CJSM and concussions — in the news

As 2020 rolls on and COVID dominates, quite rightly, much of the conversation in sports medicine, important research continues on topics of concern that have been present a lot longer than the novel SARS-CoV-2 virus.

CJSM prides itself on publishing a large number of primary research articles, which often get considerable media buzz. I wanted to share with you today two recent CJSM publications that have caught the attention of the lay press and are likely to have a significant and transformative impact on sports medicine practice.  The two research articles both address a long-standing concern of sports medicine — concussion in sport.

The first such article was published in our March 2020 edition: Distribution of Head Acceleration Events Varies by Position and Play Type in North American Football, a study whose team of authors primarily comes from Purdue University in the United States.  This pilot study contributes to the literature of risk mitigation in contact sport — how might we lower the incidence of concussion in a sport like North American football?  The findings were interesting enough to command the attention of Forbes magazine.

John Miller of the Buffalo Bills demonstrating a ‘2-point’ or ‘up’ stance. Photo Erik Drost, Wikimedia

This study evaluated the number of head acceleration events (HAEs) based on position, play type, and starting stance.  The most significant outcomes were reported for offensive linemen.  Offensive linemen in North American football have typically begun plays in a ‘down’, or what is known as a 3- or 4- point stance, as opposed to an ‘up’ or a 2-point stance. The position taken at the start of the play is sometimes dictated by what type of play, run vs. pass, may be run.

The study group looked at 78 adult male offensive linemen.  They looked at HAEs in play when starting in these positions, and compared these individuals with HAEs in individuals starting plays in an ‘up’ or 2-point stance.  They conducted this study during both practices and an exhibition game and they measured both peak linear acceleration and number of HAEs > 20g.

Among the outcome measures they reported, they noted that offensive linemen who began plays in an ‘up’ stance have a significantly lower occurrence (40% lower) of notable HAEs than the linemen who start the plays in a ‘down’ stance, and this finding held regardless of what type of play was run (a pass or run play).  The authors concluded that “Changing the stance of players on the offensive line and reducing the number of full-contact practices will lower HAEs.”  And, consequently, it is hoped that such a rule change may lower the incidence of concussions.

The second study also published in the March 2020 issue was a large 2-year prospective study from an author group in New Zealand: Less than half of patients recover within 2 weeks of injury after a sports-related mild traumatic brain injury. This study caught the eye of US News & World Report, which noted that “… current guidelines from the global Concussion in Sports Group (CISG) say that nearly all sports-related concussions resolve within 10 days.”  [I would note as a physician who primarily cares for children and adolescents with concussion, a time frame closer to 3 – 4 weeks is what I think reasonable for ‘the kids’].

In this large (N=594 patients) prospective study with considerable follow-up (two years), the authors conversely found across all age groups a much slower recovery from concussion.  They reported after 14 days less than half, 45% of patients, had recovered.  Rates of recovery increased to 77% after four weeks and to 96% eight weeks after injury.

The patient study group was primarily male with an average age of 20, including 7.5% of the group under age 12.

I thought this was a notable study which upended my notion of what is a reasonable time frame for recovery in adults with concussion [and confirmed my notion of what is ‘reasonable’ for children].

As secondary outcome measures, the author team reported that recovery times tend to be longer for female athletes, those with pre-morbid conditions including migraines and mental health issues, and those who delayed seeking initial treatment.

Look forward to our third issue of 2020 (the July edition), due to be published very soon, where we will surely have more primary research studies catching the media’s eye.

Stay well until then!