Beantown & the MomsTeam Summit

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With the illustrious Brooke de Lench, Executive Director of MomsTeam. Friend and fellow traveller in the quest to make youth sports safer.

I’m flying to Boston today, and it feels like going home.

As I’ve shared with readers of this blog, I spent many of my formative years of education and medical training in ‘Beantown.’  I’ve experienced both sports (university track and cross-country) and sports medicine (fellowship training, coverage of the Boston marathon, and more) in ‘the Hub.’

This morning I head to Boston in advance of attending and speaking at a very special gathering taking place on Monday:  a ‘Youth Sports Summit’ taking place at Harvard Medical School.  The summit will focus on evidence-based best practices to address almost every facet of #YouthSportsSafety:  concussion prevention, sound nutrition, screening for sudden cardiac death, prevention of sexual abuse, to name a few topics.  I am one of several speakers and I’ll be speaking on injury prevention in youth athletes.

The host for the “Smart Teams Play Safe” summit is MomsTEAM  an especially influential organization addressing #YouthSportsSafety concerns. I serve on the Board of Advisors for the non-profit MomsTEAM Institute.  The Board is full of authors who have published in CJSM:  Tracey Covassin, Neeru Jayanthi, Dawn Comstock, Johnana Register-Mihalik……it’s a veritable ‘Who’s Who’ of sports medicine.  Most of the Board will be in attendance, and many will be speaking.

As I prepare for my talk, I find myself so frequently turning to the pages of CJSM to find the evidence for best practices in this area.  I will be relying heavily on studies ranging from the AMSSM position statement on youth overuse injuries, published in January 2014; to the CASEM position statement on neuromuscular training for ACL injury prevention; to some of the compelling research regarding the benefits of postponing body checking in youth hockey.

I’ll be blogging and tweeting from Boston, so look to these pages and to our twitter feed for updates on the proceedings.

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Spoiler Alert (will be mentioning this in my talk):  if there is any group that is going to begin solving the epidemic of youth sports injuries, it is a determined group of mothers like those involved in MomsTeam.  From the Playground Movement of the late 19th century, to the push by MADD to address the public health crisis of drunk driving, motivated mothers have made major impacts on societal health.  I have no doubt that in the arena of #YouthSportsSafety, the same will hold true.

The September CJSM

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September brings with it sideline football duties…. and the new edition of CJSM to share on social media

Our year at the journal is punctuated with unique excitement when we publish a new edition of the journal, six times per annum.

There are literally months and months of prep work; ranging from the entire peer review process to the meticulous proof-reading and manuscript editing done by the hard-working CJSM staff to the staging of each edition:  what studies will we publish this month, what is our page limit, will we run a case report on-line this month, are we publishing a consensus statement, etc.?

Months and months of work reaching a crescendo of activity:  Is this what giving birth is like?  (Wait, my wife may actually answer that while she puts me in an arm bar. Sorry, the question was merely rhetorical!).

After all that group work–resulting in the ‘birth,’ if you will, of the new journal–I start kicking into another gear as the Emerging Media Editor…trying to share the new content through the various social media spheres (blog, podcast, Twitter, Facebook, LinkedIn, etc.) CJSM occupies.

Our most recent offering–the September 2014 CJSM–is a particularly fine edition, and I’m proud to be sharing this with you on these different media channels.  It leads off with an editorial on the effect of the Ramadan fast on the risk of sports injuries written by Roy Shephard of the University of Toronoto.

Dr. Shephard notes the importance of understanding the effect of the 29 day fast as he notes “…..that a growing proportion of participants in both national and international athletic competitions are Muslims…..”  He then goes on to provide an elegant and concise review of what is known about the issue.  Among the articles he includes is a 2013 study by Eirale et al., “Does Ramadan Affect the Risk of Injury in Professional Football?”  This study was profiled in this very blog last year.  I encourage you to click to the primary study and to my post to learn more about what Drs. Eirale and company discovered about the differential effect of the Ramadan fast on Muslim and non-Muslim athletes in Qatar.

May I commend to you, as a relevant aside, the work that Dr. Eirale has published in CJSM.  I certainly have found it illuminating; his case report on a frontal bone fracture in a soccer player is another bit of his work that I have used for a chapter I was writing for an upcoming text:  I just discussed this same report in a recent blog post.

Thanks Dr. Eirale, for all the clinically relevant sports medicine research you are doing!

Over the months of September and October I plan to review in more detail a few of the articles in this new edition of CJSM.  And then, as November approaches, the push will begin….to organize the sixth and final issue of 2014….and to experience another surge of excitement!

I’ll close with a reminder to take the poll at our previous post on shoulder dislocations.  Do you have a preferred method for reducing an anterior shoulder dislocation?  If so, head to the poll and let us know which technique you prefer.  We’d love to hear from you.

See you on line!

 

Reducing a Shoulder

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A common sequela of football

Football, American style: the season for anterior shoulder dislocations.

My specialty group and I manage this condition throughout the year, of course, but the numbers surge in the fall.  Pre-reduction on the sideline, or post- in the clinic, the dislocated shoulder is an entity that loves this time of year.

There are so many aspects to the treatment of this injury, which occurs so frequently on the playing field.  First time dislocators: surgery or no?  What to do about recurrent dislocations?  If an apparent anterior shoulder dislocation shows up in your urgent care, do you take the time to image prior to reduction? Do you use anesthesia or sedation?  When do you return them to play?

One aspect of this issue I especially like to discuss:  What’s your favorite method for reduction?  Hippocratic?  Spaso?  Slump method?

A lot of us use what we were taught; and if it works, then that’s our go to procedure.

I had the good fortune of spending a month working with Dr. William MacAusland, Jr., an orthopedist from Boston who spent years working at Harvard.  He sponsored a medical student rotation at the Carlos Otis Ski Clinic at Stratton mountain, in Vermont, and I spent a month in medical school skiing the slopes and treating the injured with Dr. MacAusland.  He favored the ‘modified Kocher method,’ and that is what I have used ever since.

I should say, as well, that Dr. MacAusland took great pride in reducing a shoulder with no anesthesia; he favored a slow, gentle approach that essentially relied on hypnotic techniques.  He believed the ‘humerus wanted to get back in place,’ and any significant effort on the practitioner’s part (e.g. traction) was more apt to get in the way of rather than aid the reduction.  Certainly, I have found that if I can see a shoulder within the first hour or so of the injury, before significant spasm has set in, that Dr. MacAusland’s approach in toto works like a charm.  I was taught as a general principle to have two techniques at the ready, in case the first method was ineffective for a particular patient. The Spaso method is my second method.

So, what’s your favorite method?  Take the poll below and tell us in the comments section why you prefer it.

 

 

On Call and Evidence Based Medicine

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Calling Dr. MacDonald…..

When I am ‘on-call’ for my sports medicine clinic practice I receive a mixed bag of phone calls.  The calls come in from patients we take care of, to emergency physicians looking for help triaging patients, to community physicians looking for consultation. Because I do non-operative, primary care sports medicine, I’m rarely involved in an emergency when ‘on-call'; any urgent or emergent issue I need to manage typically occurs when I am on a sideline and not nominally ‘on-call.’

Last week, I received an interesting query about muscle pain in a high school runner who had been doing some intense pre-season training.  The physician seeking my advice had felt obliged to check the patient’s creatine kinase (CK) and told me the level was 1400 U/L.  He had already obtained a urine for myoglobinuria (negative), and he was asking if he should be clearing the patient to return to sport.

Most of my clinical work involves taking care of fractures or concussions, spondylolysis or osteochondritis dissecans.  As with a lot of clinicians, I suspect, for the conditions I treat in high volume I have the facts usually at the tip of my tongue.  Though I have manged the condition, I don’t routinely treat patients where rhabdomyolysis is in the differential.  And so, with this specific phone consultation, I assured the physician the patient was in no imminent danger, but I wanted to get back to him later that day after I had done a literature search.

Though I did not think about this explicitly at the time, I later realized that this little vignette represents an example of “Evidence Based Medicine” (EBM) in use.  As Sackett et al. state in 1996, “Evidence-based medicine is the conscientious explicit and judicious use of current best evidence in making decisions about the care of individual patients.”

In this particular case, I wanted to find some of the primary research done on CK levels in athletes in this age group.  Among the articles I pulled were two from CJSM:  “A Cluster of Exertional Rhabdomyolysis Affecting a Division I Football Team” , which was published in 2013; and a ‘Brief Report’ that was available only on-line until it was just published with the new, September CJSM, “Creatine Kinase Levels During Preseason Camp in National Collegiate Athletic Association Division-I Football Athletes.”

The former study I have actually profiled in these blog pages before.

There can be limits to the application of EBM in making decisions about ‘individual patients.’ Read more of this post

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