5 Questions with Dr. Chad Asplund — President of the AMSSM

Dr. Chad Asplund, President of the American Medical Society for Sports Medicine (2018 – 2019)

The 2019 annual meeting of the American Medical Society for Sports Medicine (AMSSM) commences in Houston April 12 and ends April 17.  Like many of hundreds of sport and exercise medicine (SEM) specialists around the world we’ve been looking forward to the event for months.

This meeting represents one of the high points in our field of SEM, a venue for sharing much of the most current, relevant, evidence-based information in our field.  And, as for most such meetings of a medical society, it also represents something of a shareholder meeting for AMSSM members (I happen to be one, as are many of the members of CJSM’s editorial board):  it’s a time for the society to gather and, perhaps change bylaws, discuss finances, introduce new executive and board members, and say good-bye and thank you to the service given by those individuals who are stepping down from such posts.

One of those individuals in any society is the president, the head dude/dudette. We have traditionally touched bases with the outgoing AMSSM president prior to the annual meeting, and this year we had the chance to catch up with Chad Asplund MD, MPH on the ‘year that was’ for AMSSM.

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1. CJSM: We have to begin by asking you about your year as President of the AMSSM. What were your major challenges this year?  What were your high points?

Dr. Asplund (CA): The high points of the year were the finalization of the marketing and branding strategy with a new logo, member seal and messaging.  It was also great to meet and to hear from so many of our members throughout the year.  It was a humbling, but rewarding term as president and I am honored to have been selected.  There were no major challenges, other than media requests regarding the USA Gymnastics (Larry Nassar) and Ohio State (Richard Strauss) cases and the Maryland incident involving the death of Jordan McNair.

2. CJSM: Can you tell the readers a bit about your ‘day job’ – what do you do when you are not busy with AMSSM duties? Read more of this post

5 Questions with Christian Baumgart

Baumgart, Christian

Christian Baumgart, lead author of new study, Pubished Ahead of Print

It’s been a while since I’ve had the chance to ask a guest ‘5 questions,’ a recurring feature of this blog.  Our May issue is still a few days from being published…..too soon for guests!  And so I thought it was time to give readers a taste of our ‘Published Online First’ feature.

Once a manuscript has passed CJSM’s rigorous peer review process, ‘made the grade’ and been accepted, it is still a few months away from being published in print.  Like many journals, we have a healthy backlog of manuscripts which have been accepted but await publication.

But it’s not too soon for the authors to break out the champagne, because the article can be fully formatted and made available electronically prior to print–fully searchable in PubMed, prime time for the C.V.

One such study came to us from researchers in the Department of Movement Science at the University of Wuppertal in Germany: Effects of Static Stretching and Playing Soccer on Knee Laxity.  This is a randomized clinical trial looking at the effects of static stretching and playing soccer on anterior tibial translation.  I emailed the lead author, Christian Baumgart, and he was more than happy to join us on funf fragen…er, five questions!

Danke Christian!  I hope to meet you some day in Germany.

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1) CJSM: What would you say was the most notable finding in your study?

CB: Previous studies have shown that different exercises lead to an increase in the sagittal knee laxity. The surprising finding of our study was that static stretching also increases the sagittal knee laxity and even to a greater extent than playing soccer. From a biomechanical point of view this fact seems to be logical, because in healthy athletes the joint mobility during stretching is limited primarily by ligaments and capsules. Subsequently, these connective tissues were short-termed plastic deformed. It is unclear whether the connective tissues adapts structurally, if the external load is applied long-term.

2) CJSM: Do you think the statistically significant increases in anterior tibial translation (ATT) you found both in static stretching and playing football (soccer) are clinically significant? Read more of this post

LeBron and Exercise-Associated Muscle Cramping

LeBron_James_2

Does this count as “Old School”? LeBron James, in his first incarnation as a Cleveland Cavalier (photo: Dave Hogg, Wikimedia)

Game 2 of the NBA finals is this weekend, and I’m sure the Miami Heat (despite their nickname) are hoping the air conditioning works.  In truth, I think most of us are hoping that we witness a straight up basketball affair determined more by athletic skill and less by Exercise-Associated Muscle Cramping (EAMC).

If you need a primer to know what I’m talking about, here’s a brief rundown of Game 1 and LeBron’s EAMC. 

‘Most of us’?  I truly have no horse in this race (speaking of that….I most definitely am rooting for California Chrome to bring home the Triple Crown later today), but outside of Texas, it seems that most of the country may be leaning toward the Heat.  At least that’s what ‘Big Data’ would suggest:  check out this great, data-driven map from the New York Times showing the breakdown of team allegiances across the United States.

Truly though, aside perhaps from a pocket deep in the heart of Texas (who may want victory, no matter what!), I think most fans of the NBA would rather see the outcome of the games determined by the players and not by a lack of AC.

As a team physician, like many of you, I have had–along with my Athletic Trainers–to deal with plenty of muscle cramping in my career.  Here in the States, I find it occurs most often in the very beginning of football season:  during August pre-season, or the early September games that may be played in temperatures approaching 90 degrees.  It seems the combination of relative deconditioning, environmental conditions, and plain foolishness (my adolescent athletes frequently forget to stay hydrated, despite constant reminders to do the same)  gives rise to any number of trips on to the field to assist a player downed with quad or abdominal cramps.  At some levels of the game, to circumvent that inability to maintain adequate oral hydration during a game, teams will turn to pre-game intravenous hydration, as has been discussed in literature published in this journal and blog.

Then again, perhaps there are other issues altogether different than these potential risk factors that give risk to EAMC. Despite the high incidence, the etiology of EAMC continues to be debated.

Yes, I am a believer in the powers of pickle juice, but EAMC remains a puzzle to me and others.  And so I turned to the CJSM website  this morning for guidance and found a great 2013 study:  Collagen genes and exercise-associated muscle cramping, from a group of South African authors.  I especially appreciated this article for its contribution to my basic science knowledge:  I learned so much about the biology behind EAMC.  I encourage you all, clinicians and non-clinicians, to check it out.

The authors begin the paper with an excellent overview of various hypotheses of EAMC, ranging from electrolyte depletion to altered neuromuscular control. They then explored the literature that points to the possibility that EAMC may be associated with a genetic predisposition to musculoskeletal soft tissue injury. Specifically, their research hypothesis was that “variants within collagen genes that code for components of the musculoskeletal system would increase susceptibility to EAMC.”  To test this, the authors conducted a ‘retrospective case-control genetic association study’. Read more of this post

Osteoarthritis: Part I

I’ve been an Associate Editor for CJSM now for six months, and so some of you in the blog world may already know a little bit of my background as it has come out over time in my various posts.

For those of you who may be new readers of this blog, I thought for today’s post it was important for me to let you know that I work at Nationwide Children’s Hospital, the pediatric hospital affiliate of Ohio State University, and my specialty is pediatric sports medicine.

So……I don’t manage a lot of osteoarthritis (OA) in my current practice.

ocd of knee jpeg

Adult OCD of the knee,
unstable lesion: destined for osteoarthritis?

However, I didn’t narrow my clinical scope of practice to the younger crowd until 2010, and I have managed my fair share of OA in my career, injecting plenty of knees with hyaluronic acid derivatives, encouraging weight management and low impact exercise…….Now, I suppose I’m more on the end of the spectrum of primary prevention of the disease: if I manage my young patients’ knee osteochondritis dissecans properly, perhaps I can spare them from degenerative joint disease later in life.

I’m not telling anyone reading this something they don’t know already when I write that career paths are varied in modern medicine.  There’ s no telling if I’ll be taking care of kids exclusively in 10 years.  We all have mandates from Certification Boards requiring us to stay abreast of the current medical literature; we’re tested on it every few years now, as Maintenance of Certification is a phenomenon here to stay.  Forces like these make it incumbent that I read and ‘stay on top of’ developments in the world of OA diagnosis and management, even if I am not seeing much of this disease in my current practice.

After all, OA is the leading cause of chronic disability among older adults in the United States.  That’s a disease worth knowing about.

I thought, therefore, that I would share with you a couple of interesting studies that have come out recently on major issues in the world of osteoarthritis.  Both studies were just published within the last month:  the first, “Shared Decision Making in Patients with Osteoarthritis of the Hip and Knee,”  published in the Journal of Bone and Joint Surgery (JBJS), I will discuss in my next blog post.  And the second, “Effects of Intensive Diet and Exercise on Knee Joint Loads, Inflammation, and Clinical Outcomes Among Overweight and Obese Adults with Knee Osteoarthritis,” published in the Journal of the American Medical Association (JAMA), I will review now.   They are both large, high quality evidence (Level 1) studies which focus on low tech, low cost interventions that have the potential of having major clinical impact.  They are both studies primary care sports/MSK clinicians like myself might be expected to be aware of. Read more of this post

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