The 2019 AMSSM Position Statement on Concussion — a Podcast with Dr. Kim Harmon

How to manage concussion in sport in 2019: The AMSSM Position Statement, and the new CJSM podcast

As one of our partner societies, the American Medical Society for Sports Medicine (AMSSM) contributes significantly and regularly to the global sports medicine discussion.  When the AMSSM authors a position statement, it’s a document that should be read by the active sports medicine clinician

Prof. Kim Harmon, past-president of the AMSSM

Hence, the publication of the AMSSM Position Statement on Concussion in Sport is news we want to make sure you all know about.  And if you haven’t had the chance to read it yet, you can now take the opportunity to hear about it from the publication’s lead author, Dr. Kimberly Harmon of the University of Washington.

For the new statement, Dr. Harmon notes that she and a panel of expert authors adopted a very specific focus: what does the practicing clinician need to be current when diagnosing and managing a concussion in 2019. This is a document for the sideline, the training room, the clinic.  A document for ‘now.’

It is evidence-based, but also ready to assist clinicians in the areas of concussion where evidence is currently limited.  That is, the statement makes suggestions for needed future research directions, but also reports current best practices informed by consensus or expert opinion.

After reading it, I found myself immediately referencing the statement when conversing with patients and families, whose questions might range from whether their child should take fish oil after their concussion (no, unless your child is a rat, as Dr Harmon may say….) to whether they are ready to drive (well, that depends….).

Take a listen to all of our podcasts on our main website or on iTunes.

If you want especially to hear interviews we’ve had with authors of previous AMSSM Position Statements, check out as well our podcasts with Dr. Jonathan Drezner (cardiovascular screening) and this one with Dr. Irfan Asif  (best practices for a sports medicine fellowship).

As ever give us feedback on these podcasts at the iTunes page, or in the comment section here!

Super Bowl Blues

The 2018 – 19 NFL season has ended with a familiar conclusion:  the New England Patriots having won (their sixth such championship).

Are you among the people who watched the game and found it boring (‘worst ever’)*?  Did you forego viewing entirely? Are you among the majority (reportedly) of fans disappointed because those Patriots won?  Sad simply because the season is over?

February can be a slog for all of us in the Northern Hemisphere — sports like the NFL can keep us going, and so perhaps you, my dear reader, are a bit blue for any number of reasons?

Well, I do not have something to cheer you up per se — rather I have something, perhaps, that will make you more blue….but it is an issue of vital importance to our profession.  And we can’t turn our eyes askance.

Recently published ‘ahead of print’ is headline-making original research: Reasons for Prescription Opioid Use While Playing in the National Football League as Risk Factors for Current Use and Misuse Among Former Players.

Headlines indeed. Over the Super Bowl weekend the New York Times published an article profiling former NFL players and their struggle with chronic pain and opioid addiction. It referenced the CJSM study authored by Dr. Eugene Dunne of Brown University and his team of authors.  Some of the more important findings reported are that among “….retired NFL players with exposure to prescribed pain medication during their playing career 26.2% reported recent use of prescription opioids (past 30 days).”  Moreover, the authors found that the past may be midwife to the future: use of opioids to manage pain during their career was associated with a 30% increased risk of present-day use of opioids in retired NFL Players.

Opioid use and abuse is a public health crisis of unprecedented scale in the USA according to JAMA.  Sports are not untouched by this epidemic.  CJSM has always striven to publish important and relevant research which can be translated into practical use — we provide this platform for clinicians helping individual patient-athletes, and we provide this platform for public health advocates as well.  We devoted an entire issue (Sept 2018) recently to the oft-neglected subject of pain management in athletes.  Guest Editor Prof. Wayne Derman of Stellenbosch Univ., South Africa emphasized in our podcast with him that it is imperative that clinicians seek holistic methods of pain control and that researchers look more intentionally at the issue of analgesia in athletics. An over-reliance on pharmacology, most especially opioids, is a potential recipe for problems (to wit, the experience of former NFL players in this new CJSM study).

Join us in this work and the global conversation on issues of importance to athletes, clinicians, researchers and public health advocates by checking out some of these references and following us on Twitter. We’ll always keep you abreast of what’s new and breaking in our world of sport and exercise medicine.

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*P.S. I really enjoyed the Super Bowl. Though low scoring, I loved watching Pats’ defense flummox such a great Rams’ offense, and I thought the game was tense until the very end. How about you?

Gender Bias in Medicine — the CJSM podcast with Dr. Esther Choo

@choo_ek (a.k.a. Dr. Esther Choo) — a definite follow on Twitter!

We are excited to share the first CJSM podcast of 2019 with you.  Special guest Esther Choo M.D., M.P.H. joins us to discuss issues of gender bias in medicine:  “From Mansplaining to Bromotion — How We Can Move the Needle on Gender Bias in Sports Medicine.” 

For those not familiar with Dr. Choo’s work, I would direct you to a CJSM blog post from December 2018 where I shared with you some of my thoughts about one of her more recent commentaries published in the British Medical Journal (BMJ): “A Lexcion for Gender Bias in Academic Medicine.”

I would also direct you to her Twitter feed and heartily encourage you to follow her @choo_ek to continually learn from her, as I do on a nearly daily basis.  She argues strongly that issues of equality inform all our attempts to deliver high quality medicine; that issues of bias should be of interest to us all, because they affect not only our fellow professionals, but the patients we serve.

She also does this typically with a sense of humor, which has often put me in mind of Mark Twain’s quotation, “Against the assault of laughter nothing can stand.”  This work and this tone can be hard to achieve, because many of the issues Dr. Choo and others are tilting against can be dark.  In thinking of our own word of sports medicine, the complicated and horrific story of Larry Nassar and USA Gymnastics comes to mind.  I’m also mindful of stories like that of Eva Carneiro, former team physician of an English Premiership Club, whose summary dismissal was entwined with these issues of sexism.  Or the exceedingly common phenomenon of attending a sports medicine conference only to find that all the keynote speakers are male

The world we serve is rife with issues of gender bias.  On his recent retirement, Andy Murray was lauded as an all too rare light in men’s sport — a man who would publicly stand up for women’s issues, a #HeForShe.  Or what to make of the arena of NCAA Division I coaching, where the sight of a man coaching a women’s team is common (think Gino Auriemma of UConn Women’s Bball), but the reverse is an exceedingly uncommon phenomenon.

There is light in this darkness.  Dr. Choo and groups like Feminem.org are doing great work.  I am also mindful of the lead that the IOC 2020 Prevention Conference has taken on this — the organizers publicly stated their intention to assemble a gender balanced planning committee, and they got it right, I think, including many luminaries in our field including Margo Mountjoy, Kate Ackerman, Caroline Finch, and Christa Janse van Rensburg, among others. Bravo!

I hope you go to our podcast page on our main website, or subscribe to the podcast on iTunes, to listen to our conversation with Dr. Choo and sample all of our podcasts.  Please let us know what you think. Take the time if you can on our iTunes feed to give us your opinion on the podcast in general, as we always take feedback seriously and use it to ‘tweak’ our media to make it ever better for you.

 

It’s a New Year — CSJM Blog Journal Club 2019 Starts Now

Japan (and its iconic Mt. Fuji) will be one of the places on the globe that will be enjoying an exciting 2019 in the world of sport.

We here at CJSM hope all of our readers have enjoyed a festive and relaxing holiday season.  I am sure for most of us reading this post, ‘things’ have picked back up, because the global sports world never sleeps.  From Australian Open tennis to the NFL playoffs to the English Premiership, and beyond, the sports (and sports medicine) scenes have been ushered in with a bang.

2019 promises to be an exciting year in sports all over, but perhaps in no place quite like Japan, as it hosts the Rugby World Cup at year’s end and busily prepares for the 2020 Summer Olympic Games in Tokyo.  I just spent my holidays there and fell in love with the country.  I am looking forward to posting more about the upcoming global events Japan is hosting this year and next.

CJSM has entered the new year with a bang as well, as we begin our 29th year with an issue that is full of interesting offerings.

Among the pieces of original research we have just published in this January 2019 issue is this one: Head Impact Exposure in Youth Soccer and Variation by Age and Sex. This piece has already received a good deal of attention. The accompanying editorial arguing (relatively speaking) against a ban on heading in youth soccer has realized a comparable buzz.

Jason Zaremski MD, Junior Associate Editor CJSM

We thought this would be a particularly good study to ‘de-construct’ in the Journal Club, and so we contacted our regular correspondent Jason Zaremski MD to pen one of his ever popular, recurring posts.  Thanks Dr. Zaremski, as always.

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Title:

Chrisman SPD, Ebel BE, Stein E, Sarah J. Lowry SJ, Rivara FP. Head Impact Exposure in Youth Soccer and Variation by Age and Sex. Clin J Sport Med 2019;29:3–10. http://dx.doi.org/10.1097/JSM.0000000000000497

Introduction:  

The newest edition of the Journal Club commentary for the Clinical Journal of Sports Medicine (CJSM) will be a review of an original research manuscript highlighting a very interesting topic, heading in “soccer” (referred to as “football” outside the United States) and its effects on our youth athletes. As the authors note, there are more than ¼ of a billion soccer players worldwide. In the USA, there are approximately 24 million soccer players and more than 37% are youth players. In the past few years there have been growing concerns about heading in youth soccer and possible associations with concussions and sub-concussive head impact exposures (HIE). Due to these concerns, individuals and some leagues (from local levels to national) have suggested a ban of heading to limit body contact and potential HIE. However, prior research has suggested that the actual number of youth players heading a soccer ball as well as intentional impacts with head to ball are low and heading restrictions may not be indicated. (Comstock et al JAMA Ped 2015, Lynall et al MSSE 2016, Press and Rowson CJSM 2016). Therefore, in order to obtain more objective data, the authors of this study wanted to objectively measure HIE in males and females at the youth level.

Purpose/Specific Aim(s):

The purpose of this study was to measure HIE using adhesive-mounted accelerometers during 1 month of soccer. Read more of this post

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