to avoid entering into the deeper stages of the sleep cycle; thus minimizing the chances of waking up “tired” after a daytime nap
   - Use an alarm to signal the time to wake up from your (20 minute or less) nap; or employ the assistance of a trusted individual (parent, sibling, etc) to ensure that you wake up and do not sleep too long
   - Avoid at all costs, taking daytime naps after 2:00 PM, because afternoon naps can be very disruptive to nighttime sleep

Getting an adequate amount of sleep for scholar-athletes and athletes in general is as essential as hydration, nutrition and technical training.  If you are aspiring to separate yourself from your competition, you will find that the differences are often in the details.
Well-rested athletes are likely to have greater stamina, concentration and accuracy with respect to technical and tactical tasks.
 
If you are finding that your sleep challenges are becoming debilitating or otherwise worrisome, do not hesitate to communicate with a parent, guardian, coach, trainer or other qualified and licensed health professional.

I encourage you to work to harness the super-power of quality sleep—you won’t be disappointed with the results!

Christopher T. Conti, MD is the Founder and Owner of Steel City Direct Care, LLC, a Pittsburgh, PA-based medical practice specializing in the care of athletes and aviators.  He is an emergency medicine physician with additional training in sports and concussion health.  He is currently a Team Physician for the US Soccer Federation (USSF), U14-U17 Youth National Team player pools, Medical Advisor for the PA West Soccer Association, a local affiliate of the United States Youth Soccer Association and the Medical Advisor for the Woodland Hills School District in suburban Pittsburgh, PA. Dr. Conti serves as Medical Advisory Board Member for  SportGait and is also a Credentialed ImPACT Consultant (CIC) for sports concussion care.  Dr. Conti is a designated Senior Aviation Medical Examiner (AME) for the Federal Aviation Administration (FAA)

Disclaimer
The information, opinions and content presented do not necessarily represent the policies or opinions of USSF, the FAA, PA West Soccer, USYS, FIFA, ImPACT, SportGait, the Woodland Hills School District or Steel City Direct Care, LLC.

None of the information presented should be construed as formal medical advice, nor should it be considered an acceptable substitute for a formal virtual or in-person encounter with an appropriately trained and licensed healthcare professional.  None of the above-listed entities, including Steel City Direct Care, LCC, are responsible for any adverse outcome associated with this content.
 
If you would like to schedule a virtual or in-person visit with Dr. Conti, please contact Steel City Direct Care

Steel City Direct Care is a Direct Patient Care (DPC) practice that provides targeted & specialized in-person and virtual care for aviators and athletes of every age and level of skill and participation.

Effective January 1st, 2025, the FAA Color Vision Testing (CVT) standards changed.  Now, only specifically designated and approved computer-based color vision screening tests will be acceptable for pilot exams.

Additionally, the test results will now be uploaded into the Airman’s medical examination similar to ECG’s.

The following tests are currently FAA-approved:

        • Waggoner CCVT
        • Rabin Cone Test (RCCT) Air Force/Army/Navy/Coast Guard Version
        • City Occupational Colour Assessment & Diagnosis (CAD; AVOT-PRO-US)

All new pilot applicants will be required to meet the new CVT standards.  Pilots who have previously met the CVT standards are not required to test unless they are upgrading their FAA Medical Certificate to a higher class or unless they disclose a new medical condition that has impacted their color vision.

In the event that an airman does not pass one or more of the accepted color vision tests, the AME will be required to make the appropriate notation and upload the test scoring sheet.  In this case, the AME will issue a 3rd Class Medical Certificate provided the airman is otherwise qualified with the added limitation “Valid for day visual flight rules (VFR) only.”  

If the airman were to seek an upgrade to 1st or 2nd class medical certificate, an appeal to the Federal Air Surgeon will be necessary.

When scheduling your aviation medical examination, make sure that the AME is using an approved CVT platform.  If not, your medical certificated will be invalidated once the error is identified.

If you have any questions about these new CVT requirements or anything else related to medical certification, please connect with us, because we know pilots, we know the regs and we are here to help.

Whether you simply love to fly, or you fly for a living, Steel City Direct Care works to keep you healthy, well and flight-ready!  Our practice specializes in aviators, athletes and urgent care for individuals, families and businesses.

We look forward to connecting with you!

Christopher T. Conti, MD is the Founder and Owner of Steel City Direct Care, LLC, a Pittsburgh, PA-based medical practice specializing in the care of athletes and aviators.  He is an emergency medicine physician with additional training in sports and concussion health.  He is currently a Team Physician for the US Soccer Federation (USSF), U14-U17 Youth National Team player pools, Medical Advisor for the PA West Soccer Association, a local affiliate of the United States Youth Soccer Association and the Medical Advisor for the Woodland Hills School District in suburban Pittsburgh, PA. Dr. Conti serves as Medical Advisory Board Member for  SportGait and is also a Credentialed ImPACT Consultant (CIC) for sports concussion care.  Dr. Conti is a designated Senior Aviation Medical Examiner (AME) for the Federal Aviation Administration (FAA)

Disclaimer
The information, opinions and content presented do not necessarily represent the policies or opinions of USSF, the FAA, PA West Soccer, USYS, FIFA, ImPACT, SportGait, the Woodland Hills School District or Steel City Direct Care, LLC.

None of the information presented should be construed as formal medical advice, nor should it be considered an acceptable substitute for a formal virtual or in-person encounter with an appropriately trained and licensed healthcare professional.  None of the above-listed entities, including Steel City Direct Care, LCC, are responsible for any adverse outcome associated with this content.
 
If you would like to schedule a virtual or in-person visit with Dr. Conti, please contact Steel City Direct Care

Steel City Direct Care is a Direct Patient Care (DPC) practice that provides targeted & specialized in-person and virtual care for aviators and athletes of every age and level of skill and participation.

Anyone who has ever participated in physical exertion from playing sports in the backyard with family and friends to highly competitive, high performance competition, has their own stories about sore muscles both during and after activity.

And at a very basic level, physical activity produces cardiovascular, neurologic, chemical and musculoskeletal stresses on the body which, as a result, build muscle mass, muscle strength and flexibility, neurologic fitness, and cardiovascular endurance.  These stress-events in both training and competition, when monitored closely, are the primary way to improve our over all on-field athletic performance.

Soccer, for example, is one of the most physically demanding cardiovascular and physiologic sports in the world.  Depending on the level of participation and the length of the training interval or competition, it is not uncommon for soccer players to log their participation in miles traveled rather than minutes played.  Did you know that the average professional soccer player will cover over 5-6 miles (9-10 km) in the course of a 90-minute match?  Ironically, many studies report that less-experienced soccer players actually log more mile as a result of having to work harder due to a lack of technical and tactical expertise and soccer IQ.  In other words the youth players and 'weekend warriors' have to work harder in order to make-up for not being able to work-'smarter'!  

This blog post answers the questions that many athletes in every sport and at every level often ask sports health and performance professionals:

     - Why do my muscles burn during training or competition?
     - Why do my muscles ache sometimes for days following physical exertion?
     - How do I know if  the pain I am experiencing is ‘normal’?

EXPECTED PAIN WITH ACTIVITY
Muscles contain nearly 75% water, 20% protein, 4% fat and 1% glycogen (the storage form of glucose).  Additionally, skeletal muscles (muscles that control movement) are huge consumers of oxygen, meaning that hydration and good cardiovascular fitness are essential to proper muscle function.  

But like any other engine that ‘burns’ fuel; active muscles also produce a by-products that must be eliminated.  One of these by-products is called lactic acid.  Lactic Acid is often responsible for the ‘burning’ sensation that athletes experience during exertion.  Typically, this burning sensation lasts only as long as the exertion event (say a 30-yard sprint to track down a ball); and ends once that event is over.  Provided that the athlete remains properly hydrated throughout the competition and does not actually ‘injure’ a muscle or joint, this burn-recovery cycle will repeat itself throughout the event, though the period of time between burn and recovery may get longer as the contest wears on.

TYPICAL MUSCLE SORENESS AFTER EXERTION
Unlike the ‘burn’ of discomfort during exertion, most athletes have their own personal stories of the lingering soreness that occurs after exertion.  This soreness is often described as a dull ache and is typically accompanied a sensation of muscle ‘stiffness’ typically begins within thirty minutes of completing the exertion event and can linger for several days.  This condition is called Delayed-Onset Muscle Soreness (DOMS).  This condition is not only associated with highly strenuous or rigorous activity, but may also occur when beginning a new activity that requires muscles or muscle groups not typically used.  Unlike the activity-induced ‘burning’, lactic acid is not the culprit in DOMS, but rather it is due to physiological stress to individual muscle fibers and connective tissue causes microscopic stretching of these fibers and the release of inflammatory chemicals and sometimes the chemical creatine phosphokinase (CPK).  

DOMS does not typically impact continued performance, although the athlete my report that it seems to take longer to 'warm-up' prior to participation.  In general, pain due to DOMS typically resolves over several days and sometimes can improve with dynamic recovery and neuromuscular activation sessions, replenishment of nutrients and calories, and continues hydration with water and electrolyte drinks.

PAIN YOU SHOULD NEVER IGNORE
Beyond exertion-related ‘burning’ and delayed-onset soreness, there are circumstances that should not be minimized or overlook, because they may signal a true musculoskeletal injury.
 
And because this is often very difficult to determine in younger athletes at every competitive level, it is always better in this sub-group to always err on the side of caution because contrary to many parents, coaches and the players themselves—the young athlete will live to compete another day.

The list of musculoskeletal pain conditions that should never be overlooked or minimized include:

  - Sharp, sudden pain in a muscle or joint that prevents that body part from moving normally or limits the normal range of motion for that body part.

  - Unusual pain in the vicinity of any ,musculoskeletal area where the athlete has had previous surgery

  - Any pain that is associated with or accompanied by swelling or any other deformity that can be seen or felt.

  - Any muscle or joint pain that persists more than 3-5 days despite rest, ice, compression (ace wrap), elevation and/or over-the-counter pain and inflammation medications

  - Any muscle or joint pain that appears to be getting worse, even without swelling or noticeable deformity

  - Any pain involving a muscle or joint that produces, numbness or tingling or an inability to move that injured part (paralysis)

  - Any pain involving a muscle or joint that is associated with nausea, vomiting or fever

Sometimes exertional burning, delayed-onset soreness as well as the more serious injuries requiring prompt attention can be traced-back to overuse, over-scheduling (insufficient rest.recovery intervals) and/or improper technique or body-shape or position.  Other times, these conditions may be related to serious or ongoing muscle or joint injury, or may indicate a significant electrolyte or other chemical imbalance.  

This is why it is important to seek the help of trained individuals not only for evaluation and treatment, but for help in developing proper technique, body mechanics, preparation and recovery strategies.  These individuals might include sports medicine doctors, sports performance professionals, athletic trainers and physical therapists.

At the end of the day, even the most competitive among us are looking to seek enjoyment from sports participation.  Understanding the facts, listening to your body, and learning how to self-evaluate discomfort can keep you healthy, safe, satisfied and at your best on and off the field, court or other sports venue.

At Steel City Direct Care, we place athletes and student-athetes of all ages, skill and level of participation at the center of all that we do.

Whether you are active sports enthusiast, 'weekend warrior' or highly conditioned, accomplished, elite-level athlete, Steel City Direct Care looks forward to partnering with you to keep you healthy, well, 'balanced', in the game, and at your best!

Christopher T. Conti, MD is the Founder and Owner of Steel City Direct Care, LLC, a Pittsburgh, PA-based medical practice specializing in the care of athletes and aviators.  He is an emergency medicine physician with additional training in sports and concussion health.  He is currently a Team Physician for the US Soccer Federation (USSF), U14-U17 Youth National Team player pools, Medical Advisor for the PA West Soccer Association, a local affiliate of the United States Youth Soccer Association and the Medical Advisor for the Woodland Hills School District in suburban Pittsburgh, PA. Dr. Conti serves as Medical Advisory Board Member for  SportGait and is also a Credentialed ImPACT Consultant (CIC) for sports concussion care.  Dr. Conti is a designated Senior Aviation Medical Examiner (AME) for the Federal Aviation Administration (FAA)

Disclaimer
The information, opinions and content presented do not necessarily represent the policies or opinions of USSF, the FAA, PA West Soccer, USYS, FIFA, ImPACT, SportGait, the Woodland Hills School District or Steel City Direct Care, LLC.

None of the information presented should be construed as formal medical advice, nor should it be considered an acceptable substitute for a formal virtual or in-person encounter with an appropriately trained and licensed healthcare professional.  None of the above-listed entities, including Steel City Direct Care, LCC, are responsible for any adverse outcome associated with this content.
 
If you would like to schedule a virtual or in-person visit with Dr. Conti, please contact Steel City Direct Care

Steel City Direct Care is a Direct Patient Care (DPC) practice that provides targeted & specialized in-person and virtual care for aviators and athletes of every age and level of skill and participation.

Recovery is defined as the strategies and practices used by an athlete during the period of time between highly strenuous training activities or competitive events and the next scheduled strenuous training event or competition.

Recovery activities allow the body to return to baseline neuromuscular and biochemical function as measured by objective performance testing and biochemical analysis.

These activities include:

     - Rest/sleep
     - Hydration
     - Balanced overall nutrition and recovery-specific nutrition
     - Injury management
     - Recovery-focused stretching

Future blogs will address each of these elements in detail, however,  sports science data is compelling and suggests that, on average and under conditions where there are consistent and intentional recovery practices—

     - It takes 48 hours for the body to return to a baseline, neuromuscular state, barring injury, as measured by performance on Counter Movement Jump (CMJ) and sprint testing

     - It takes, on average, 72 hours for the body to return to a neurochemical baseline state, barring injury, as measured by serum (blood) creatine kinase (CK), testosterone and cortisol levels

Sports science data also consistently noted should that the lower the level of organized participation the longer these recovery intervals should be suggesting that, in general, younger and lower-level performing athletes should have even longer recovery intervals built into their competitive schedule than their higher performing, elite-level counterparts.  This is likely due to general lower levels of baseline pre-performance conditioning.

Developing consistent, evidence-driven recovery interval habits and practices not only supports safety and performance, but it also helps athletes develop healthy habits that will serve them long after the competitive participation days are over.

At Steel City Direct Care, we place athletes and student-athetes of all ages, skill and level of participation at the center of all that we do.

Whether you are active sports enthusiast, 'weekend warrior' or highly conditioned, accomplished, elite-level athlete, Steel City Direct Care looks forward to partnering with you to keep you healthy, well, 'balanced', in the game, and at your best!

Christopher T. Conti, MD is the Founder and Owner of Steel City Direct Care, LLC, a Pittsburgh, PA-based medical practice specializing in the care of athletes and aviators.  He is an emergency medicine physician with additional training in sports and concussion health.  He is currently a Team Physician for the US Soccer Federation (USSF), U14-U17 Youth National Team player pools, Medical Advisor for the PA West Soccer Association, a local affiliate of the United States Youth Soccer Association and the Medical Advisor for the Woodland Hills School District in suburban Pittsburgh, PA. Dr. Conti serves as Medical Advisory Board Member for  SportGait and is also a Credentialed ImPACT Consultant (CIC) for sports concussion care.  Dr. Conti is a designated Senior Aviation Medical Examiner (AME) for the Federal Aviation Administration (FAA)

Disclaimer
The information, opinions and content presented do not necessarily represent the policies or opinions of USSF, the FAA, PA West Soccer, USYS, FIFA, ImPACT, SportGait, the Woodland Hills School District or Steel City Direct Care, LLC.

None of the information presented should be construed as formal medical advice, nor should it be considered an acceptable substitute for a formal virtual or in-person encounter with an appropriately trained and licensed healthcare professional.  None of the above-listed entities, including Steel City Direct Care, LCC, are responsible for any adverse outcome associated with this content.
 
If you would like to schedule a virtual or in-person visit with Dr. Conti, please contact Steel City Direct Care

Steel City Direct Care is a Direct Patient Care (DPC) practice that provides targeted & specialized in-person and virtual care for aviators and athletes of every age and level of skill and participation.

The human eye is a remarkable anatomic marvel however most modern mammals have dichromatic vision—that is they have red-green color blindness.   Color vision in the human eye is the result of specialized cells called cones.   The healthy human eye has 6 – 7 million cone cells and 100- 130 million rod cells to produce normal vision. The cones—blue, green, and red—are located in the center of the retina —the part of the eye that receives images from the lens and converts them to electrical impulses to send to the brain— and are responsible for color vision, light adaptation, and fine detail. The rods are located in the periphery of the retina and are responsible for night vision, brightness perception, and distinguishing shapes.

Humans, as a result, have trichromatic vision which allows them to identify over 7 million different colors!

It is estimated that approximately 1 in 12 men and 1 in 200 women in North America have some form of color vision deficiency, though most retain some ability to distinguish some colors.  True, complete color blindness is extremely rare, though the term ‘color blind’ is universally used to describe all color vision deficiencies by most non-health professionals.  Red-green deficiency is the most common color vision deficiency.

Color Vision Deficiencies 101
Protanomaly describes a deficiency where blue-green and red-purple are perceived as an indistinct grayish shade.

Deuteranomaly describes a deficiency where green and red-purple are perceived as an indistinct grayish shade.

Both protanomaly and deuteranomaly are forms of anomalous trichromatism, which means that blue, green, and red cones are present, but the pigments contained within them are abnormal.  Nearly 50% of the people with anomalous trichromatism can make precise color matches but not as precisely as those with normal color vision.
 
Red-green color vision deficiency is called dichromatism (two colors), in which one of the three cone types is absent. Dichromatism is divided into two subtypes, protanopia—where blue-green and red-purple are perceived as gray—and deuteranopia—where green and red-purple are perceived as gray.

The rarest form of color deficiency is monochromatism (one color), which is divided into rod and cone subtypes.

A person with cone monochromatism has good central vision but cannot make most color distinctions because two of the three cone types are missing.

A person with rod monochromatism, or achromatopsia (no color), has no cones at all and can therefore make no color distinctions.  A person with achromatopsia sees everything in shades of gray.

Achromatopsia affects about 1 in every 30,000 people in the US and individuals with this condition generally have very poor visual acuity and experience difficulty adjusting to bright light.

Although color vision deficiencies can be caused by eye diseases or normal aging, the majority are inherited—impacting men far more commonly than women.
 
Men therefore often pass the genetic predisposition to their daughters who are symptom-free carriers, who can then pass the gene to their sons to the extent that each male child of a female who carries the gene for a color vision deficiency has a 50-50 chance of getting the gene from his mother.

Color Vision Deficiency and the Airman FAA Medical Candidate Medical
Color vision is essential for recognizing aircraft position lights, light-gun signals, airport beacons, approach-slope indicators, and chart symbols, especially at night. The 14 CFR Part 67 regulations state that a pilot must have “the ability to perceive those colors necessary for the safe performance of airman duties” for all medical certification classes, which is why color vision assessment is a part of the flight physical for all classes.

Many new airman candidates with a color vision deficiency don’t know they have it, because it doesn’t impact them day-to-day.  Even many report having passed many other vision tests including non-commercial drivers’ license testing, because color vision assessment was not a part of the process.

Many will learn about a color vision deficiency during their first visit to an AME resulting in an automatic minimum restriction prohibiting anyone failing a color vision test from flying at night or by reference to light-gun signals.

The good news is there are certain circumstances where these color vision deficiency-related restrictions may be removed.

If you are a new pilot are found to have a color vision deficiency or if you are a current pilot with an existing color vision restriction, Steel City Direct Care may be able to help remove the restriction from your medical certificate.

Please connect with us, because we know pilots, we know the regs and we are here to help.

Whether you simply love to fly, or you fly for a living, Steel City Direct Care works to keep you healthy, well and flight-ready!

We look forward to connecting with you!

Christopher T. Conti, MD is the Founder and Owner of Steel City Direct Care, LLC, a Pittsburgh, PA-based medical practice specializing in the care of athletes and aviators.  He is an emergency medicine physician with additional training in sports and concussion health.  He is currently a Team Physician for the US Soccer Federation (USSF), U14-U17 Youth National Team player pools, Medical Advisor for the PA West Soccer Association, a local affiliate of the United States Youth Soccer Association and the Medical Advisor for the Woodland Hills School District in suburban Pittsburgh, PA. Dr. Conti serves as Medical Advisory Board Member for  SportGait and is also a Credentialed ImPACT Consultant (CIC) for sports concussion care.  Dr. Conti is a designated Senior Aviation Medical Examiner (AME) for the Federal Aviation Administration (FAA)

Disclaimer
The information, opinions and content presented do not necessarily represent the policies or opinions of USSF, the FAA, PA West Soccer, USYS, FIFA, ImPACT, SportGait, the Woodland Hills School District or Steel City Direct Care, LLC.

None of the information presented should be construed as formal medical advice, nor should it be considered an acceptable substitute for a formal virtual or in-person encounter with an appropriately trained and licensed healthcare professional.  None of the above-listed entities, including Steel City Direct Care, LCC, are responsible for any adverse outcome associated with this content.
 
If you would like to schedule a virtual or in-person visit with Dr. Conti, please contact Steel City Direct Care

Steel City Direct Care is a Direct Patient Care (DPC) practice that provides targeted & specialized in-person and virtual care for aviators and athletes of every age and level of skill and participation.