CJSM Blog Journal Club — is Low-intensity Pulsed Ultrasound an Effective Treatment in Spondylolysis?

Spondylolysis in the adolescent athlete — what to do?

Symptomatic isthmic spondylolysis in the adolescent athlete — for many of us in the world of primary care sports medicine who have a large pediatric/adolescent patient base, this is one of the more common clinical entities we treat.

I’ve written previously about some of the controversies surrounding this condition, and I have had the pleasure of seeing some of the spondylolysis research I’ve conducted published in the pages of CJSM.

Recently published “On Line first” in CJSM is research coming from a Japanese center renowned for its work in this area:  Low-intensity Pulsed Ultrasound (LIPUS)for Early-stage Lumbar Spondylolysis in Young Athletes.

I’m delighted to introduce again our Junior Associate Editor, Jason Zaremski, M.D., who is pioneering our on-line CJSM journal club.  He’ll take us through this new study and help us decide:  LIPUS — should we be using it in our clinical practice when treating an adolescent-athlete with early-stage, or ‘acute,’ isthmic spondylolysis?


Clinical Journal of Sports Medicine

Online Journal Club

Jason Zaremski, M.D.

Jason L Zaremski, MD, CAQSM, FACSM, FAAPMR

Title: Tsukada M, Takiuchi T, and Watanabe K. Low-Intensity Pulsed Ultrasound for Early-Stage Lumbar Spondylolysis in Young Athletes. Clin J Sport Med. Published Ahead of Print October 10, 2017. doi: 10.1097/JSM.0000000000000531.


The spring Journal Club commentary for the Clinical Journal of Sports Medicine will be a review of new research examining the effects of pulsed ultrasound for early-stage lumbar spondylolysis in young athletes. This is a retrospective case control therapeutic study with level three evidence. The specific aims of the study were 1) to determine differences in median time to return to previous sports activity with and without the use of low intensity pulses ultrasound (LIPUS); and 2) to determine if healing rates are improved with LIPUS. Read more of this post


Five Questions with Dr. Hamish Osborne — the Surfer’s Paradise Edition

Familiar faces to CJSM readers! (L to R): Bob Sallis, Peter Brukner, Hamish Osborne, Connie Lebrun

We have on deck today our intrepid Associate Editor Hamish Osborne.  Dr. Osborne, of the University of Otago, Dunedin, NZ, is a member of the Australasian College of Sport and Exercise Physicians (ACSEP), one of our affiliate societies.

Over the last few years, he has pulled the “hard” duty of reporting from the beaches of Queensland, Australia on the proceedings of the annual ACSEP meeting. He’s here to tell us what we missed at Surfer’s Paradise and, just as importantly, what we can anticipate in Queenstown, NZ, site of the 2019 ACSEP meeting 6 – 10 February 2019.


1) CJSM: The 2018 ACSEP has just wrapped. Let’s start things off the way we might with a patient in an exam room – with a big, broad open question. And so: what were some of the more memorable presentations from the proceedings?

Dr. Osborne: I really enjoyed hearing from Prof Lorimer Mosely. The study of pain translated so that mere mortals like me can make sense/use of it. I’ve recently extended my first consultation with patients mostly so that I can spend 15 minutes with them undoing bad images/poor language they use/ have in their heads,  much of it having been learned from us, the professionals treating them.

They come in with a “stuffed back” and leaving knowing they are not injured, just sore and that that soreness is a danger sign of trouble coping with load rather than damage happening. If only we could get “Lorimer” into our undergraduate courses and teach the new generations about this. We don’t have the problem of pain being a vital sign in Australasia but we still have some work to do.

“Ah, but I was so much older then. I’m younger than that now.” At Lake Tekapo, NZ

And then there is your old mate, Dr. Kathryn Ackerman from Boston Children’s Hospital, Sports Medicine – what doesn’t she know about RED-S?  Awesome keynote talks from her, and funny.

By the way Jim her photo from 8 years hasn’t changed as much as your recently tweeted photo (see right) from 8 years ago in New Zealand – perhaps you can come to our 2019 ACSEP conference in Queenstown and update that one with another great set of mountains in the background.

2) CJSM: I followed the meeting via Twitter and the #ACSEP18 hashtag, and was heavily reliant on your prolific tweeting.  The ACSEP does fantastic work all around; one of the more interesting programs it has pioneered is the Reconciliation Action Plan (RAP).  What is the RAP

Dr. Osborne: The ACSEP is very proud of its reconciliation action plan. It is a written practical action plan outlining how ACSEP will build relationships with, and respect and opportunities for, the indigenous peoples of Australia.

There is unfortunately a gap between traditional custodians of the land – Australian Aboriginal and Torres Strait Islander peoples – and non-Indigneous Australians, particularly in health standards. Read more of this post

ECOSEP in Dubai

The Burj Khalifa, the tallest structure in the world — among the dazzling sights in Dubai

Our intrepid Junior Associate Editor, Dawn Thompson, has been busy not only with her training but also her travels:  she recently attended the ECOSEP Congress in Dubai, where she was Tweeting her thoughts in real time.  At last having the chance to catch her breath in between the demands of the registrar’s life, she shares with us a post on the congress’ proceedings.


If you are a follower of CJSM on twitter you may recall that back in December I attended the 5th Congress of the European College of Sports and Exercise Physicians (ECOSEP) in Association with FIFA in Dubai. Somehow it’s now a new year and January is already behind us – if only there were a magic button to stop time and give me a few extra hours in each day! Now, with a few quiet moments to myself’ I wanted to reflect on what was a great conference with plenty on offer for anyone involved in Sports and Exercise Medicine.

This was the first International Sports Medicine Conference held in Dubai, with experts from around the world meeting at this central hub.  During the congress one speaker described it as a huge step forward for the future of Sports Medicine in Dubai: a country in which sports physicians normally have to travel to other continents to get the opportunity to learn from leaders in the field. The event was held at Mohammed Bin Rashid University of Medicine and Health Sciences, and there was a real sense of pride from all the staff who had worked tirelessly to make it a success. With the FIFA Medical Centre of Excellence already based in Dubai, I really hope the success of this event will prompt more organisations to consider Dubai when looking for a central location for a worldwide conference.

Dr. Thompson at the podium, ECOSEP Dubai

It was also the first ECOSEP Congress to hold a careers talk and discussion of trainee opportunities as well as a junior doctors workshop – run by myself as part of the ECOSEP Junior Doctors Committee. This was a chance for trainees to ask questions on SEM in a low-key environment and learn more about this important specialty. Juniors are the future of the specialty, and ECOSEP prides itself on helping to nurture and develop young doctors who will carry forth the work of SEM. Read more of this post


“…like the Oscars, but with concussions.”

Oscars….or Super Bowl? Justin Timberlake — photo Mark Briello, Wikimedia

It would be hard to have spent any time this past month in the United States, my home country, and not be aware that today is “Super Sunday,” when the Philadelphia Eagles and the perennial champion New England Patriots will be playing the final game of the NFL Season.  For all the marbles. For the big kahuna. For (insert your favorite, overused metaphor here).

I woke up this Sunday in my customary manner:  with some coffee and the New York Times. The newspaper had several articles about the upcoming Main Event, including profiles of the halftime highlight, Justin Timberlake.  The story that most resonated with me was a piece by Bruce Weber, whom I find to be an uncommonly funny writer.  He wrote of the Super Bowl’s grandiosity, with its “…pregame blah, blah, blah….the rollout of new advertisements at a cost that might otherwise stabilize Social Security, and the betting line in Vegas, where gamblers risk enough to underwrite a single-payer health care system.”

He summarized:  the Super Bowl is “not so much a ballgame as a happening, like the Oscars but with concussions.”

Spot on.

Eagles or Patriots?  It’s hard to say, though the line favors the Patriots slightly (and most neutral observers with whom I’ve spoken say it’s an, er, no-brainer, the Patriots will be winning) — but one bet that is a sure thing: there will be injuries. And very likely, a high profile concussion, which may or may not be mishandled.

Who can forget the game three years ago (which the Patriots won): Julian Edelman sustained a hit which appeared certain to require medical evaluation, but remained in the game.  And then caught the go-ahead touchdown.

Concussions and gridiron football– the pairing appears in the pages of CJSM nearly every issue, so common is the injury and so prominent the issue.  Our first issue of the year contained cutting-edge, original research on the frequency with which professional football players hide their potential concussions. The article is free, but if you don’t have time to read it, you can even ‘listen in’ on what the author has to say about the study in our most recent podcast.

Super Sunday is upon us. There’s a game, yes, and a whole lot more. Will we see a hologram of Prince? Will Janet Jackson make a reprise showing and sing a duet/have a wardrobe ‘malfunction’ with Timberlake?  What will be the most memorable commercial?

And, oh yes, who will win:  Eagles or Patriots?

Enjoy the game and/or its attendant bells and whistles, if you’ll be watching.  And share your reactions with us on Twitter [@cjsmonline ] if you have thoughts about one of the injuries you’re bound to see.

%d bloggers like this: