Offensive Linemen Research Articles

Unique Treatment Regimen for Effort Thrombosis in the Nondominant Extremity of an Overhead Athlete: A Case Report

To advise athletic trainers on the potential for effort thrombosis to occur in nonthrowing athletes and to underscore the importance of early recognition and treatment. An 18-year-old offensive lineman presented with a 1-day history of diffuse shoulder pain with no specific history of injury; swelling and erythema involved the entire left upper extremity. He was immediately referred to the team physician, who suspected deep vein thrombosis and sent the athlete to an imaging center. Duplex ultrasound was obtained on the day of presentation, and he was admitted to the hospital that evening. Deep vein thrombosis, thoracic outlet syndrome, shoulder tendinitis. Anticoagulation with heparin was administered at the hospital, and he was sent home the next day on subcutaneous enoxaparin sodium, followed by a 5-mg daily dose of oral warfarin sodium. Oral anticoagulants were continued for a total of 4 weeks. The athlete began upper body lifting and was released 5 weeks postinjury to gradually return to football without restrictions. Effort thrombosis is typically seen in the dominant arm of athletes, and the current treatment protocol calls for thrombolysis or surgical intervention. This athlete, whose position required repeated elevation of his arms in forward flexion, sustained the injury in his nondominant arm, was treated with anticoagulation only, and had a full return to football. At 18-month follow-up, he had no recurrence of symptoms. Early recognition and treatment of athletes with effort thrombosis is paramount to a successful clinical outcome and prompt return to play.

Performance and Blood Pressure Characteristics of First-Year National Collegiate Athletic Association Division I Football Players

The authors were aware of no published studies in which the performance characteristics of first-year National Collegiate Athletic Association Division I collegiate football players were reported. From 2003 to 2006, 73 freshman and 12 transfer football recruits were tested before twice-a-day practices for bench press (BP), squat (SQ), power clean (PC), vertical jump (VJ), calculated jump power (CP), treadmill endurance capacity (Vo2peak), and maximal treadmill time (MTT). Individuals were grouped by player position for descriptive statistical analysis. As a group, offensive linemen (OL), defensive linemen (DL), linebackers (LB), tight ends (TE), and running backs (RB) averaged 152.8 kg for BP, 210.5 kg for SQ, 127.3 kg for PC, and 224.2 W for CP. These values were 22% to 30% higher than those for quarterbacks (QB), wide receivers (WR), defensive backs (DB), and kickers (K), who together averaged 120.2 kg for BP, 163.4 kg for SQ, 104.6 kg for PC, and 172.4 W for CP. Quarterbacks, WR, DB, and K as a group showed the highest MTT (13:13 m.s) and Vo2peak values (47.24 mL.kg.min), 15% to 20% higher than those for OL, DL, LB, RB, and TE, who averaged 11:27 m.s for MTT and 39.51 mL.kg.min for Vo2peak. Running backs, TE, LB, DB, and WR averaged 82.56 cm for VJ, which was 14% higher than that for DL, QB, K, and OL, who averaged 72.72 cm. On the basis of average resting blood pressure, 23.5% (20 players) were categorized as hypertensive (i.e., >/=140/90 mm Hg), 54% (46 players) as prehypertensive (i.e., 120-139/80-89 mm Hg), and 22.5% (19 players) as normal (i.e., <120/80 mm Hg). These data serve as a basis for comparisons among other Division I programs, benchmarking development and improvement through training, and creating position performance norms for incoming football athletes.

Knee Injury-Football

HISTORY: A 17 y.o. offensive lineman on a Div. I football team sustained a knee injury during practice. The patient was blocking in open field when the back of his extended planted leg was struck lightly. He stated "it felt like my knee cap shifted." He was removed for evaluation. PMH: One year h/o intermittent anterior knee pain that was worse during high school basketball. Pain subsided then returned during summer workouts for football 6 weeks prior to acute injury. Normal x-ray. Dx. with quadriceps tendonitis. Placed on modified activity with eccentric strengthening, quad stretching, and NSAIDS for 2 weeks prior to acute injury. PHYSICAL EXAMINATION: Exam on Field- rapid moderate effusion; marked apprehension to lateral stress of patella with mild pain over medial retinaculum; neg. Lachman, valgus and varus stress; unable to perform McMurray secondary to pain; VMO fired with leg extension Exam in Training Room- persistent patella pain and apprehension with decreased retinacular pain; compression, knee immobilizer with patella support, ice, crutches for non-weight bearing, and pain meds. Exam 24 Hours- large effusion; patella pain laterally with reduced pain over medial retinaculum; mild apprehension, minimal pain over the quadricep tendon; difficulty firing VMO and straight leg lift DIFFERENTIAL DIAGNOSIS: Patella Subluxation Meniscal Tear Fracture - Tibial Plateau, Patella Patella/Quadricep Tendon Tear TEST AND RESULTS: Knee X-ray: Transverse fracture of the patella that appears old with smooth sclerotic edges Review of knee x-ray taken 2 weeks prior: Questionable lucency on the lateral aspect of patella Knee X-ray of left knee: Normal Knee MRI: Acute patella fracture with suspected chondral fragment at the fracture site along the medial retropatellar cartilage; partial tear of the quadriceps tendon; partial tear of the lateral patellar retinaculum; hemarthrosis; no meniscal tear FINAL WORKING DIAGNOSIS: Acute noncontact fracture of transverse bipartite patella TREATMENT AND OUTCOMES: ORIF with bone grafting Repeat x-ray at 5 weeks with union of fracture Clinical outcome pending rehab

Multiclonal outbreak of methicillin-resistant Staphylococcus aureus infections on a collegiate football team

An outbreak of methicillin-resistant Staphylococcus aureus (MRSA) skin and soft tissue infections (SSTIs) occurred in a college football team in August 2006. Of 109 players on the team roster, 88 (81%) were interviewed during a cohort investigation. Twenty-five cases were identified, six of which were culture-confirmed. Available culture isolates were typed by pulsed-field gel electrophoresis (PFGE), which identified two different MRSA strains associated with the outbreak. Playing positions with the most physical contact (offensive linemen, defensive linemen, and tight ends) had the greatest risk of infection [risk ratio (RR) 5.1, 95% confidence interval (CI) 2.3-11.5. Other risk factors included recent skin trauma (RR 1.9, 95% CI 0.95-3.7), use of therapeutic hydrocollator packs (RR 2.5, 95% CI 1.1-5.7), and miscellaneous training equipment use (RR 2.1, 95% CI 1.1-4.1). The outbreak was successfully controlled through team education and implementation of improved infection-control practices and hygiene policies.

Left Forearm Pain and Swelling - Football

HISTORY: A 15-year old Caucasian high school male athlete presented to the clinic with left forearm pain and swelling of two weeks duration. He thought he injured his left forearm while playing football (offensive lineman) about 2–3 weeks ago but was unable to recall a specific incident or injury. He was able to move his fingers and elbow without difficulty. He reported no fever, chills, weight loss, numbness, tingling, or muscle weakness. PHYSICAL EXAMINATION: Examination revealed a 4 cm fusiform swelling and warmth in the left distal radius (mildly tender). Although wrist range of motion was normal, he did experienced pain with wrist flexion and extension. Ecchymosis was not observed. Grip was symmetric. Capillary refill was less than 2 seconds. Examination of the elbow was unremarkable. Sensation in the left upper extremity was normal. DIFFERENTIAL DIAGNOSIS: muscle strain ligament sprain osteomyelitis bone fracture bone tumor TEST AND RESULTS: X-rays of the left wrist (AP and lateral oblique): - in the radial metadiaphysis, there is a heterogenous lucency surrounded by cortical resorption with spiculated margins and a proximal periosteal elevation with thickening (sunburst mineralization pattern) - mixed sclerotic and lytic lesion with cortical resorption and aggressive periosteal reaction - consider primary bone tumor and osteomyelitis Chest CT scan with contrast: - negative for metastasis (no mediastinal or hilar adenopathy) Bone scan: - positive only in the left radius MRI: - tumor of the metaphysis of the left radius with a soft tissue component Incisional biopsy: - confirmed osteogenic sarcoma (osteosarcoma) FINAL/WORKING DIAGNOSIS: Left radial osteosarcoma TREATMENT AND OUTCOMES: Referral to orthopedic bone tumor specialist and hematologist-oncologist Surgery: left below elbow amputation Chemotherapy: VP-16 and ifosfamide, 20 weeks Patient with myoelectric prosthesis Patient able to practice and play with the football team Per hematologist-oncologist, patient needs close follow-up with imaging because of the concern for osteosarcoma of the lung: forearm x-ray and chest CT every 3 months for the first year, every 4 months for the second year, and every 6 months for the third. Starting the fourth year, forearm x-ray and chest x-ray were recommended annually.

Metabolic and Thermoregulatory Responses to a Simulated American Football Practice in the Heat

Energy cost is a major factor influencing the tolerable thermal load, particularly during exercise in the heat. However, no data exist on the metabolic cost of football practice, although a value of 35% of maximal aerobic capacity (VO(2)max) has been estimated. The energy cost and thermoregulatory response of offensive linemen (OL) was measured wearing different American football ensembles during a simulated half of football practice in the heat. Five collegiate offensive linemen (133 kg, 20% fat, 42 ml x kg(-1) x min(-1) maximal oxygen uptake) completed each of four 60-minute test sessions in an environmental chamber (28 degrees C, 55% relative humidity [RH]) wearing shorts (S), helmet (H), helmet and shoulder pads (HS), and full gear (FUL). Core temperature in the digestive tract (TGI) was obtained using an ingestible sensor. During simulated football drills (e.g., repetitions of drive blocking), exercise intensity ranged from 30 to 81% VO(2)max but averaged 55%VO(2)max (6.7 METS) overall. Blood lactate remained >5 mmol x L(-1), and heart rate (HR) averaged 79%HRmax. Equipment had a significant effect on %VO(2)max but only during recovery between drills with HS (61.4 +/- 3.7%) compared with H (53.3 +/- 6.9%) and S (40.1 +/- 8.5%). The TGI was higher (p < 0.05) with HS compared with H at several time-points after 30 minutes. Football practice for OL elicits a significantly higher overall metabolic cost (>6 METS, >50%VO(2)max) than assumed in previous studies. The addition of shoulder pads increases core temperature and energy cost, especially during recovery between active drills in unacclimatized linemen.

Atypical Shoulder Injury In A High School Offensive Lineman

Atypical Shoulder Injury In A High School Offensive Lineman

Atypical Shoulder Injury In A High School Offensive Lineman

Atypical Shoulder Injury In A High School Offensive Lineman

Prior Injuries &amp; Future Participation in National Football League (NFL) Prospects

2215 PURPOSE & METHODS: To analyze sports medicine injuries and to predict future participation in the National Football League, we evaluated medical, physical, and performance variables in 384 (196 Offense, 149 Defense, and 39 Undefined) top US college football players who were tested at the 2000 Indianapolis NFL Combine. We then tracked these players' participation in the NFL over the next two consecutive years by using NFL consolidated summaries collected after each pro game. RESULTS: Within the previous 5 yr, 58% (n = 223) of players accounted for 524 significant injuries and 257 surgeries or 1.4 injuries and 0.7 surgeries per player for the entire group. 17% (n = 64) had 1 injury, 18% (n = 70) had 2 injuries, 15% (n = 58) had 3 injuries, and 8% (n = 31) had 4 or more injuries within the past 5 yr. The most recent, primary sites of injury were the knee (20%, n = 77), shoulder (11%, n = 42), ankle (7%, n = 26), lower back (5%, n = 19) and hand (3%, n = 13). The top primary diagnoses were tear (18%, n = 70), dislocation/subluxation (9%, n = 36), fracture (7%, n = 28), and repetitive trauma/loose bodies (7%, n = 26). 14% of players (n = 54) had significant degenerative joint diseases or arthritis as documented by comprehensive orthopedic analyses and imaging. The highest body mass indices (BMI) were in offensive lineman and defensive tackles (both 38), while the lowest were in defensive backs (27) and wide receivers (26). For all player classifications, average BMI were higher than national recommendations (< 25) predicting relatively higher disease risk and a shortened life span. Though there was wide variability, offensive lineman (yr 1: 16%, yr 2: 21%), wide receivers (yr 1: 14%, yr 2: 18%), defensive ends (yr 1: 17%, yr 2: 27%) and linebackers (yr 1: 15%, yr 2: 29%) had the highest participation. 61% of players (n = 235) were classified as minimal participants (<10% of plays for both yr). For offense, orthopedic grade was a significant predictor of participation in running backs (8% of variance) and wide receivers (10% of variance) for the 1st year (both P<0.05). For defense, the total number of injuries (11%) and total number of surgeries (11%) were significant predictors of participation in linebackers only (both P<0.05). CONCLUSIONS: While predicting participation may be crucial from an owner and coach perspective, we are concerned more with the health and well-being of these athletes well into the future. Our data imply that many players who report to the Combine have significant injuries prior to entering the NFL, that a vast majority subsequently drafted have very little impact in the 1st and 2nd yr, and that BMI, preexisting injuries and arthritis predict significant future health consequences.

Prior Injuries &amp; Future Participation in National Football League (NFL) Prospects

2215 PURPOSE & METHODS: To analyze sports medicine injuries and to predict future participation in the National Football League, we evaluated medical, physical, and performance variables in 384 (196 Offense, 149 Defense, and 39 Undefined) top US college football players who were tested at the 2000 Indianapolis NFL Combine. We then tracked these players' participation in the NFL over the next two consecutive years by using NFL consolidated summaries collected after each pro game. RESULTS: Within the previous 5 yr, 58% (n = 223) of players accounted for 524 significant injuries and 257 surgeries or 1.4 injuries and 0.7 surgeries per player for the entire group. 17% (n = 64) had 1 injury, 18% (n = 70) had 2 injuries, 15% (n = 58) had 3 injuries, and 8% (n = 31) had 4 or more injuries within the past 5 yr. The most recent, primary sites of injury were the knee (20%, n = 77), shoulder (11%, n = 42), ankle (7%, n = 26), lower back (5%, n = 19) and hand (3%, n = 13). The top primary diagnoses were tear (18%, n = 70), dislocation/subluxation (9%, n = 36), fracture (7%, n = 28), and repetitive trauma/loose bodies (7%, n = 26). 14% of players (n = 54) had significant degenerative joint diseases or arthritis as documented by comprehensive orthopedic analyses and imaging. The highest body mass indices (BMI) were in offensive lineman and defensive tackles (both 38), while the lowest were in defensive backs (27) and wide receivers (26). For all player classifications, average BMI were higher than national recommendations (< 25) predicting relatively higher disease risk and a shortened life span. Though there was wide variability, offensive lineman (yr 1: 16%, yr 2: 21%), wide receivers (yr 1: 14%, yr 2: 18%), defensive ends (yr 1: 17%, yr 2: 27%) and linebackers (yr 1: 15%, yr 2: 29%) had the highest participation. 61% of players (n = 235) were classified as minimal participants (<10% of plays for both yr). For offense, orthopedic grade was a significant predictor of participation in running backs (8% of variance) and wide receivers (10% of variance) for the 1st year (both P<0.05). For defense, the total number of injuries (11%) and total number of surgeries (11%) were significant predictors of participation in linebackers only (both P<0.05). CONCLUSIONS: While predicting participation may be crucial from an owner and coach perspective, we are concerned more with the health and well-being of these athletes well into the future. Our data imply that many players who report to the Combine have significant injuries prior to entering the NFL, that a vast majority subsequently drafted have very little impact in the 1st and 2nd yr, and that BMI, preexisting injuries and arthritis predict significant future health consequences.

COMPARISON OF PHYSICAL AND PERFORMANCE CHARACTERISTICS OF NCAA DIVISION I FOOTBALL PLAYERS

The purpose of this study was to compare normative data from present Division I National Collegiate Athletic Association football teams to those from 1987. Players were divided into 8 positions for comparisons: quarterbacks (QB), running backs (RB), receivers (WR), tight ends (TE), offensive linemen (OL), defensive linemen (DL), linebackers (LB), and defensive backs (DB). Comparisons included height, body mass, bench press and squat strength, vertical jump, vertical jump power, 40-yd-dash speed, and body composition. Independent t-tests were used to analyze the data with level of significance set at p < 0.01. Significant differences (p < 0.01) were found in 50 of 88 comparisons. From 1987 until 2000, Division I college football players in general have become bigger, stronger, faster, and more powerful. Further research is warranted to investigate if these trends will continue.

Youth Football Injuries

A paucity of literature exists on the subject of youth football with the majority of research concentrating on athletes of high-school age or older. Youth football participants include those athletes who compete in organised football prior to high school. Injury rate and severity for youth players is surprisingly low when compared with those competitors who have passed through puberty. As children mature they become bigger, faster and stronger, which is accompanied by an increased injury risk. Quarterbacks and running backs are injured almost five times more often than offensive linemen and linebackers. The knee is the most common site of injury followed by the ankle, wrist and hand. Fortunately, traumatic brain and cervical spine injuries are exceedingly rare. In this article, we review the youth football literature, identify the most common injuries by anatomical location, discuss the differential diagnoses and outline treatment options.

Body Composition in Division I Football Players

This study assessed body composition of Division I football players (n = 69) and compared the findings with previously reported data to ascertain whether the increase in player total body mass that has been observed over the past 10 years has been accompanied by an increase in body fat. Body composition was determined by hydrostatic weighing and the measurement of skinfold thicknesses. Total body mass, skin-fold thicknesses, and body fat were greater in the current players than in players in studies conducted in the early 1980s and early 1990s. Body fat varied significantly across playing position, with the defensive backs, offensive backs, and receivers being the leanest and the offensive linemen and tight ends the most fat. There was no significant relationship between body composition and playing year or scholarship status, nor were any differences observed between ethnic groups. Of important clinical relevance was the finding that the linemen (offensive, defensive) and tight ends were on average greater than 25% body fat, the borderline for obesity in this age group. Much of this fat was deposited in the abdominal region, a significant finding when one considers the high correlation between abdominal obesity and ischemic heart disease and stroke. The current findings suggest that more attention needs to be given to the nature of the increase in body mass being achieved by today's football player to minimize long-term negative health consequences, and the findings reemphasize the need identified in earlier studies of the importance of detraining programs for these athletes.

The National Football League combine: a reliable predictor of draft status?

The performance of 326 collegiate football players attending the 2000 National Football League combine was studied to determine whether draft status could be predicted from performance measurements. The combine measured height and weight along with 9 performance tests: 225-lb bench press test, 10-yd dash, 20-yd dash, 40-yd dash, 20-yd proagility shuttle, 60-yd shuttle, 3-cone drill, broad jump, and vertical jump. Prediction equations were generated for 7 position categories with varying degrees of accuracy-running backs (RBs), r(2) = 1.00; wide receivers (WRs), r(2) = 1.00; offensive linemen, r(2) = 0.70; defensive linemen, r(2) = 0.59; defensive backs (DBs), r(2) = 1.00; linebackers, r(2) = 0.22; and quarterbacks, r(2) = 0.84. The successes of the prediction equations are related to the ability of the individual tests to assess the necessary skills for each position. This study concludes that the combine can be used to accurately predict draft status of RBs, WRs, and DBs. The equations can also be used as a good to fair estimate for other positions.

Fractures about the Orbit in Professional American Football Players

A retrospective review was performed of records for players who suffered fractures about the orbit during participation in officially sponsored activities of the National Football League from 1980 to 1997. Clinical information was obtained on 19 of 29 players who sustained orbital fractures. The most common signs and symptoms included decreased visual acuity (74%, 14), decreased eye movement (42%, 8), hyphema (37%, 7), and infraorbital numbness (21%, 4). The mechanisms of injury were a digital poke (74%, 14) and blunt facial trauma (26%, 5). There were significantly more orbital fractures than zygomatic fractures suffered by offensive linemen as compared with all other positions. Fifteen of 19 players were managed with surgical reconstruction; 4 players were treated nonoperatively. The mean time from injury to surgical procedure was 7.7 days (range, 0 to 42). The mean interval to follow-up was 45.6 months (range, 3 to 146). At follow-up examination, eight (53%) of the patients treated surgically still reported diplopia with upper field gaze. Three of the four patients treated nonoperatively were asymptomatic. The mean time lost from games or practice was 25 days (range, 5 to 56). Ultimately, 17 (89%) players with orbital fractures were able to return to full football activities. Two patients were unable to resume their careers because of residual visual impairment.

Prevalence of headaches in football players.

Football coaches and team physicians rely heavily on players' reports of symptoms in deciding whether a player may return to the game after sustaining head trauma. The decision is made difficult by the wide variety of associated symptoms, some of which (e.g., headache is among the most common) may or may not be associated with serious head injury. More information is needed about the clinical significance of football-related headache. To assess the frequency of headache associated with playing football, we analyzed responses to our questionnaire asking about incidence, frequency, and outcome of football-related headache from 443 football players (320 from college, 123 from high school). Eighty-five percent of respondents reported previous headache related to hitting in football. Asked specifically about their most recent game, 21% of respondents reported having had headache during that game. Of players who had headache, only 19% informed the team physician, trainer, or coach, and only 6% were removed from the game. Twenty-seven percent of respondents reported previous diagnosis of cerebral concussion by medical personnel. Defensive backs (25%), defensive linemen (19%), and offensive linemen (18%) were most likely to have headache, related to hitting. Our data confirm that posttraumatic headache is commonly associated with football participation and often goes unreported. Given that the most serious complications of head injuries (e.g., second-impact syndrome) occur infrequently, headache as an isolated symptom lacks specificity in predicting such complications in football players. Therefore, unless it persists or is accompanied by additional symptoms, headache alone may not reliably suggest the need to remove players from the game.

Mortality and light-to-moderate alcohol consumption after myocardial infarction

To determine the epidemiology by player position, examination, imaging findings, and associated injuries of posterior cruciate ligament (PCL) injuries in players participating in the National Football League (NFL) Combine.All PCL injuries identified at the NFL Combine (2009-2015) were reviewed. Data were obtained from the database organized by the NFL medical personnel for the compilation of the medical and physical performance examination results of NFL Draftees participating in the NFL Combine from 2009 to 2015. Inclusion criteria were any player with clinical findings or a previous surgery consistent with a PCL injury who participated in the NFL Combine.Of the 2,285 players who participated in the NFL Combine between 2009 and 2015, 69 (3%) had evidence of a PCL injury, of which 11 players (15.9%) were managed surgically. On physical examination, 35 players (52%) had a grade II or III posterior drawer. Concomitant injuries were present frequently and included medial collateral ligament (MCL; 42%), anterior cruciate ligament (ACL; 11.6%), and chondral injuries (31.8%), especially in the lateral tibiofemoral compartment.Three percent of the players at the NFL Combine presented with a PCL injury, with a significant amount being either running backs (14/69, 20.2%) or offensive linemen (14/69, 20.2%). Approximately half of the players with a PCL tear had a residual grade II or III posterior drawer after sustaining a PCL injury. Concomitant injuries were present frequently and included MCL (42%), ACL (11.6%), and chondral injuries (31.8%), especially in the lateral tibiofemoral compartment. For those players with clinical concern for PCL ligamentous laxity, there should be a complete comprehensive workup that includes plain and PCL stress view radiographs, and magnetic resonance imaging.Level IV, case series.

An Empirically Based Selection and Evaluation System for Collegiate Football

Using a content validity approach, including job analysis, a model was developed for the selection and appraisal of college football players. Evaluation instruments were developed for offensive lineman, quarterback, running back, receiver, defensive lineman, linebacker, and defensive secondary. Criterion related validity studies were then conducted by sending the evaluation instruments to a nation-wide sample of college football coaches who evaluated players at each position. Criterion data (e.g., passing and rushing performance statistics) were collected on the evaluated players. Multiple linear regression analyses conducted by position revealed numerous significant relationships between the predictor variables and the criterion measures. The usefulness of the evaluation instruments was enhanced by developing a simple and cost effective model that generated performance predictions for each position. Strengths and weaknesses of the present system were discussed as well as the role that sport management may play in such an endeavor.

CHANGES IN BODY SIZE OF OFFENSIVE PLAYERS IN THE NATIONAL FOOTBALL LEAGUE: A 76 YEAR REVIEW OF 27,744 PLAYERS

1359 We evaluated change in body mass (BM) and stature (S) in 51,333 National Football League (NFL) players from it's inception in 1920 through 1966. Data came from official 1920-1996 NFL rosters ( Sports Encyclopedia, 1982, 1987) and Official NFL League Records and Facts Book, 1988-1996, Workman Publishing). The comparisons focuse on offensive lineman and tight ends (OL: N=13,528) and skill position players (SPP: QB's, receivers, run backs; N=14,216). The data represent all OL and SPP players from each NFL team. The insert figures show BM and S every 5-y from 1920-1960 and yearly thereafter.FigureResults: BM of SPP increased 10% from 1920 (85.5 kg) to 1996(94,0 kg), while BM for OL increased 53% over the same period (85.5 kg to 130.8 kg). In 1920, OL and SPP weighed the same. From 1980, the rate of increase in BM differed from the rate in 1920-1935, 1935-1965, and 1965-1980 (P<0.05). S for SPP peaked in 1979 (184.5 cm), but only rose 1.8% from 1920 to 1996. For OL, S increased 8.1% from 1920 (179.2 cm), achieving stability from 1985 to 1996 (193.5 cm). From 1920 to 1996, Body Mass Index (BMI) increased 6.2% for SPP (26.2 to 27.9) and 31.1% for OL (26.6 to 34.9 kg/m2). Conclusions: Over 76 y, BM increased 0.6 kg/y for OL while stabilizing for SPP. The 0.19 cm/y increase in S means that by 2007, OL should attain 195.5 cm (6 ft 8 in) and weigh 136.1 kg (300 lb). Unfortuneatley, a BMI=35.6 kg/m2 would clasify them as high disease risk.

POST-TRAUMATIC UNILATERAL PTOSIS-FOOTBALL 388

HISTORY: A 17 year old Division I collegiate offensive lineman developed painless, partial left ptosis several hours after minor leftsided head trauma during a scrimmage. The finding-remitted overnight, only to recur as a complete ptosis during scrimmage the next morning. Thereafter, the ptosis fluctuated in severity, clearly worsening during heavy physical activity such as weight lifting. There were no other ophthalmologic, neurologic or general medical symptoms. Two years previous, he experienced transient diplopia for two days following an injury to the left temporal area during high school football practice. Two weeks later he developed painless, partial left ptosis for several weeks. A head CT was negative, the symptom remitted and he returned to play. PHYSICAL EXAMINATION: The detailed general and neurolgic examinations were normal except for the following: moderate obesity; left ptosis (palpebral fissures = 14mm OD. 9mm OS) without decrement on 1.5 min. sustained upgaze: positive left Cogan's lid twitch: no evidence of Horner's syndrome. DIFFERENTIAL DIAGNOSIS: Myasthenia Gravis Rare myasthenic-like response seen with low grade, slow growing periorbital neoplastic or vascular lesions involving nerves to the extraocular muscles. TEST AND RESULTS: Hb 133 g/l with normochromic, normocytic indices. CXR. SPEP, TFTs, nicotinic acetylcholine receptor antibodies, Tensilon test, IM Prostigmine test = normal or negative. Electrophysiologic studies: significant decremental response on 2-4 Hz repetitive nerve stimulation to left trapezius. FINAL/WORKING DIAGNOSIS: Myasthenia Gravis. TREATMENT: No contact. OK to exercise. Daily weight, BP. No response to oral mestinon. Transient decremental response of deltoids and neck flexors several hours after strenuous physical activity. Prednisone 60mg qod, with slow taper over months. Symptomatic remission within 6 weeks of starting prednisone. Should he play collegiate football in the future?