Sideline assessment of concussion and return to play – are we practising what we preach?

June 23, 2014 by 2 Comments

Rugbyball2

A different shaped ball, a different World Cup….. Similar challenges

The more things change the more they stay the same…..this post by CJSM Executive Editor Chris Hughes was written in 2011 about the RUGBY World Cup incident involving a guy named Parra. Could have been written about the recent brouhaha over the 2014 FOOTBALL World Cup incident involving the guy named Pereira. In both cases, a player was inappropriately put back on to the field.

Be sure to take a look as well at the Zurich Consensus Statement on Concussion in Sport, found in the CJSM.  The section on the sideline evaluation of the player suspected of having a concussion is especially well written.

Chris Hughes's avatarClinical Journal of Sport Medicine Blog

The seventh Rugby Union World Cup competition ended last saturday in a tense final between strong favourites, the famous New Zealand All Blacks, and France, the former holding out for a one-point win 8-7 over Les Bleues.

The game featured a number of injuries, but one caused more of a stir than most – the injury to the French number 10 Morgan Parra.

Parra took what appeared to be an accidental blow to the side of his head from the knee of All Blacks’ Captain Richie McCaw in a ruck, and appeared to be visibly concussed, looking shaky on getting up after receiving lengthy on-field medical attention. The incident can be seen in this video.

He was taken from the field of play and replaced by Trinh-Duc. Surprisingly, however, he re-appeared on the field after around 5 minutes and continued to play on for another 5 minutes until he experienced another…

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Filed under Concussion in Sport, Elite sport, General Interest Tagged with , ,

What’s a World Cup without controversy?

June 22, 2014 by 2 Comments

Uruguay 4 - Chile 0

Uruguay’s Alvaro Pereira

Followers of this blog will know I have just returned from Quebec City, where I spent a fabulous four days catching up with professional colleagues from around the world at the 2014 FIMS sports medicine conference.  The event was hosted by the Canadian Academy of Sports and Exercise Medicine (CASEM), who conjointly held their annual meeting with FIMS.

Followers of the vastly bigger event known as the World Cup will know during this same period, there was the medical (mis)decision seen around the world involving Uruguay’s Alvaro Pereira:  knocked unconscious, and subsequently allowed to return to the pitch.

In truth, I got to see the event live, along with hundreds of millions of other people on the planet.  On a break in between conference sessions, I was in my hotel room. I had the television on while working on the laptop, when I noticed the downed Pereira.  My initial glimpse of his limp body was first out of context, which is to say I didn’t see the hit live, and I had yet to see the replay; my initial reaction was to fear the worst, as Pereira’s entirely limp body had me concerned he had suffered a cardiac event.

Quickly, though, I got to see the replay–the knee to the head–and it all made sense to me.

What followed, in some ways, made no sense.

Like the others in the viewing universe, I saw Pereira attended to by his medical staff.   As he got to the sideline he started to vigorously protest the intended substitution; and, of course as you all know, Pereira eventually made his way back to the pitch……

And at that moment I saw the twitter universe explode.

At the very least, the 2012 Zurich Consensus Statement on Concussion in Sport was being honored in the breach rather than the observance.

Just a smattering of the tweets: Read more of this post

Filed under Concussion in Sport, Elite sport, General Interest Tagged with , , , , , ,

There Be Monsters

March 31, 2014 by 1 Comment

“In like a lion, out like a lamb,” that’s what they say about March.

To the extent that expression applies to the weather this month and to this blog, I think 2014 may be the exception that proves the rule!  We may be going out like a lion in both areas.

The east coast of North America is ready for spring, but this month that opened up with winter is ending the same way.  If there was an outdoor lacrosse game in Buffalo, New York this weekend, the players were dealing with snow!

Mike_Fisher_throws_check_May_29_2006

More like a lion than a lamb: an NHL body check.

As for this blog, we opened the month with a post that had both sound and teeth, like the proverbial carnivore itself:  our first podcast was a discussion with Drs. Neil Craton and Oliver Leslie, the authors of the March 2014 CJSM lead editorial, Time to Re-Think the Zurich Guidelines: a Critique on the Consensus Statement on Concussion in Sport.  I continue to hear about this editorial, on social media, on the American Medical Society for Sports Medicine email ListServ, and most recently at a symposium on concussions held at Ohio State University (OSU).  It has stirred a tremendous amount of interest.  And so I thought it would be fitting to end the month where we started, with the subject of concussion in sport.

The featured speaker of the OSU symposium was Kevin Guskiewicz, who spoke about “Sports concussions: paranoia or legitimate concern?”  Both he and Dr. Jim Borchers, the Ohio State Team Physician, mentioned the editorial critique in their respective talks.

If you follow the literature on sport-related concussions, you most certainly will come across Dr. Guskiewicz’s name.  He has contributed mightily to the research on several dimensions of this injury.  And so it was a pleasure to hear him speak for an hour on the subject.

As the title of his talk would indicate, Dr. Guskiewicz took as his theme the fear surrounding sport-related concussion.  Dr. Guskiewicz did an admirable job underscoring the importance of both the injury (concussion) and the need to avoid throwing out the baby with the bathwater:  eliminating collision sports such as American football out of possibly misplaced concern over short- and long-term deleterious effects on the brain.  The high points of his talk focused on the various aspects of sport amenable to change which can minimize injury risk and maximize participation.

I especially enjoyed his approach because, in many respects, it is the work that he and a few others have done (amplified by the media) that has helped unleash the beast of “concussion fear.” Read more of this post

Filed under Concussion in Sport, Evidence-based Medicine in SEM, Injury Prevention, Public Health in Sports and Exercise Medicine, Safeguarding in Sport, Youth Sport

What to do about concussions?

March 19, 2014 by 1 Comment

clairey

Calling aspiring
blog post writers!

There is a lot of discussion about concussions in the world of primary care sports medicine.

Breaking news?  Not!

But truly the conversation extends and deepens by the month, it seems to me.  It might be my personal, professional myopia–during football season possibly 25% of the patients in my clinic are youth athletes with sport-related concussions (SRCs).  As a consequence of that, I try to stay on top of the literature and have begun doing research in the area myself.

I hope you all have been as interested as I have over the March CJSM offerings in this area.  The journal opens with an editorial, Time to Re-think the Zurich Guidelines?  It continues with an interesting study looking at the use of those same guidelines along with the Buffalo Concussion Treadmill Test in determining return to play in adolescents following concussion.

And this blog has profiled the Zurich guidelines as well in a recent post and podcast, our first in what will be an on-going offering here at CJSM.

We are aware that there is much more to clinical sports medicine than concussion, and we make a concerted effort at the Editorial Board level to offer a continuing, rich, and diverse set of research focussed on the panoply of sport conditions we might see as clinicians.  As we move forward, we are always interested hearing from you about areas in the world of clinical sport medicine that are of special interest to you.

You can comment on these pages, tweet us @cjsmonline, or if you are especially eager and want to take the bull by the horns:  consider being a guest blog post writer for an issue that is of special interest to you.  Our blog post guidelines can be found here and include instructions on how to contact us if you are interested.

In the mean time, take the poll here (offered concurrently on the CJSM main website).  As you know, we love to hear from you!

Filed under CJSM Polls, Concussion in Sport, General Interest

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