Exercise as a prescription to address post-concussion syndrome: The CJSM Blog Journal Club

Sports like American football are taking place in the midst of COVID19 — concussions are sure to follow

Our September 2020 edition has just published, and this edition is a particularly compelling one, full of original research.  You have to check it out.

As ever our Jr. Associate Editor Jason Zaremski M.D. has just posted his newest submission to the CJSM journal club.

While COVID19 is wreaking havoc with sports schedules around the globe, there are enough high schools and youth sports programs active that concussions will continue to remain a challenge for clinicians to treat.  And post-concussion syndrome is one particularly challenging aspect to this injury.  Dr. Zaremski walks us through original research looking at an ‘exercise prescription’ to treat post-concussion syndrome.

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Jason Zaremski MD

Gauvin-Lepage J, Friedman D, Grilli L, Sufrategui M, De Matteo C, Iverson, GL, Gagnon I. Effectiveness of an Exercise-Based Active Rehabilitation Intervention for Youth Who Are Slow to Recover After Concussion, Clinical Journal of Sport Medicine: September 2020 – Volume 30 – Issue 5 – p 423-432 doi: 10.1097/JSM.0000000000000634

Introduction:  With the change of seasons, many of our readers return to covering pediatric and adolescent sport. In the Northern Hemisphere, summer vacation is over, and academics and school sports are commencing. Fall is the start of the gridiron football season and there is often a surge of concussed youth who need effective, evidence-based management.

This month the CJSM Journal Club has chosen to highlight original research on the effectiveness of exercise-based rehabilitation in 8-17 year youth who have sustained a concussion. In this age group, return to school is even more important than return to sport, and the lingering difficulties in intellectual ability, vestibular system function, memory, and/or attention can be particularly debilitating.  The authors in this new study report that between 20% and 30% of all concussed youth will endorse post-concussive symptoms (PCS) 1 month after injury. Further research into treatments and modalities aimed at reducing the frequency with which children and adolescents experience PCS is paramount.

Purpose: The authors state two aims:

1) To determine the impact of providing participants (aged 8 to 17 years) who are slow to recover after a concussion with an active rehabilitation intervention (ARI) compared to receiving standard care alone, at 2 and 6 weeks after the initiation of the ARI.

2) To investigate functional recovery 6 weeks after initiation of the ARI.

Setting: Tertiary care pediatric trauma center and associated community health care providers. Read more of this post

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. Read more of this post

CJSM Journal Club — Nondisclosure of concussion symptoms by athletes

Jason Zaremski MD, au courant with medical clothing styles circa 2020. Go Gators!

Our May 2020 issue has recently published, and as ever our Jr. Assoc. Editor Dr. Jason Zaremski is ready to share his pick for the newest CJSM Blog Journal Club.

Concussion Symptom Underreporting Among Incoming National Collegiate Athletic Association Division I College Athletes is the subject for today’s blog post.

Dr. Zaremski is himself a physician at The University of Florida, well known for its Division 1 College Athletic program, the Florida Gators. Whether we treat collegiate athletes, pros, or children, we in sports medicine ALL have an interest in addressing the issue of concussion nondisclosure.

Thanks to the authors for this timely study, and thanks to Dr. Zaremski for your ongoing contributions in this journal club.

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Jason Zaremski, MD

Introduction:  As we enter the early stages of the summer and approach a “new normal” with regards to sports, it is incumbent upon sports medicine team physicians to be vigilant as we bring freshman athletes to college campuses with potentially different methods to screen and perform pre-participation physical examinations. While dealing with the new challenges COVID will pose, including the possibility of conducting assessments remotely, clinicians will need, as always, to obtain accurate historical information in order to care for our student-athletes. With that in mind, we present the May 2020 Journal Club on Concussion Symptom Underreporting Among Incoming National Collegiate Athletic Association Division I College Athletes by Dr Fiona Conway and colleagues.

Purpose: To examine concussion knowledge and the relationship of knowledge to reasons for concussion symptom nondisclosure in NCAA Division one incoming athletes. Read more of this post

Concussions take time — CJSM Blog Post Journal Club

Our Jr. Assoc. Editor Jason Zaremski MD looking for some help from a friend with the newest CJSM Blog Post Journal Club

Our March 2020 issue has just published, and right out of the gate one of the studies that has received the most buzz is one from a team of researchers in New Zealand demonstrating that less than 50% of concussed individuals recover within two weeks of a sports-related concussion.

Jason Zaremski, MD, CJSM’s Jr. Assoc. Editor, explores this new study today in our most recent CJSM Blog post Journal Club.  It is a two year prospective study with some revealing findings. We’re sure you will enjoy the blog post and the study itself!

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Jason Zaremski MD

Kara S, et al. Less Than Half of Patients Recover Within 2 Weeks of Injury After a Sports-Related Mild Traumatic Brain Injury: A 2-Year Prospective Study. Clin J Sport Med 2020;30:96–101. doi.org/10.1097/JSM.0000000000000811.

Introduction:  Sports related concussion (SRC) is a common and significant concern, challenging not only sports medicine practitioners, but also athletes, coaches, family members, and all sports performance team members. While diagnostic skills and research in this area have dramatically improved in the past 10 years, our patients still have several questions, including: How long until I can go back and play? Some data has suggested the majority of SRC patients recover in approximately a 2-4 week recovery time frame. According to the consensus statement in concussion in sport (5th iteration) held in Berlin, Germany, in October 2016—“the expected duration of symptoms in children with SRC is up to 4 weeks.” (McCrory, et al. BJSM 2017).  Kara and colleagues  have looked into the validity of this stated time frame.

Purpose: To describe clinical recovery time and factors that could impact recovery after a sports-related mild traumatic brain injury (SR-mTBI, aka “concussion”).

Methods/Design:  This is a prospective cohort study with level IV evidence. Read more of this post

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