CJSM Blog Journal Club — Brain Changes After a Single Season in Youth vs. High School Football

Attending to injured player, High School Football

The November 2019 Clinical Journal of Sport Medicine has just published, and as always the new edition is full of interesting and original research.

One of the studies that already is getting some buzz is one by a team of researchers (full disclosure: including myself) headed by Dr. Kim Barber-Foss entitled Relative Head Impact Exposure and Brain White Matter Alterations After a Single Season of Competitive Football: A Pilot Comparison of Youth Versus High School Football.

This is a perfect study for a journal club, as the subject of cumulative exposure to head impacts, most especially in our youngest athletes, has been a hot, hot topic in sports medicine for several years. The sport in question here is American gridiron football.

Our intrepid Blog Journal Club author and Junior Associate Editor Jason Zaremski MD leads the charge, as ever, in his most recent post.  Thanks Dr. Zaremski for your insightful analysis of this new research.

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Title: Barber Foss KD, et al. Relative Head Impact Exposure and Brain White Matter Alterations After a Single Season of Competitive Football: A Pilot Comparison of Youth Versus High School Football. Clin J Sport Med 2019;29:442–450.

Jr. Assoc. Editor and Blog Journal Club author Dr. Jason Zaremski (L) and CJSM Editor-in-Chief Dr. Chris Hughes (R)

Introduction:  The pre-holiday CJSM journal club brings you an innovative new study from expert researchers related to potential white matter changes in the brain in adolescent football players. As has been discussed in the CJSM journal club as well as throughout the media, there are many consequences to sustaining a sport related concussion (SRC). One question yet to be answered, with advances in neuroimaging techniques, can structural alterations of the brain be observed using magnetic resonance diffusion tensor imaging (DTI)? According to the authors, DTI can evaluate microscale white matter (WM) changes. This is potentially important as WM changes may be detected even without clinical signs of a SRC. More specifically, the measurable metrics include fractional anisotropy (FA), radial diffusivity (RD), axial diffusivity (AD), and mean diffusivity (MD). According to prior research, RD, AD, and MD are sensitive to detect WM changes in athletes participating in contact sports. Hence, we present “Relative Head Impact Exposure and Brain White Matter Alterations After a Single Season of Competitive Football: A Pilot Comparison of Youth Versus High School Football.”

Purpose: To determine preseason to postseason changes in WM integrity from repetitive head impacts for youth football (YFB) players compared with HS football players during a competitive football season.

Hypothesis(es): The magnitude of WM changes would be greater for YFB than for HS football players.

Methods/Design:  Prospective study with IRB approval and consent and assent obtained. Read more of this post

What to do about heading?

Heading the ball — photo courtesy of Wikimedia

I have been meaning to write a blog post for over a week, since a bit of breaking sports medicine news occurred with the publication of some research in the New England Journal of Medicine (NEJM).

It took a Tweet this morning to rouse me to action.  I promise it hasn’t been sloth on my part that has slowed my hand, but pleading “I’m busy” to the group of folks who usually will be reading CJSM media is not going to gain much sympathy.

And yes, with fall sports, I sure have been busy.  But I am sure you have too.

I hope, however, not too busy to have missed this piece of research from NEJM: “Neurodegenerative Disease Mortality Among Former Professional Soccer Players.”  There was an accompanying editorial to this study, a piece that is most definitely worth a read too. “Soccer and Mortality — Good News and Bad News”

The published research was a large retrospective cohort study looking at former professional Scottish football (soccer) players: 7676 cases were identified from databases of Scottish football players and 23,028 controls (3:1) from the ‘general population’ were identified using a Scottish ‘Community Health Index.’ Controls were matched to players on the basis of sex, age, and degree of social deprivation.  Of note, all the participants in this study were male.The researchers looked at two dependent outcome variables:  i) cause of death as noted on death certificates and ii) dispensed medications, information for which was obtained from the Scottish national Prescribing Information System.  Follow up information for study participants was for a median of 18 years (for each individual, “Age was used as the time covariate, with follow-up from age 40 years to the date of data censoring, which was either the date of death or the end of the follow up (December 31, 2016), whichever occurred first).”

The researchers report several important findings in this study, to note just a few:

Read more of this post

Sports Medicine from South Africa — SASMA biennial congress begins this week!

Dr. Pierre Viviers, President of SASMA

It’s been a while since we have invited a sports medicine colleague to a “Five Questions with CJSM” interview.

What better time to catch up with the current President of the South African Medical Association (SASMA) than on the eve of SASMA’s biennial Congress?

My dear friend Dr. Pierre Viviers of Stellenbosch University is a very busy man right now as he places the final touches on what is sure to be one of the premier events of this year’s sports medicine calendar.  Having attended SASMA in 2015  in Johannesburg, I can attest to what an exciting and stimulating event this Congress is.

True to form, Dr. Viviers did not hesitate to volunteer for this interview when I reached out to him, despite his busy schedule.  I hope you enjoy our conversation and that it whets your appetite for what is coming later this week from Cape Town.  If you can’t be there, be sure to follow #SASMA2019 on social media.

And now….Dr. Viviers!

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  1. CJSM: The biennial Congress of SASMA is taking place 10 – 13 October 2019 in Cape Town, the “Mother City.” It is a joint Congress with SASMA and BRICSCESS.  Can you tell us about what you see as the highlights of the program, and for the readers unfamiliar with BRICSCESS can you tell us about that organization?

Pierre Viviers (PV): It is a joint congress which also includes the 6th Annual Congress on Medicine and Science in Ultra-Endurance Sport which will definitely be a highlight. The pre-congress workshops are always popular and well attended. This will include 2 full-day workshops presented by ‘Exercise is Medicine South Africa” (EIM SA) and SAIDS (SA Institute for Drug-free Sport), as well as a half-day workshop by the S.A Sport-Physiotherapy group.

A highlight for me personally, is the integrated participation between scientists and medical professionals throughout the program.

Opening the narrative of social justice and the role which sport can play, especially in a country like S.A, will be one of our most influential South Africans, Prof Thuli Madonsela, activist for social justice and human rights, previous public protector and advocate in the High Court of S.A.  This is definitely a session not to be missed.

The prestigious Noble lecture will be presented by a good friend and colleague, Cheri Blauwet from Harvard Medical School & Spaulding Rehab Hospital, Boston. Cheri’s journey in injury and illness prevention in the elite Paralympic athlete will be a certain highlight. A symposium later in the conference will be another highlight, focusing on “innovations in athletes with disability.”

The sport nutrition colloquium led by Louise Burke (Australia) and other prominent South Africans in the field is another highlight.

The featured science session on player welfare in rugby union as well as the featured clinical symposium on Sport Related Concussion will reveal interesting concepts in injury prevention and management in this popular South African collision sport.

The session on mental health in athletes presented by two leaders in the field will also give new insight in prevalent mental health issues which may influence athlete welfare and performance.

The BRICES countries are Brasilia, Russia, India, China and South Africa and BRICSCESS is the Council of Exercise and Sport Science founded to specifically look into health and wellness of people within these counties. However, this is there second international congress. The council also strives to bring communication together between the BRICS countries on issues influencing health and wellness through universities and other platforms. The Council is also dedicated to leadership development in young scientists within the field.

 

  1. CJSM: You are winding down your term as President of SASMA. What are the fondest memories of your past two years of service?  Who is the incoming President?

Read more of this post

The CJSM podcast on the pediatric athlete — Guest Editor Dr. M. Alison Brooks

Dr. Alison Brooks, in a rare moment of repose — enjoying the sights from Table Mountain, Cape Town RSA

We have just published our September 2019 issue.  It is a special thematic issue focused on the pediatric and adolescent athlete, and we are grateful to Guest Editor Alison Brooks M.D., M.P.H. for the outstanding work she has done nurturing this issue from cradle to…..adulthood.

It’s been a long process watching this issue proceed from crawling to toddling to, now, standing on it’s own two feet marching off into the world!

Want to know more about pediatric sport specialization, concussion, nutrition, safe play?  Want to know more about the rigors and work involved with a guest editorship?  It’s time then to queue up your smart phones and listen to our newest podcast, where Dr. Brooks makes her debut as our guest.

I have known Dr. Brooks for several years and consider her a friend.  As a friend as well as a professional colleague, I am duly impressed with her career.  And you should be, too. An Assoc. Professor on the tenure track at the University of Wisconsin, she has published widely and can be found in the pages of CJSM as well as many other journals. A former member of the AMSSM’s Board of Directors, Dr. Brooks continues to influence youth athletic policy with her work for the AAP’s Council on Sports Medicine and Fitness.  And I know her best as the person I accompanied on the AMSSM’s Travelling Fellowship in South Africa in 2015.

Spend 20 minutes finding out more about the medical challenges facing our young athletes and learning a bit more about Dr. Brooks.  Go to our podcasts now at iTunes or our journal’s main web page.

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