Transitions: November in the USA.

Really?  Can it be that November is here?

I just covered my last high school football game of the fall, a loss in the playoffs. A season which began in the heat and humidity of August [with its attendant muscle cramps and concerns of exertional heat illness & exercise-associated hyponatremia] is now over, and injuries sustained on wrestling mats and in basketball gymnasia are beginning to show up in my clinic.  Before you know it, the skiiers and snowboarders will be filling out the waiting room.

November also brings with it the publication of our last CJSM of 2015, and it is a good one.  We have profiled two offerings in particular, both of which currently are freely available on line:  original research looking at potential limitations of American Heart Association recommendations for pre-participation cardiac screening in youth athletes; and a provocative editorial [and just right for the change of seasons] arguing for adult autonomy in deciding whether or not to wear helmets when skiing.

Both subjects are among the more controversial in sports medicine.  Whether or not to consider pre-participation screening with ECG when taking care of our younger athletes–well, that’s a question whose answer can vary depending on what side of the Atlantic one is on, or what part of the United States you may live in.  It’s a question whose answers may lie in much of the research we publish in our journal, with luminaries such as Jonathan Drezner and William Roberts weighing in.

Whenever we publish research or commentary on the question of mandatory personal protective equipment, I sometimes feel as if we have entered the ‘blood sport’ arena of sports medicine.  This issue’s editorial  on the ‘Ethics of Head Protection While Skiing’ has already generated some buzz on our twitter feed. Two years ago, we published the Canadian Academy of Sport and Exercise Medicine (CASEM) Position Statement on the Mandatory Use of Bicycle Helmets, and our social media feeds erupted.  I have never seen so much discussion on the blog site.

There is much more to be read carefully in this November 2015 issue.  A very interesting piece of original research, from one of our more prolific authors (Dr. Irfan Asif), looks at the potential psychological stressors of undergoing pre-participation cardiovascular screening.  As a pediatric sports medicine specialist, I’ll be reading with great interest a study on the potential prognostic implications of post-injury amnesia in pediatric and adolescent concussed athletes–lead author Johna Register-Mihalik continues to make major contributions to our understanding of that injury in that population.

So, enjoy this issue.  And brace yourself–2016 is on its way.  It will be here before you know it!

Alphabet Soup: Concussion Assessment in Youth

alphabet soup 1

Chicken soup: good for the soul….good for concussion? Photo: strawberryblues Wikimedia

SCAT2, SCAT3, Child-SCAT 3, SAC, BESS…….as those of us in sports medicine know, concussion assessments have become an alphabet soup!

Our July 2015 edition of CJSM contains an interesting study looking at baseline SCAT2 assessments of healthy youth student-athletes; it also included some preliminary evidence for the use of the Child-SCAT3 in children younger than 13.

The 4th International Consensus Statement on Concussion in Sport introduced the SCAT3 and Child-SCAT3 instruments.  The Child-SCAT3, in particular, was a significant advancement as there had been no pre-existing instrument for pediatric concussion assessments prior to the 2012 Zurich conference.  If you have not ever looked the Child-SCAT3 over, take the chance now by going to the freely available consensus statement–the Child-SCAT3 PDF is readily downloadable.  Among the differences between the SCAT3 and Child-SCAT3:  a different set of Maddocks questions (is it before or after lunch?); days of the week (as opposed to months of the year) in reverse order; a parent- as well as a self-assessment of symptoms (and the self-assessment is written in more age appropriate language).

Throughout the year, but especially at this time of year (late summer–football has begun) we do assessments like this for the large number of kids we see with concussions or suspected concussions.   Read more of this post

CJSM Podcast 8: A Conversation with South Africa’s Jon Patricios

Our newest podcast guests jsm-podcast-bg-1Jon Patricios, M.D., the current president of the South African Sports Medicine Association (SASMA) and the 2015 Travelling Fellow of the American Medical Society for Sports Medicine (AMSSM).

Dr Patricios is currently Director of the Morningside Sports Medicine Unit and a sports physician at The Centre for Sports Medicine and Orthopaedics in Johannesburg. He is a Fellow of the American College of Sports Medicine, the Faculty of Sports & Exercise Medicine (UK), and the International Sports Medicine Federation.

Dr. Patricios has been a team physician to school, club, provincial and international sports teams in rugby, cricket, soccer, athletics and basketball.  He is a member of the Cricket South Africa and SA Rugby medical committees and the Rockies Comrades Marathon Panel of experts. He is chief medical officer for the MTN Qhubeka cycling team and the Kaizer Chiefs Football Club; founder and Director of Sports Concussion South Africa; sports concussion consultant to World Rugby; and serves on tribunals for the South African Institute for Drug Free Sport.

jon p at work

Dr. Jon Patricios, President of the South African Sports Medicine Association

He has authored a case report on thoracic outlet syndrome in CJSM and is someone I have collaborated with on a talk focused on the use of social media by sports medicine clinicians, given in Orlando, Florida  at the 2014 meeting of the American College of Sports Medicine.

j pat

Jon Patricios, Speaking at ACSM 2014 on Social Media for Sports Medicine Clinicians

Somehow, among these many duties, he found the time to sit down for a chat, which you will find here in the podcast.  Thanks Jon, and we’re looking forward to seeing you soon in Hollywood, Florida at #AMSSM15 !

[check out all of our podcasts and subscribe to the feed too, on iTunes]

There Be Monsters


As I prepare for the 2015 OSU Sports Medicine Concussion Symposium (I am in front of my computer working on my Powerpoint Presentation), I am reminded of the post I penned exactly a year ago and am re-blogging today. Attending the 2014 symposium I shared my thoughts (see below) about the future of contact sports in our new world of concussion concern.

The intervening year has seen a veritable slew of new research and new thought on the attendant problems.  In our March 2015 CJSM, for instance, we have an editorial by Iain Murray on the need for a ‘culture change’ in sports concussion and several pieces of original research, including a study on the detection of concussion using cranial accelerometry.

I am looking forward to what co-panelists in the symposium have to say, including Stan Herring, who wears among many other hats that of co-author of the Zurich 4th International Consensus Statement on Concussion in Sport.  I am thankful to my friend Jim Borchers, the course co-director and Team physician for the Ohio State Buckeyes, for the chance to talk as well.   I’ll be sure to post the high points of the symposium, both here on the blog and on Twitter @CJSMonline

Originally posted on Clinical Journal of Sport Medicine Blog:

“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!

Mike_Fisher_throws_check_May_29_2006 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, 

View original 810 more words

%d bloggers like this: