Monica is a freshman in high school and quite an athlete. She made the varsity squad in soccer as a ninth grader last fall, and is now on a club team this spring. As captain of this team she helped guide them to a state tournament soon to take place.
Almost three weeks ago she was diagnosed with infectious mononucleosis. Thanks to spring break no critical games were missed. She was brought in with fever, an impressively red throat with pus pockets on her tonsils, large swollen glands in her neck and a fine rash. The rest of her exam was normal, and, very importantly, she did not have an enlarged spleen.
The spleen is an organ that is located just under the diaphragm in the upper left abdomen. It is protected by the rib cage and can only be felt if it is markedly enlarged (6-8 times it’s normal size). In mono, the concern with letting one do ANY activity that might cause undue trauma to the left side of the body is the potential for a ruptured spleen. This can and does happen. There have been deaths because of this.
When, then, can an athlete who is getting over mono return to their contact sport? Until recently, it was widely accepted that these athletes were not allowed to participate in a contact sport for one month. Recent sport-medicine literature has modified this to three weeks from the time of diagnosis...provided that the spleen was never palpable.
Such was the case with Monica. By the end of the first week I reexamined her, and she said that she felt back to her usual self. Her exam was much improved, and she did not have a palpable spleen. She was afforded the luxury of spring break and did not have to miss school. As it turned out, her team’s first playoff game was exactly three weeks to the day since the diagnosis was made. She was cleared to play and had no complications.
Jason is an eighth grader who is a gifted athlete. His junior high school has flag football, basketball and baseball teams. Having watched him grow and mature over the years it came as no surprise to me that he was the star quarterback of his team. He set a school record for most points scored during a basketball season and was currently an ace pitcher on the baseball team.
It was time to register him at his new high school. Since he planned to play football in the fall a special sports physical needed to be filled out. As a newborn, Jason was found to have a torsion of the testicle. The blood supply to the testicle was severely compromised because the structure that supported the blood vessels and nerves twisted on itself. This probably occurred in utero before he was even born. Immediate surgery was not successful in saving the testicle. Therefore, it was removed. This in no way interfered with Jason’s growth or development. Quite the contrary...he is a superb athlete.
His mom put the sports form on the table in front of me and asked, “Do I let him play football or not?” Most experts would agree that having one testicle should not be a contraindication to playing a contact sport because wearing a cup should provide sufficient protection. This cup, however, must be worn at ALL times, with no exceptions.
Jason’s dilemma raises a number of other questions about absence of other paired organs and sports participation. As recently as the mid-1990’s, the AMA recommended that athletes who have one eye should be kept from ANY contact sport. More and more, the experts are permitting these athletes to participate in their sport provided they wear appropriate eye protection. The equipment that is now available has been thoroughly tested and researched. An eye specialist should clear these athletes before they set foot on the field or court. Two exceptions to this rule might be wrestling and boxing, as there is no accepted protective eye gear that would allow participation in these sports.
What about the athlete who only has one kidney? Can they be cleared for a contact sport? There is no simple answer to this question. The decision can only be made after looking at a number of variables, and with the input of a kidney specialist. It used to be that this condition disqualified all athletes from contact. Some athletes recently sued under the Federal Rehabilitation Act of 1973, and the courts sided with the athletes allowing them to play contact sports. If an athlete is cleared for such a sport, the decision must be an informed one, with all parties in agreement, knowing that there are certain risks.
Other issues might come up regarding the clearing of an athlete for a contact sport. Can an athlete with a detached retina that has been successfully repaired surgically return to their contact sport, once they have been through rehabilitation and are back to their baseline? The general consensus among experts is a resounding NO. The risk of recurrence and the risk of blindness are very high.
Should an athlete who has insulin dependent diabetes be kept from participating in a contact sport? If their blood sugars are well controlled, there is no reason why they should be kept from ANY activity or sport. If, however, their sugars are poorly controlled, or if there is poor compliance on the part of the athlete, they should be kept from sports until this is properly regulated and closely monitored.
A part of the high school physical that all males remember is the exam for an inguinal hernia. “Turn your head and cough,” the doctor says to the humiliated and embarrassed barely pubescent male. It is a rite of passage. What if an inguinal hernia is found during one of these exams? Does this disqualify the boy from a contact sport? What most experts agree upon is that if the hernia is small and easily reducible, they may partake in a contact sport. It would be wise to get clearance from a surgeon beforehand, to concur with the decision of clearance to play, as well as giving some guidance to when this hernia should be repaired on an elective basis.