Heading in Football

December 18, 2022 by

The men’s FIFA World Cup Trophy

Like a lot of folks in the field of sport medicine I am, at heart, a lover of sport.  From participation to fandom, my relationship with sport runs deep and has been lifelong.

And so, if you are similarly inclined, then you are likely still recovering from what already is being described as the greatest final in World Cup history.

I spent the better part of the day enjoying the titanic struggle between La Albiceleste and Les Bleus followed by several more hours watching highlights and reading analyses.  Truly, Argentina v. France was one of the best live sporting events I have ever witnessed.

And for the many, including myself, who have long admired the greatness of Lionel Messi, it was a joy watching him, at long last, kiss the FIFA World Cup trophy.

The entire month of football was exciting — so many good matches, and relatively little in the way of overt controversy in the area of sports medicine (I’m thinking about the 2018 and other past World Cups where there were clear controversies surrounding players’ returning promptly to play after probable concussions).

Heading in football (soccer) — photo courtesy Wikimedia

But there is always, arguably, something puzzling about the ‘beautiful game,’ possibly the most popular sport on the planet:  the intentional use of the head as a sporting instrument.

‘Heading’ in soccer has, with our modern understanding of concussion and the sequelae of repetitive head impacts, become an issue surrounded by controversy.  How much heading is safe?  At what age should an individual begin to learn how to head a football (or soccer ball, for my American colleagues)? Read more of this post

Filed under Concussion in Sport, Elite sport, General Interest, Youth Sport

IOC Concussion Conference Amsterdam 2022

November 1, 2022 by

The podium at CISG meeting in Amsterdam — Dr. Jacklyn Caccese of Ohio State University presenting

What is the definition of a concussion?

If you are wondering whether this is a rhetorical question, would it confuse you still more to know this is how the IOC Concussion in Sport Group (CISG) Consensus Conference in Concussion began in Amsterdam?

Would it concern you that this is still an open question for one of the more vexing problems we deal with in sports medicine? Even among the panel of world experts gathered to bring together the most recent update of consensus statement for concussion in sport?

I think the answer is — yes. Yes to the confusion, yes to the concern.

I had never been to an IOC CISG meeting. As many of the journal’s readers will know, there have heretofore been several meetings with a consensus statement as their output: 2001 Vienna was the first, 2016 Berlin was the most recent.

CISG was set for a meeting to take place in Paris in the autumn of 2020, but we all know what occurred in that year’s spring.  And so the 6th meeting was rescheduled for 2022 and for a new venue: Amsterdam.

I have just returned home from Amsterdam and wanted to collect my thoughts to give you the reader a brief rundown.

These meetings have become huge, and I am not merely referring to the number of participants (hundreds).  The worldwide press recognizes the importance of the CISG and its influence on global sports.  Over the past year the press has been following closely the story of the previous leader, and now discredited academician, Paul McCrory. And……..immediately prior to the gathering in Amsterdam, the news broke that America’s NIH formally acknowledges the causal link between concussion and chronic traumatic encephalopathy (CTE). 

That’s a lot. Read more of this post

Filed under Concussion in Sport, General Interest, Medical Conferences Tagged with , , , , ,

What is the association between suicide risk and a history of playing high school football? The CJSM Podcast.

November 2, 2021 by

The concern over the potential long-term negative consequences of playing youth contact sports has grown over the last two decades.  The Clinical Journal of Sport Medicine — this blog and the CJSM podcasts as well — have been a vital forum for publishing the evidence regarding the relative safety of these sports exposures.

The impact of ACL ruptures and other musculoskeletal injuries — with long-term risks of osteoarthritis — give me pause as a pediatric sports medicine physician, but it is the long-term risk of concussions that generate the most concern among my colleagues, parents, and the public at large.  Will my child get CTE like Junior Seau?

In the United States especially, this concern over long-term risk gets wrapped up with medicolegal concerns, resulting in clickable stories such as this: “WIll Injured Kids Sue the Catholic Church Over Youth Football?” It is easy and understandable that fear may soon outrun the current evidence.

The science underpinning such concerns has grown in parallel with the awareness of the safety issues themselves, and in today’s podcast (and in the November 2021 CJSM) we examine a new study investigating the potential association of exposure to football as a high schooler and long-term suicidality risk.

Senior author Dr. Douglas Terry of Vanderbilt University joins us today to report on his team’s findings in their new publication: Playing High School Football is Not Associated with Increased Risk For Suicidality in Early Adulthood.

The principal finding of the study is right there, in the title; as Dr. Terry and I joked on the podcast, the authors definitely did not bury the lede on this manuscript.  They found no association with playing high school football earlier in life and an increased risk of suicidality in early adulthood.  A valuable contribution to the growing literature, indeed.

Mental health in athletes, including concern for suicide, and the long term effects of concussions are among the most pressing issues in sports medicine.  We think you will find a listen to this podcast and a read of the study itself to be invaluable resources to you as engage with these same issues.

Filed under CJSM Podcasts, Concussion in Sport, General Interest, Mental Health in Sport Tagged with

CJSM May 2021 Journal Club — Blood Biomarkers in Pediatric Concussions

May 3, 2021 by

The May 2021 CJSM issue has just published, and as always it is full of articles you will want to read.

As I gaze at the table of contents, a non-random sampling of eye catching articles includes

CJSM Junior Associate Editor Jason Zaremski, MD breaks it all down for us.

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Clinical Journal of Sports Medicine

Online Journal Club May 2021

CJSM Junior Associate Editor Jason Zaremski, MD

Jason L Zaremski, MD, CAQSM, FACSM, FAAPMR

Anzalone AJ, et al. Blood Biomarkers of Sports-Related Concussion in Pediatric Athletes.

Introduction:  There has been a substantial amount of interest in the diagnosis, evaluation, and management sports related concussions (SRC) in the past decade. An emerging area of interest has been the study of biomarkers as a more objective measure of head trauma. Two blood biomarkers — Neurofilament light polypeptide (Nf-L), primarily found in axons, and Tau, a microtubule-associated protein necessary for axonal transport — have been studied at advanced level of sport (collegiate, professional, and Olympic athletes).

The authors of this new study evaluated these blood biomarkers in pediatric athletes.  The main outcome measures they looked at were correlations between self-reported symptom measures biomarker concentration levels.

Purpose/Specific Aims: The authors examined patterns of blood biomarker concentrations (tau and Nf-L) in pediatric athletes seen in clinic in the days following a SRC and at a six-month follow up.  A comparator group of non-injured controls were assessed as well.  Correlations between biomarker concentrations and self-reported symptom scores were assessed. Read more of this post

Filed under Concussion in Sport, General Interest, Journal Club, Youth Sport

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