Tip-off: The NBA Season is Set to Begin!



“Kobe Bryant 61 NYK3,” by C.J. Iuzer.

The NBA regular season begins in a week, but there has been a lot happening already on the sports medicine front in the league.

From Paul George’s tib/fib fracture  to Kevin Durant’s ‘Jones fracture’  to Anthony Davis’ ‘wrist sprain,’  the athletic trainers, sideline physicians, and orthopaedic surgeons have had a busy ‘off season.’

And then, there is the question of Kobe.  He has been in the press a lot!

The NY Times recently had an interesting chat with the Kobe and Arianna Huffington, a unique friendship to say the least.  It seems Kobe is indeed looking at his future, however many seasons he may have in front of him.  And before he has even taken a shot in the regular season, pundits aplenty have shared their skepticism about his ability to perform on the court:  seems like a lot of folks are betting Kobe will be an albatross around the neck of the Lakers.

As most readers would know, Kobe Bryant ruptured his Achilles tendon at the end of the 2013 season. We blogged about it at the time (I’m reblogging the original post below) and discussed the pros/cons of operative vs. non-operative treatment of such injuries.  The issues of managing Achilles tendon pathology find their way frequently into the pages of CJSM.  Two such articles I would especially commend to the readers as being particularly relevant to the question of Kobe’s ability to recover:   “Complications after surgery or non-operative treatment for acute Achilles tendon rupture,”  and “Does accelerated functional rehabilitation after surgery improve outcomes in patients with acute Achilles tendon ruptures?”

Kobe, of course, went through operative treatment and an accelerated rehab.  His 2014 season was cut short because of a knee injury.  For the brief time he played, it would seem his Achilles held up quite well.  I suspect his knee injury was of the sort we saw after the NBA lockout, where a prolonged layoff from the sport can lead to higher rates of injury; that is, I think his knee injury was more linked to a prolonged absence from high-level running and jumping related to his prolonged recovery from Achilles tendon surgery.  A similar process was involved in Derek Jeter’s case, where a quick return from one injury (ankle fracture) led to a season-ending issue in another body part (quad strain).

I wouldn’t bet against Kobe, no sir.  He is as tough as they come, and throughout his career he has been at the forefront of athletes employing cutting-edge concepts in training and recovery.   I don’t know about the Lakers as a unit.  But I think Kobe can make some headlines that are not related to injury this season.  Draining 61 points at Madison Square Garden one more time in his career?  I think the Black Mamba may just have it in him.

Originally posted on Clinical Journal of Sport Medicine Blog:


Kobe Bryant

I woke up this morning to hear very sad news that occurred in the NBA last night:  Kobe Bryant has ruptured his Achilles tendon.

Kobe, who turns 35 this year, is one of the most recognized athletes in the world (maybe one of the few things that China and the USA can agree on). He had been leading his team to crucial victories as they were making a playoff run when he succumbed to this not uncommon injury in the middle aged athlete. 

As he is quoted saying, he made a move he had executed a ‘million times’ when he felt like someone had kicked him in the leg, and he subsequently crumpled to the ground.  This is the classic history one might obtain when caring for an athlete with such an injury.  If you watch the video, you’ll see Kobe perform a classic…

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The Black Cyclone


#42, Jackie Robinson Photo by Bob Sandberg, Look

The intersection of art and sport, that’s the subject of my brief post today.  And who can get away from the subject of concussion in sport medicine these days?  So that’s in the mix too……

First, a quiz:  who is the first African-American to play professional football in the United States?

We all know Jackie Robinson broke the ‘color barrier’ in Major League Baseball.  April 15, the anniversary of that day in 1947, is now celebrated as a holiday in MLB, and his #42 is retired across the league.

But what of football?  I had thought the answer was Marion Motley of the Cleveland Browns, but it turns out I had the wrong man, and the wrong era.

Charles Follis, a native Ohioan, played for the Shelby Athletic Club from 1902 – 06, and has the distinction of being the first black professional American football player.  He lived and played before the NFL even existed, and he is a subject of a play which I just watched, “The Black Cyclone.”

It’s a fascinating story and a wonderful play.  Malabar Farms, the venue where I watched the show, is equally enchanting, a true gem of central Ohio:  the working farm and former home of Louis Bromfield, an author and screenwriter as well as a man truly devoted to sustainable agriculture.  Malabar Farms is simply beautiful, and is perhaps best known as the place where Humphrey Bogart and Lauren Bacall (who died earlier this year) were married.


Charles Follis, ‘The Black Cyclone’

The play was held in a barn on the farm, and was well attended.  The story of Charles Follis’ life has dramatic power and should deservedly be better known.  I felt somewhat chastened that I had never known his name prior to watching the play.  There is even a direct connection between Charles Follis and Jackie Robinson:  Branch Rickey*, the general manager of the Brooklyn Dodgers and the man who brought Jackie Robinson on to the team, was a friend and football teammate of Charles Follis.

One of the more fascinating moments of the evening was what I saw as the intersection of my sports medicine life and this story.

Charles’ younger brother Curtis died when they were both young men playing football. The scene is recreated on stage. Curtis is playing football and gets tackled roughly by players who are none to happy to be playing against a black man. The actor demonstrates symptoms of a concussion; he returns to the playing field and is hit again, at which point–in dramatic fashion–he succumbs to ‘diffuse cerebral swelling.’

Head injury fatalities in youth football remain, unfortunately, a contemporary subject.  Only a week before watching this play, the national news was running the story of a New York high school player who died on the field after an on-field collision.

In Curtis Follis’ case, one might hope that should these injuries occur on the field in 2014, an athletic trainer or team physician would identify the first injury and hold the player from a return to the game.  It certainly is incumbent upon those of us caring for athletes to monitor the situation on the field, as underreporting of significant head injuries remains distressingly all too common:  in high school football more than 50% of such injuries are not reported by the players, according to a well-known 2004 CJSM study by McCrea et al. 

Better concussion management is also the subject of one of our podcasts:  take a listen when you have the chance. 

I do not know what plans the producers of the play have for taking ‘The Black Cyclone’ on the road, but I do hope it comes your way.  The Charles Follis story is most definitely one that should be better known.  The same can be said for Malabar Farms:  if you’re ever in central Ohio, it’s well worth the visit.


*Branch Rickey is deservedly famous for his instrumental role in integration of American sports.  As he put it, “Ethnic prejudice has no place in sports, and baseball must recognize that truth if it is to maintain stature as a national game.”

He should also be known as being instrumental in the introduction of batting helmets, a major step toward improving baseball player safety…..but that’s a subject for another post!


Gender Issues in Sport: the case of Dutee Chand



Berlin Olympia Stadium: site of the 12th IAAF Athletics Championship

It’s time for a poll.

Issues of gender in sport are a regular feature in the pages of the CJSM journal and this blog.

I wanted to share with you, again, a poll that got a lot of traffic earlier this year when I wrote about the IAAF policy on gender testing in sport. The issue continues to be relevant:  just this week, the New York Times published an excellent article on the subject of the Indian sprinter Dutee Chand.  She is the Indian 100m women’s U18 champion, and she cannot currently compete for her country because of her naturally high testosterone levels.  She faces the decision, as several female athletes have before her, of whether to retire or compete…..but the latter option is contingent on medical interventions aimed at lowering her testosterone.

The issue is highly charged, and I think both the pro and the con side of such testing and intervention make some sense in the field of competitive athletics.  At the end of the day, however, I find the IAAF policy to be highly flawed.  I think it is largely discriminatory, sexist, and reductionist:  too high of testosterone = you cannot compete as a woman. 

Read the rest of this post and take the poll.  At CJSM, we’re interested to know what you think!

Take Our Poll (function(d,c,j){if(!d.getElementById(j)){var pd=d.createElement(c),s;pd.id=j;pd.src='http://s1.wp.com/wp-content/mu-plugins/shortcodes/js/polldaddy-shortcode.js?m=1381478258g';s=d.getElementsByTagName(c)[0];s.parentNode.insertBefore(pd,s);} else if(typeof jQuery !=='undefined')jQuery(d.body).trigger('pd-script-load');}(document,'script','pd-polldaddy-loader'));

Originally posted on Clinical Journal of Sport Medicine Blog:

I was taken by an editorial that I read in the New York Times this weekend:  The Trouble With Too Much T.  If you didn’t have the chance to see it yourself already, by all means click on the link and read this piece.


Caster Semanya, South African Olympian

The authors, Katrina Karkazis and Rebecca Jordan-Young, give a broad overview of how current sports governing bodies determine if an athlete is ‘really’ female.  Of note, Karkazis and Jordan-Young are also the principal authors of  The American Journal of Bioethics critique of the current gender-testing policies of the IOC, IAAF and other governing  bodies.

They lead with the well-known story of Caster Semanya, the South African woman who, in 2009, was barred from international competition and was compelled to undergo testing after the Berlin World Championships (she has subsequently been reinstated, and in the 2012 London Olympics was…

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Return to Play Decisions: The hits and the HIT (system).


It’s October, and I thought I’d share a blog post I previously wrote about return to play decisions (see below). The football teams I cover are smack dab in the middle of their seasons; I, like all my colleagues covering teams this fall, have been busy making plenty of ‘return to play decisions.’

What do you all do with your 7 and 8 year olds? Yes, your 7 and 8 year olds……little did I know when I started my career that I would be making ‘return to play’ decisions for this age group, but that is among my duties here at Nationwide Children’s Hospital in Columbus, Ohio. How about you?

With that sort of return to play decision in mind, I could hardly find a more relevant piece of original research than the study on head impact exposure in youth football in the September 2014 CJSM.  The authors–a group from Virginia Tech and Wake Forest–are well known for recently publishing various studies on head  impact exposure using the ‘Head Impact Telemetry’ (HIT) system.   The HIT system is being used more regularly at various levels of football in helping to determine when an athlete may need a sideline evaluation.  As we all know, athletes in the heat of competition are not always the most forthcoming in sharing when they may have had a symptomatic hit; for that matter, the collective body of sideline physicians, athletic trainers and coaches don’t always pick up on the hits that occur right in front of our eyes:  just ask Brady Hoke and the Michigan Wolverines.

Returning to youth sport…..as my friends at MomsTeam have written, “the day when monitoring of head impact exposure in football and other contact and collision sports becomes commonplace is closer at hand than one might think.”  Here’s a list of what’s available right now for players from youth level on up to the pros (again, thanks MomsTeam for the reference).

I can forsee the time when I will integrate head impact exposure data along with what I find with my other concussion assessments to determine when I will release one of my youth athletes back to the field.  Next season, I will likely be involved with coverage of a high school which uses “Shockbox” technology.  However, I don’t currently use such systems; that is to say, none of the teams I cover, high school or university, use the HIT system or any other impact exposure technology.  Are you already using such technology in your determinations? Let me know if you are.  I’d like to learn more.

Enjoy the reblogged post below.


Originally posted on Clinical Journal of Sport Medicine Blog:


Though a beautiful time of year, fall is not
the most idyllic for a sports medicine clinician

Like many of the readers out there, my colleagues and I are deep in a football season, where we are managing various teams and their mounting injuries.  For a sports medicine physician, fall in America must be a bit like early spring for an accountant (tax day = April 15):  it’s the time to buckle down and crank through patients, the time, from a certain perspective, to see the volume of patients that will sustain the business through leaner times of the year.

When I’m out of the clinic and on the sidelines, I’m also doing one of the parts of my job that is the most fun, and I’m sure my colleagues out in the blog sphere will agree.  But I wouldn’t describe the work as an idyll.  I can be enjoying…

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