“got pain?” Get the new issue of CJSM

A tibial spine avulsion fracture — an injury requiring surgery, and significant pain management.

The new academic year has begun in North America, and with it a new set of sporting seasons and a surge in sports’ injuries in our clinics.  Youth and school soccer and football provide many of the injured patients I manage.  For instance, a few days ago, on a Friday, I saw a 12-year-old boy who described a twisting injury to his knee, with immediate disability and an effusion.  I saw him in my clinic the day after his injury and discovered he had sustained a tibial spine avulsion fracture.

These injuries typically occur in skeletally immature patients aged 8 to 14 who sustain twisting or valgus moments to a hyperextended knee.  Though relatively uncommon, a tibial spine avulsion fracture is seen rather often in a specialty center like mine that focuses on the care of the pediatric and adolescent athlete.

In the USA (perhaps everywhere?), these will almost always require surgical fixation.  Since I am a primary care sports medicine physician, this means I was on the phone immediately with my orthopedic surgical colleague, and the child was booked for the OR on Monday.

What remained for me to deal with were the important issues of splinting and pain management over the weekend.

Pain management in the injured athlete — a broad topic which challenges a clinician on an almost daily basis.  I would add that I have found the issue has become increasingly challenging with the opioid epidemic that has ravaged the USA, most especially in states like Ohio, where I practice.

Over the nearly 25 years I have been a physician, I have seen the conversation about analgesia change from one putting an emphasis on ‘pain as a vital sign’ to one asking the question:  in the physician’s efforts to alleviate pain, has patient safety been compromised?

(L to R) Three greats from South Africa: Martin Schwellnus, Wayne Derman, Pierre Viviers

It is an ever-timely contribution, then, that our September 2018 issue is a thematic issue devoted to the topic of pain management in the athlete.  I am delighted to add that our Guest Editor this month is Professor Wayne Derman who is Director and Chair of the Institute of Sport and Exercise Medicine at the Division of Orthopaedic Surgery, Stellenbosch University, Cape Town, South Africa.

I count Wayne as a friend, and I am happy to let you know I plan to conduct a podcast with him in the next month so you can hear directly from our guest editor how he brought this issue together.

In the meantime I urge you to go to this issue  and check out the many interesting articles, ranging from the excellent editorial about ‘deromanticising’ the image of athletic pain authored by Prof. Derman to the open access study on Cannabis and the Health and Performance of the Elite Athlete.

 

CJSM Podcast: Dr. David Howell looks at pediatric concussions

One of the top young guns in the world of pediatric sports medicine research is David Howell, PhD, ATC of Children’s Hospital Colorado, and the University of Colorado School of Medicine.  Dr. Howell has graced the pages of the CJSM blog before and, even more notably, the pages of the journal itself many times.  He has been one of CJSM’s more prolific authors over the last few years.

When we recently published several of his articles within a span of months, I knew it was time to reach out and get him on the podcast.

Listeners will not be disappointed — Dr. Howell is as erudite and lucid a speaker as he is a writer.  Together in this, our newest podcast, he and I discuss “Breaking research developments in pediatric and adolescent concussions.”  We were able to focus on three of his most recent studies published in CJSM:

Dr. Howell’s work continues to fill a significant research gap noted by the Berlin consensus statement on concussion group — the relative lack of evidence for how to diagnose and manage concussions in the under 13 year old crowd.  Not surprisingly, several of these new CJSM studies have received a lot of buzz, most especially the first study in that litany (on Concussion symptom profiles).  As someone who sees concussions in this age group on a nearly daily basis, I have found the results of this published research to be, already, of significant practical use.  The Altmetrics on the paper underscore the importance of the work.

This newest podcast can be found with all of our podcasts here on the CJSM website and here on iTunes  And don’t forget you can subscribe to our podcasts on iTunes so you never miss one.

Thank you, again, Dr. Howell for the continued work you do in the field of sport medicine at large, and in the area of pediatric sport-related concussion in particular.

Five Questions with Dr. Nick Peirce: The Role of Physical Activity and Sport in Mental Health

Dr. Nick Peirce, lead on the FSEM team producing recent exercise and mental health position statement.

Reduce depression and cognitive decline by up to 30% with regular exercise?  Can this be so?

For those of us ‘in the know’ in this field of sport and exercise medicine, that statement may seem understood.  But medical research translating to broadly held knowledge which then may lead to meaningful change:  well, we ALL know how rare that situation can be.  The management of recent concussion events in the FIFA World Cup reminds us of the difficulty of knowledge translation: there were instances where it seemed as if we were ‘partying like it’s 1999’ so to speak.

Reviews of the current state of evidence-based knowledge about medically important findings continue to be of vital importance in ‘getting the word out’.  In that spirit, we couldn’t be happier to see the recent position statement released by one of our partner societies, the Faculty of Sport and Exercise Medicine (UK) : The Role of Physical Activity and Sport in Mental Health.

The lead on the team of authors which produced this FSEM UK Position Statement is Dr. Nick Peirce, Chief Medical Officer of the England and Wales Cricket Board.  We wanted to pick his brain to get a bit more of the background work which resulted in this statement.  The summer Cricket season has kept Dr. Peirce occupied above and beyond his usual level of busyness.  During a gap between competitions, CJSM caught up with him — the results of our interview can be found here.

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1. CJSM: We want to discuss the new FSEM statement on the role of physical activity and sport in mental health, but first can you tell us a bit about yourself: your background as a sports medicine clinician and your involvement with FSEM?

NP: I have been involved in Sports and Exercise medicine for over 20 years having worked across a large number of Olympic and Professional sports, including Leading Sports Medicine for English Institute of Sport (EIS) at the busiest site in the country at Loughborough University, the Davis Cup team and the football team Nottingham Forest. I am a Hospital Consultant in Sport and Exercise Medicine in the NHS and have been Chief Medical Officer for the England Cricket for the more than 10 years. I have been involved in many of the Sports Societies and for 3 years have sat on the Faculty (FSEM), although professional sport commitments make this challenging.

2. CJSM: How did you become involved with this particular FSEM project on mental health – was there a large team involved in the production of this project? Was FSEM the only organization involved in the drafting of this document? Read more of this post

CJSM podcast with Chris Nowinski: What FIFA might consider doing differently in 2022

It was a whirlwind of a month that just ended:  World Cup 2018 has been rightfully celebrated as a wonderfully exciting display of sport.  Media outlets around the globe are reflecting on the highs and lows of the tournament. 

One of my favorite comments was a tweet conversation involving former English professional footballer Gary Lineker:  “Back to politics now, eh?/ What a depressing thought.’ 

Politics. Ugh.

Twitter was also the media where I read some of the most insightful commentary on the various concussion controversies that occurred this tournament, and Chris Nowisnki, Ph.D. was among the most prolific and penetrating in his analyses of the injuries to Matuidi and others.

Dr. Chris Nowinski of the Concussion Legacy Foundation

Dr. Nowinski will be a familiar figure to anyone involved in the management of sport-related concussions. Dr. Nowinski is the CEO and co-founder of the Concussion Legacy Foundation and a co-founder of the Boston University CTE center. He has been a guest on the CJSM podcast previously.

He was the perfect analyst to review what sport still gets wrong about concussions in 2018, and to review the directions where we all might consider going as we turn toward FIFA 2022 in Qatar.

Go to our podcast link on the CJSM website or on iTunes — listen to what Dr. Nowinski has to say, and then let us know what you think.

 

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