Concussions — looked at from multiple perspectives

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With one of the great ones — Dr. Greg Myer, leading concussion and ACL prevention researcher

It should come as no surprise that there has been a lot of ‘discussion’ recently about the topic of concussions in our world of sports medicine. That subject has been a ‘hot button’ issue for a decade.

Whether the issue is one of Cam Newton playing on through an injury that may have warranted immediate evaluation or whether it’s the topic of concussion reporting at the youth level, there is an on-going conversation in the media, social media, medical literature and conferences on sports-related concussions (SRCs) in all their many facets.

I was given an entirely new view on SRCs today. I had the great pleasure of attending a lecture on concussion prevention given by my friend (and frequent CJSM contributor) Greg Myer, PhD, who was visiting my home institution of Nationwide Children’s Hospital.  He delivered a talk entitled, “Concussion Prevention:  Has Nature Already Provided the Solution?”

It was a fascinating exploration of biomimetics influencing primary sports medicine research.  Dr. Myer and his team saw in nature a paradox:  species of woodpeckers knock their heads against hard objects thousands of times,  generating up to 1500 g-force units with each hit, all the while avoiding getting concussed. They then looked at the biology of how the bird manages this  and developed a device that players can wear in their sport to, potentially, reduce their own risk of SRCs.

The lecture was compelling, both for the details of the device and the research, and for the overall brilliance of the concept.  Talk about thinking ‘outside the box’:  looking at a woodpecker, and seeing a way of making athletes safer on the playing field.  Fascinating stuff.

I finished off the day with more of Dr. Myer and more of concussions, by picking up the September CJSM. In this issue, we have four original research studies focused on sport-related concussions (SRCs). Three come from Boston, a ‘hub’ of research on SRCs, and one comes from South Africa, which I was able to review  in the last CJSM blog post.  One of the Boston studies includes Dr. Myer as a contributing author:  Young Athletes’ Concerns About Sports-Related Concussions:  The Patient’s Perspective.  Another reports results of a survey of American Medical Society for Sports Medicine (AMSSM) Physicians on concussion management practices.  And the third looks at SRCs from the perspective of another set of stakeholders, coaches: Content, Delivery, and Effectiveness of Concussion Education for US College Coaches.

In this issue, therefore, we look at SRCs from the perspective of the patient, the doctor, and the coach.  We look at SRCs ‘spanning the globe,’ from Boston to Cape Town.

And though Dr. Myer’s work on concussion injury prevention is not published in our pages, please use the links I have provided above to read (and see) more of what’s behind the idea that woodpeckers may help provide part of the solution to SRCs.

The animal perspective, so to speak.

Enjoy all the different views of this common injury, and, as ever, let us know what you think in the comments section of this blog.

 

 

Dreams of South Africa

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With Wayne Viljoen (@BokSmart), one of the authors of new rugby research in CJSM

It was just a year ago that I was preparing to travel to South Africa on an American Medical Society for Sports Medicine (AMSSM) Travelling Fellowship — dreams of Cape Town and safaris danced in my mind [see post reblogged below].

I haven’t stopped dreaming of South Africa. Should I ever have a mental lapse and not think of the Rainbow Nation for a day or two, I have only to turn to my Twitter feed or my medical journals to be reminded — the country punches well above its weight in both sports and sports medicine. I enjoy reading of the exploits of current South African Sports Medicine Association (SASMA) President Phathokuhle Zondi as she takes care of Paralympic athletes in Rio, for instance — she is a definite follow on Twitter….

And I most certainly enjoyed reading some recent rugby research just published in our September 2016 CJSM: Incidence and Factors Associated With Concussion Injuries at the 2011 to 2014 South African Rugby Union Youth Week Tournaments.  It was a delight to read this epidemiological study, whose authors include good friends Sharief Hendricks, Clint Redhead, and Wayne Viljoen — researchers all of whom most definitely have made their mark internationally.

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Partying with Sharief Hendricks (@Sharief_H), author of new rugby research in CJSM, in Johannesburg

In the authors’ words, the “….study provides the first published incidence of concussion, per player-match-hours, in South African youth rugby union and falls well within what was previously published elsewhere for youth rugby.”  They found the incidence of concussion in youth rugby to be 6.8/1000 player match-hours.  Importantly, and what for me was new information, was that under-13s and under-16s had higher incidence rates than under-18s.  The younger kids were at greater risk for concussion.  This may have important implications for rules and policy making in youth rugby.

For anyone with an interest in rugby, or South African sports and sports medicine, the study, in our newest edition of CJSM, is a definite read.  And it’s never too early to start dreaming of the 2017 SASMA biennial congress, which will take place in Cape Town 2017.  To stay ‘in the know’ for the timing and details of that pre-eminent conference, follow President Phathokuhle Zondi and SASMA itself on Twitter.

Clinical Journal of Sport Medicine Blog

IMG_1630Every so often, sports takes a back seat to other world events. So too for sports medicine.

We all know this, whether in our personal lives or in our interactions with the world at large.  There is the NFL player who is torn between performance on Sunday and ‘being there’ for his young daughter with leukemia.  There are cases where the athlete him- or herself is felled with illness–think of Lou Gehrig and amyotrophic sclerosis.  The issues of who won the last game, the intricacies of a salary negotiation, or the season missed from a knee injury pale in comparison with such ‘real world’ contingencies.

In sports medicine we sometimes experience directly the intersection between serious illness and athletics.  I think immediately of the young gymnast I saw with anterior knee pain that turned out not to be Osgood-Schlatter’s but osteogenic sarcoma of the tibia…….a ‘game changing’ event…

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ECG for the PPE? A conversation with Dr. Jonathan Drezner

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Dr. Jonathan Drezner in South Africa. Photo courtesy Alison Brooks.

Highlighting the just-published issue of CJSM is the new American Medical Society for Sports Medicine (AMSSM) position statement on cardiovascular preparticipation screening in young athletes.  The position statement is an invaluable contribution to the ongoing discussion over the pros and cons of adding the ECG to the preparticipation evaluation/examination (PPE) to prevent sudden cardiac death/arrest (SCD/SCA).

Those familiar with this debate will be familiar as well with the lead author of the statement, Dr. Jonathan Drezner. Dr. Drezner is a Professor in the Department of Family Medicine at the University of Washington and a team physician for the Seattle Seahawks of the NFL.  Dr. Drezner has published frequently in our pages, most often on the subjects of the PPE and screening for SCD/SCA.

The debate over the role of ECG in the PPE is one of the more contentious in sports medicine.  We look forward to seeing how the AMSSM statement will contribute to the direction that debate will take.  jsm-podcast-bg-1

You can gain added perspective on the statement and the controversy by listening to our newest podcast — a conversation with Dr. Drezner himself.  You can access the podcast both on iTunes and you can find it on our CJSM website as well.

Enjoy the discussion, and be sure to check out the statement itself, freely available in the 2016 September CJSM.

 

Hot child in the city

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Tamara Hew-Butler on TruTV’s “Adam Ruins Everything”

My topic for today is not that glorious piece of 70’s bubble gum pop from Nick Gilder — no, it is a topic much more directly related to sports medicine.

It’s August and it is hot indeed, with a day here in Ohio set to be one of those classic 90/90 days (>90 F and > 90% humidity).  And it’s the first day of high school Friday night football, with middle school and Pop Warner following this weekend.   These are days we need to do all we can to prevent exertional heat illness (EHI), most especially in our children and adolescents.

In our zeal to prevent EHI, we must be careful not to overhydrate.  A year ago CJSM published the Third International Consensus Statement on Exercise Associated Hyponatremia and followed this up with a blog post and a podcast where we discussed the risks of overhydration with lead author, Tamara Hew-Butler.

The hashtag that came out of those discussions — #Drink2Thirst — spread over social media last year.  The concept is an important one, and one which remains controversial.  There are still many proponents of mandatory water breaks, or of drinking to a certain color of urine.  Others argue that while both are potentially life-threatening, the risk of EHI outweighs the risks of the much rarer condition of EAH — better to err on the side of overhydration they say.  On the other side, some note that hydration is pushed on athletes as something of a panacea, touted as helping to prevent exercise associated muscle cramping (EAMC) when the science argues against that concept.

Now, Adam Ruins Everything, on TruTV, has weighed in on the issue of overhydration in sports, with hilarious effect. And I see Adam has recruited Dr. Hew-Butler herself to debunk some of the hydration mythology and spread the mantra of #Drink2Thirst

Watch the video, and laugh.  Then check out some of the links in this post that will take you to the consensus statement and podcast and you’ll get more of the hard science from Dr. Hew-Butler.  It might change your thinking, and you may start translating some of this science to how you approach the athletes you manage.

Stay cool out there and #Drink2Thirst!

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