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THE PHYSICIAN AND SPORTSMEDICINE - VOL 33 - NO. 7 - JULY 2022


NFHS Finalizes Weight Cutting Rules for Wrestlers

Weight cutting in wrestling prompted intense scrutiny in 1997 after three deaths among college competitors. The National Federation of State High School Associations (NFHS) quickly banned certain weight loss practices, made body fat percentage recommendations, and mandated that weigh-ins take place within 1 or 2 hours of meets and tournaments.

Since then the NFHS's sports medicine and wrestling rules committees have been working on more comprehensive rule changes to make the sport safer. The new rules, approved by the NFHS board of directors in April, establish a minimum weight certification program at the national level. According to a 2003-2004 NFHS survey, about 238,700 students participate in wrestling. The same survey notes that about 4,000 high school girls participate in the sport.

What's New

According to an NFHS press release, the most significant rule change outlines a weight management program. Beginning in the 2006-2007 school year, a wrestler's hydration level should not exceed 1.025, body fat percentage must not fall below 7% for boys or 12% for girls, and weight loss is limited to 1.5% of body weight per week.

Another rule revision limits the amount of weight a wrestler can gain during consecutive days of competition. Wrestlers can now gain no more than 2 lb; the previous rule allowed them to gain 1 lb for each consecutive day of competition, regardless of the number of days.

Dave Carlsrud, a member of the NFHS wrestling rules committee and an official with the North Dakota High School Activities Association, said that the rule changes won't take effect immediately, which will allow states to prepare for implementation. Many states have already put in place minimum weight certification programs, though not all have addressed body fat and hydration testing.

Among other safety-related rule changes that don't relate to weight cutting, all pads worn by wrestlers must fit snugly against the body to avoid an opponent's hand getting caught between the pad and the wrestler. The rules changes also make illegal two seldom-used wrestling moves: the straight-back suplay and the straight-back salto to the head. The NFHS also drew attention to preventing communicable skin conditions by issuing a point of emphasis for the 2005-2006 season. Coaches and athletes are urged to disinfect all mats, immediately shower and wash clothes and towels after practice, use detergent with bleach or dry clothes on the high setting, use clean practice and match gear that has remained separate from dirty items, keep fingernails trimmed, and disinfect all gear daily.

Response

Vito A. Perriello, Jr, MD, a pediatrician in Charlottesville, Virginia, and chair of the NFHS Sports Medicine Committee, says the rules were the result of much work and compromise between coaches who were concerned rule changes would detract from the competitiveness of the sport and those who are concerned about the health consequences of rapid weight loss practices. Perriello says the committees are not trying to stop weight loss or eliminate it. "Some wrestlers are at a healthy weight and have fat to lose," he says. One of the primary concerns, though, is dehydration, he says. "That's the only way to lose weight rapidly." Even relatively small rule changes that further limit weight gain during meets or tournaments will produce health benefits, he says.

Weight cutting rules in college wrestlers have shown some promising results, Perriello notes. In 1992, he says the National Collegiate Athletic Association (NCAA) found that wrestlers gained an average of 8 lb the day after a match. In 1998, a rule change required wrestlers to weigh in 1 hour before meets, and wrestlers gained an average of 5 lb the day after a meet. By 1999, the average weight gain after a meet had shrunk to 1.5 lb, Perriello says. "And that's a very reasonable amount."

Perriello says that though 35 states already have weight certification programs, it will be a challenge for other states to get up to speed. To make the change easier for state associations, the rule changes include broad language, he says. For example, he says the requirement for measuring doesn't stipulate a certain measurement technique or who performs the technique.

A Culture Change?

Over the past decade, Robert B. Kiningham, MD, a family practice physician at the University of Michigan and medical adviser to the Michigan High School Athletic Association has helped establish and maintain a weight monitoring program for high school wrestlers in Michigan. He says the NFHS rules bring the rest of the country in line with rules set by the NCAA and other state high school associations. "These rules are part of an effort to change the culture of wrestling by de-emphasizing weight loss and allowing wrestlers, coaches, and parents to focus on the sport itself," he says.

At the annual meeting of the American Medical Society for Sports Medicine this year, Kiningham presented survey data comparing weight lost in Michigan wrestlers in 1996—when the states weight certification program first went into effect—with weight lost in 2000. "I found that after the implementation of the weight monitoring program, fewer wrestlers lost weight. Among wrestlers who lost weight, average weight lost was significantly less," he says. Wrestlers also reported less use of harmful weight loss methods such as fasting, dehydration, and vomiting. "So I believe the program has the impact that we intended: to prevent not only excessive weight loss over the course of the season, but to prevent very rapid weight loss that is potentially harmful," Kiningham says.

Randall R. Wroble, MD, an orthopedic surgeon in Columbus, Ohio, who has been involved with wrestling rule modifications as chair of the Joint Advisory Committee on Sports Medicine for the Ohio High School Athletic Association, says he doesn't think the new rules will change competition much. Wroble agrees that rule changes within the past few years have dramatically reduced unhealthy weight cutting practices in wrestling. Coaches rarely make extreme requests, he says, and he no longer encounters wrestlers who are suffering from extreme dehydration.

Wroble says he supports body fat testing, "but not in such a black and white way" as with the new rules. He says dehydration is a serious health risk that needs to be addressed, but he believes that body fat percentage rules are unfairly rigid and may prohibit some athletes at lighter weight classes from competing. "We've all seen kids who are at 5% body fat. They're healthy at that weight, but the line has been drawn at 7% body fat," Wroble says. The 7% body fat number is based on findings in healthy, championship wrestlers that were gathered in the early 1960s and were periodically updated. "The number seems arbitrary, but it seems to be making people happy," Wroble says, adding that further research on body fat percentages in wrestlers should be done so that the number seems less arbitrary.

In talks on nutrition to wrestlers, Wroble urges athletes to seek the lowest sensible weight, not the lowest permissible weight. "It's how you perform in the classroom and as a person. You can optimize your performance as a wrestler while not suffering in any sphere of your life," he says.

Lisa Schnirring
Minneapolis


Noteworthy

Carl Foster, PhD, is the new president and L. Larry Durstine, PhD, is president-elect of the American College of Sports Medicine (ACSM). Their 1-year terms began in June at the ACSM annual meeting in Nashville, Tennessee. Foster is professor in the department of exercise and sports science at the University of Wisconsin-LaCrosse; Durstine is a professor and chairperson of the department of exercise science at the University of South Carolina in Columbia, South Carolina.

Elected as second vice presidents are Steven J. Keteyian, PhD, program director at the Henry Ford Heart & Vascular Institute in Detroit, and Melinda Millard-Stafford, PhD, professor at the School of Applied Physiology at Georgia Institute of Technology in Atlanta.



Field Notes

Activity Recommendations for Kids Emphasize Daily Exercise

In past years, expert panels have gathered to write exercise recommendations for broad groups such as adults, older adults, and pregnant women. Now there's a recommendation for children, based on the work of a panel assembled by the Centers for Disease Control and Prevention.

School-age children should participate in at least 60 minutes of moderate to vigorous physical activity daily, according to a press release on the group's report from the Medical College of Georgia in Athens. Jumping rope, soccer, basketball, and brisk walking are examples of moderate to vigorous activity. William B. Strong, MD, a pediatric cardiologist and retired professor at the Medical College of Georgia, said that sedentary children should increase their activity gradually. The experts noted varying activity is important to avoid boredom, and that much of the needed activity can be achieved at school with appropriate physical education, recess, intramural sports, and before- and after-school programs.

Robert M. Malina, PhD, cochair of the panel and professor at Tarleton State University in Stephenville, Texas, said that the technology revolution of the 1980s has produced more sedentary options for children while their caloric intake has essentially remained the same. "This means that parents, coaches, teachers, and others who influence youngsters need to become active role models and get children involved with regular participation in physical activity," he says.

In making the recommendations, the group convened in January 2004 to review the medical literature on the impact of physical activity on children's health. They reviewed more than 850 articles and 1,200 abstracts. Their findings were published in the June issue of The Journal of Pediatrics. Most studies used 30 to 45 minutes of supervised, continuous activity 3 to 5 days a week. The panel contends that a greater amount of cumulative physical activity would be needed to produce beneficial effects.

Rule Change Jeopardizes Referrals to ATCs

The National Athletic Trainers' Association (NATA) filed a lawsuit in May to delay the implementation of a new rule from the Centers for Medicare & Medicaid Services that would prohibit the reimbursement of therapy services provided by athletic trainers. According to a news update on the NATA Web site, the court responded by delaying the implementation of the rule pending the results of a court hearing in July.

The rule was set to take effect June 6 and would have prevented physicians from being able to receive Medicare reimbursement for treatment provided by athletic trainers. NATA's position is that the rule limits athletic trainers' practices.

Posttraumatic Migraine Linked to Neurocognitive Impairment

Athletes who report migraines after a concussion have changes that may be seen on neurocognitive function tests, according to researchers from the University of Pittsburgh Sports Medicine Concussion Program. Their findings were published in the May issue of the Journal of Neurosurgery.

The study is the first to compare acute neurocognitive impairments after concussions in athletes who have migraine symptoms, those who reported headaches, and those who did not report headaches. The study included 261 high school and college athletes with a mean age of 16. Concussed athletes were included in the migraine group if they had headache, nausea, and either photophobia or phonophobia during their first postconcussion evaluation. Athletes who reported headache without nausea, photophobia, or phonophobia were placed in the headache group.

Researchers used ImPACT computerized neuropsychological testing (Impact Applications, Inc, Pittsburgh) to evaluate the athletes. Sixty-two percent (162) of the patients had completed a baseline neurocognitive test. Researchers used standardized norms based on age, education level, and gender as a baseline in patients who had not undergone off-season neurocognitive testing.

The results showed that the athletes who had postconcussion migraines scored significantly lower than the other groups on verbal memory, visual memory, and visual motor speed scores. Athletes in the migraine group also had significantly slower reaction times than the other two groups. There was little difference between the headache and nonheadache groups; however, those in the headache group trended toward lower visual motor speed scores, and those in the headache group had significantly slower reaction times than the nonheadache group.

The authors concluded that the study findings support the need for increased vigilance regarding return to play and follow-up for athletes who have migraine symptoms after sustaining a concussion.


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