There Be Monsters

“In like a lion, out like a lamb,” that’s what they say about March.

To the extent that expression applies to the weather this month and to this blog, I think 2014 may be the exception that proves the rule!  We may be going out like a lion in both areas.

The east coast of North America is ready for spring, but this month that opened up with winter is ending the same way.  If there was an outdoor lacrosse game in Buffalo, New York this weekend, the players were dealing with snow!


More like a lion than a lamb: an NHL body check.

As for this blog, we opened the month with a post that had both sound and teeth, like the proverbial carnivore itself:  our first podcast was a discussion with Drs. Neil Craton and Oliver Leslie, the authors of the March 2014 CJSM lead editorial, Time to Re-Think the Zurich Guidelines: a Critique on the Consensus Statement on Concussion in Sport.  I continue to hear about this editorial, on social media, on the American Medical Society for Sports Medicine email ListServ, and most recently at a symposium on concussions held at Ohio State University (OSU).  It has stirred a tremendous amount of interest.  And so I thought it would be fitting to end the month where we started, with the subject of concussion in sport.

The featured speaker of the OSU symposium was Kevin Guskiewicz, who spoke about “Sports concussions: paranoia or legitimate concern?”  Both he and Dr. Jim Borchers, the Ohio State Team Physician, mentioned the editorial critique in their respective talks.

If you follow the literature on sport-related concussions, you most certainly will come across Dr. Guskiewicz’s name.  He has contributed mightily to the research on several dimensions of this injury.  And so it was a pleasure to hear him speak for an hour on the subject.

As the title of his talk would indicate, Dr. Guskiewicz took as his theme the fear surrounding sport-related concussion.  Dr. Guskiewicz did an admirable job underscoring the importance of both the injury (concussion) and the need to avoid throwing out the baby with the bathwater:  eliminating collision sports such as American football out of possibly misplaced concern over short- and long-term deleterious effects on the brain.  The high points of his talk focused on the various aspects of sport amenable to change which can minimize injury risk and maximize participation.

I especially enjoyed his approach because, in many respects, it is the work that he and a few others have done (amplified by the media) that has helped unleash the beast of “concussion fear.” Read more of this post

What to do about concussions?


Calling aspiring
blog post writers!

There is a lot of discussion about concussions in the world of primary care sports medicine.

Breaking news?  Not!

But truly the conversation extends and deepens by the month, it seems to me.  It might be my personal, professional myopia–during football season possibly 25% of the patients in my clinic are youth athletes with sport-related concussions (SRCs).  As a consequence of that, I try to stay on top of the literature and have begun doing research in the area myself.

I hope you all have been as interested as I have over the March CJSM offerings in this area.  The journal opens with an editorial, Time to Re-think the Zurich Guidelines?  It continues with an interesting study looking at the use of those same guidelines along with the Buffalo Concussion Treadmill Test in determining return to play in adolescents following concussion.

And this blog has profiled the Zurich guidelines as well in a recent post and podcast, our first in what will be an on-going offering here at CJSM.

We are aware that there is much more to clinical sports medicine than concussion, and we make a concerted effort at the Editorial Board level to offer a continuing, rich, and diverse set of research focussed on the panoply of sport conditions we might see as clinicians.  As we move forward, we are always interested hearing from you about areas in the world of clinical sport medicine that are of special interest to you.

You can comment on these pages, tweet us @cjsmonline, or if you are especially eager and want to take the bull by the horns:  consider being a guest blog post writer for an issue that is of special interest to you.  Our blog post guidelines can be found here and include instructions on how to contact us if you are interested.

In the mean time, take the poll here (offered concurrently on the CJSM main website).  As you know, we love to hear from you!

CJSM Podcast 1

cjsm front page

Clinical Journal of Sport Medicine
Podcast 1

We are delighted to bring you our first Clinical Journal of Sport Medicine podcast: 

We begin this month with a look at the provocative editorial in our new issue: Time to Re-Think the Zurich Guidelines: a Critique on the Consensus Statement on Concussion in Sport. The article is authored by Drs. Oliver Leslie and Neil Craton, from Legacy Sport Medicine in Winnipeg, Manitoba, Canada.  I caught up with the authors last week for an exciting discussion about their argument that it’s “…time for us to reject (the) diagnostic and therapeutic algorithm” proposed by the Zurich guidelines.

Let us know what you think on the comments section of this page, tweet us @cjsmonline, or go to the CJSM main page and take the Zurich guideline poll we have for you there.  Check out our recent blog post on this same subject.  And be sure to check out the many other offerings we have this month in the journal.  We’ll be writing and talking about them in the coming weeks.


(music: Jeff Manning)

Is it Time to Re-think the Zurich Guidelines?


Zurich: Site of the 2012 Meeting which
developed the current Consensus Statement
on Concussion in Sport

Vienna, Prague, Zurich:  I’ve often wondered why the Consensus Statements on Concussion are made in central European cities.

The ‘International Consensus Conference on Concussion in Sport’ has taken place successively in Vienna (2001), Prague (2004), Zurich (2008) and again in Zurich (2012).  It’s looking like the timing is an Olympiad!  And as for venue, I suggest Budapest should start lobbying for 2016…..

But today we won’t be answering the ‘why’ of venue or timing regarding these conferences.  We’ll be looking at commentary on the output of the last Zurich meeting:  the so-called “Zurich guidelines,”  or the Consensus statement on concussion in sport:  the 4th International Conference on Concussion in Sport held in Zurich, November 2012.

An editorial in our new, March 2014 issue, is entitled:  Time to Re-think the Zurich Guidelines?  A Critique on the Consensus Statement on Concussion in Sport.  Written by Drs. Neil Craton and Oliver Leslie of Legacy Sport Medicine in Winnipeg, Manitoba, Canada, the piece is a provocative deconstruction of the Zurich Guidelines.


Investors Group Field, where the team doc
Neil Craton cares for the CFL’s
Winnipeg Blue Bombers

The authors have contributed to CJSM in the past.  Last year, the pair wrote Concussion:  Purely a Brain Injury? and Dr. Craton has contributed several other pieces over the years.  The pair are also educators at the University of Manitoba Primary Care Sports Medicine Fellowship.  They are busy clinicians as well as writers and teachers, and Dr. Craton includes as his clients the players of the Winnipeg Blue Bombers of the Canadian Football League (CFL).

Concussion,  as defined by Zurich, is a subset of traumatic brain injuries. The formal definition, with which many of you will be familiar, is “…a brain injury and is defined as a complex pathophysiological process affecting the brain, induced by biomechanical forces.”

The editorial authors state that the Zurich guidelines, while providing high sensitivity,  lack sufficient specificity.  Consequently, they argue that Zurich opens up the possibility that a host of other pathologies (e.g. cervical strain, cervicogenic headaches, benign positional vertigo, etc.) can be construed as concussions.  And if understood that way, the potential ‘mis-diagnosis’ can lead to iatrogenic harm:  either by initiating a cycle of ineffective treatments, or causing undue worry among patients and families regarding a perceived brain injury.  They go so far as to write, “The inclusion criteria for a diagnosis of concussion as articulated by Zurich are absurd (my itals).” Read more of this post

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