Sports Medicine in Oz

coffs harbour

Coffs Harbour, Australia, site of the 2015 ACSP meeting.

While many of us in the Northern Hemisphere are shivering and shoveling our way through winter, members of the Australasian College of Sports Physicians (ACSP) are holding their annual meeting under a summer’s sun at the Pacific Bay Resort, Coffs Harbour, New South Wales, Australia.  “Exercise is Medicine” is the theme for the five-day conference.

The ACSP is one of our partner societies and this year, I regret to say, I’ll not be able to make it Down Under to catch the proceedings myself.  I do, however, have a friend who is at the conference right now and has volunteered to write a post or two about what is happening in the lecture halls and on the beaches.

Dr Hamish Osborne, MBChB, MMedSci, FACSP is a Sport and Exercise Physician, a Senior Lecturer in Sport and Exercise Medicine, and Academic Co-ordinator for the Post Graduate Diploma in Sport and Exercise Medicine, Department of Medicine, University of Otago, Dunedin, New Zealand.   I know him best as one of this journal’s Associate Editors–I saw him last at our 2014 Editorial Board meeting in Canada, and we stay in touch via conference calls and Twitter the rest of the year.

Here is his first post from the meeting:

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The Australasian College of Sports Physicians Conference kicks off here in Coffs Harbour on Tuesday. Coffs Harbour is on the Australian east coast approximately half way between Brisbane and Sydney and enjoys a beautiful coastal location with temperatures in the high 20’s predicted. I got here safely last night driving the near 400km from Brisbane and managed to avoid any Kangaroos hopping across the road around dusk.

The conference is preceded by a mini conference for our trainees and is underway as I write. All trainees present their research to date from the various stages of the four years of their training. The variety of the work presented today has been fantastic. For example, while  plenty of work has been published on the accuracy of ultrasound vs MRI for identifying rotator cuff tears in those having operations for their rotator cuff pain, it’s important as a clinician to know how this translates to the undifferentiated painful shoulder that walks through the clinic door:  i.e. how good or bad is ultrasound vs MRI at looking at the rotator cuff if clinically I’m suspicious of the labrum being the problem? This recognizes that the history and to a greater extent examination has poor sensitivity and specificity in the undifferentiated patient and we do need to rely somewhat on the imaging.

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Hamish, thanks for taking the time from both the conference and the lovely beachfront of Coffs Harbour to write this post.  I hope you will have the time to write another post as the proceedings wind down.

And to all of you reading this, make sure to follow Dr. Osborne and the Division of SEM at Univ. of Otago on Twitter @Hamish_Osborne and @OtagoUniSEM respectively; and make sure to follow #ACSP_conf and @ACSP_SportsDocs this week!

Super Bowl Aftermath

Julian_Edelman_2014

Julian Edelman, New England Patriots pic: Jeffrey Beall

It’s a Tuesday as I write, so literally (and figuratively) I do not propose to do any “Monday Morning Quarterbacking.”  I’ll leave it to others to deconstruct Pete Carroll’s decision at the end of the game (though I don’t think it was that crazy of a call, and was in keeping with other contrarian decisions he has made that actually got the Seahawks into the Super Bowl–like the fake field goal call against Green Bay in the NFC Championships).

The Russell Wilson interception obviously turned out badly for Seattle, and sent all of New England into a frenzied state of joy (though a snowstorm in the region is causing the fans there to hold off one more day from a celebratory parade through Boston).

No, I’m here to focus on sports medicine–specifically the management of Julian Edelman’s apparent concussion in the big game–and encourage you, the reader, to take a poll to stimulate conversation about the issue.

I’m sure a lot of us in the sports medicine world had a sense of deja vu when we saw Edelman stay in the game after what many viewers thought was a concussion:  in the 2014 FIFA World Cup there were several similar incidents, when several players had suspicious head injuries whose management was questionable.  In the aftermath of that tournament, we had a podcast with guests Matthew Gammons and Cindy Chang , physicians of the American Medical Society of Sports Medicine (AMSSM), exploring the issues involved with management of possible concussions in real time, in the setting of a highly visible sporting event…like the Super Bowl.

The NFL has, in the wake of much criticism, introduced new concussion protocols.  It is my understanding that “….. the NFL assigns an independent physician to each team to monitor head injuries, and there is another independent ‘spotter’ who watches players on both teams from a booth above the field and can radio to the sidelines if there is evidence of an on-field concussion.” [1] Additionally, each team has its own medical personnel to monitor the situation as well as do any necessary evaluations.

It is not clear to me, however, that there is an independent physician who is empowered to remove a player from the field of play; to mandate removal if necessary, and not just ‘monitor.’  Should there be a clinician who i) has no conflict of interest [as exists intrinsically in any dynamic that involves medical personnel employed by a team:  player safety comes first, but there are, inarguably, biases that can creep into our decisions when player performance, especially in the setting of the World Cup or the Super Bowl, is at a premium]; and ii) who has the power, and the backing from the league, to disregard the player’s opinion, the coaches’ opinions, etc. and can mandate even the removal of a key player like, say, Tom Brady, for suspicion of a concussion, on the biggest stage of their sport.

And so, today’s poll:

 

References

[1] The Super Bowl’s Concussion Calculation, The New Yorker, Ian Crouch.

http://www.newyorker.com/news/sporting-scene/super-bowls-concussion-calculation, accessed 2/3/15