Jet Lag

One of the more popular studies we have published in the last few years has been ‘Jet Lag and Travel Fatigue:  A Comprehensive Management Plan for Sport Medicine Physicians and High-Performance Support Teams.’  The paper was written by Charles Samuels, M.D., the Medical Director of the Centre for Sleep and Human Performance, Calgary Alberta and published in our May 2012 CJSM.  It has been ‘hit’ on-line and emailed many, many times.  If you have not had the chance to read it yet, it remains freely available; my colleague Chris Hughes previously reviewed the study in depth on this blog as well.

I am thinking about this study quite a bit right now, as I recover from 24+ hours of travel making my way back from SE Asia to my home in Columbus, Ohio, where I resume work seeing patients tomorrow a.m.  I’m using melatonin to help re-adjust my circadian rhythm so that I can be as ‘sharp’ as possible taking care of the athletes I’ll see soon.  I began taking 0.5 mg melatonin each morning in Thailand 2 days before departing; and now that I am back in the USA I will continue taking 0.5 mg melatonin each night for five nights.  So far, so good.

I thought it high time that I post a poll on this blog.  I have been remiss in not doing so for several months.  And so, whether you are a clinician who manages teams doing a lot of long-distance travel, or whether you are only responsible for yourself, I have written this poll for you!  Let me know your management of this common problem–and if you have not had the chance to read this study previously, by all means do so!!!


Sports Ultrasound and the New Year


Chillin’ like Bob Dylan: Folly Beach, Charleston, S.C.

Happy New Year y’all!

Returning from lovely Charleston, South Carolina after a relaxing week, I’ll be able to retain a southern, laid-back lilt to my voice for perhaps a day or two more….As many of you would likely agree, there’s nothing quite as bracing as the need to attend to the post-vacation crunch of full email accounts, urgent work-inbox tasks, and full clinic days!

It certainly makes a difference to return to a job and profession one loves.  Sports medicine:  what would I do without you?

I hope you have had a chance to peruse the new, January 2015 CJSM, which is as full of excellent articles as the aforementioned inboxes.  One of the highlights of the issue is the American Medical Society for Sports Medicine Position Statement on Interventional Radiology, which is currently freely available.  I hope, too, you’ve had a chance to catch the new podcast interview with Dr. Jonathan Finnoff, the lead author of the paper.

As a clinician who currently (and regretfully) does not employ sports ultrasound in my current practice, I’m always curious about those professional colleagues who do.  With that in mind, it’s time for the first poll of the year:

Thanks for sharing your thoughts.

The November CJSM and the PPE

Halloween, El Dia de los Muertos….Guy Fawkes Day!  We end October and roll into November in an exciting way in North America and across the Atlantic…..all the more so here at CJSM, where November 1 marks the publication of our sixth and last issue of the calendar year.  Our crew–ranging from the Editor in Chief in London to our Managing Editor in Canada–can, perhaps, take a few days break and indulge in the candies, dulces, or bonfires, as the case may be.  And the rest of us can enjoy the treat of the new journal.   We have a great issue in store, and I plan on profiling over the next month several of the published studies here in the blog.  The headliner has to be the in-depth view on the athletic preparticipation physical evaluation (PPE):

Advancing the Preparticipation Physical Evaluation:  An ACSM and FIMS Joint Consensus Statement.

Check it out:  it’s free even without a subscription to the journal, for the time being.

I am working on the podcast production phase of an interview I had with the lead author, William Roberts, M.D.;  the final product promises to be a lot of fun and will be broadcast soon. One of the subjects Dr. Roberts and I touched on in that talk was the potential value of the electronic evaluation, or ‘e-PPE.’  To whet your appetite for what is to come, why don’t you take the poll at the top of this post, and let us know if you use an e-PPE in your practice (in Ohio, where I practice, we just started using them with high school athletes this spring).  Then, click on the link above to the study itself.

Stay tuned for the podcast, and be sure to check out the entire new issue.  November is here, and with it the promise of good things in the journal and on the blog.

Reducing a Shoulder

anterior shoulder dislocation

A common sequela of football

Football, American style: the season for anterior shoulder dislocations.

My specialty group and I manage this condition throughout the year, of course, but the numbers surge in the fall.  Pre-reduction on the sideline, or post- in the clinic, the dislocated shoulder is an entity that loves this time of year.

There are so many aspects to the treatment of this injury, which occurs so frequently on the playing field.  First time dislocators: surgery or no?  What to do about recurrent dislocations?  If an apparent anterior shoulder dislocation shows up in your urgent care, do you take the time to image prior to reduction? Do you use anesthesia or sedation?  When do you return them to play?

One aspect of this issue I especially like to discuss:  What’s your favorite method for reduction?  Hippocratic?  Spaso?  Slump method?

A lot of us use what we were taught; and if it works, then that’s our go to procedure.

I had the good fortune of spending a month working with Dr. William MacAusland, Jr., an orthopedist from Boston who spent years working at Harvard.  He sponsored a medical student rotation at the Carlos Otis Ski Clinic at Stratton mountain, in Vermont, and I spent a month in medical school skiing the slopes and treating the injured with Dr. MacAusland.  He favored the ‘modified Kocher method,’ and that is what I have used ever since.

I should say, as well, that Dr. MacAusland took great pride in reducing a shoulder with no anesthesia; he favored a slow, gentle approach that essentially relied on hypnotic techniques.  He believed the ‘humerus wanted to get back in place,’ and any significant effort on the practitioner’s part (e.g. traction) was more apt to get in the way of rather than aid the reduction.  Certainly, I have found that if I can see a shoulder within the first hour or so of the injury, before significant spasm has set in, that Dr. MacAusland’s approach in toto works like a charm.  I was taught as a general principle to have two techniques at the ready, in case the first method was ineffective for a particular patient. The Spaso method is my second method.

So, what’s your favorite method?  Take the poll below and tell us in the comments section why you prefer it.



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