Six Nations — a hymn to rugby

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In the President’s Box, watching South African Rugby — photo: A Brooks

One of Rugby Union’s big, international events – The Six Nations Championship – kicked off this weekend, and we’re looking forward to the great sport the event will offer through mid-March (the last competitions take place March 18).

I have a soft spot for rugby (union and league), though it is a sport I never played myself (a middle- and long-distance track runner, I would have been eaten up and spit out on the rugby pitch). I’ve lived at different times in southern Africa and New Zealand, where I was exposed to the glorious traditions of both Springbok and All Blacks rugby.  And I did my sports medicine training under Dr. Lyle Micheli, whom many know played rugby well into his sixties.  Inevitably, one gets to take care of plenty of rugby athletes when spending some time with Dr. Micheli.

Rugby is a sport that combines collision with endurance, fierce play with fluid movement.  It is also a sport about which it has been written:  “Rugby is a game for barbarians played by gentlemen. Football is a game for gentlemen played by barbarians.”  I don’t intend on offending fans of soccer/football, but I do want to emphasize the special character of so many of the players, coaches, referees and others I see in the sport of rugby.

“Building character since 1886”:  that’s how World Rugby, the sport’s international governing body states their mission.

Consequently I have become, over time, increasingly involved with USA Rugby and have written several of these CJSM blog posts on various issues related to the sport.  My interest continues to grow.

This personal interest parallels the interest CJSM has in publishing research related to the sport. Read more of this post

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Boxing in the Olympics

 

Rio de Janeiro - Robson Conceição derrotou na tarde deste domingo o cubano Lázaro Álvarez e vai a final do boxe categoria peso ligeiro. (Fernando Frazão/Agência Brasil)

The new look to Olympic Men’s Boxing  (photo: Fernando Frazão/Agência Brasil)

With summer holidays and work, I will be honest — I have not been watching too much of the Olympics on the television.  I have made a point to watch Michael Phelps’ last (possibly?) Olympic swim and Usain Bolt’s historic 100m gold medal performance.  I am a former track and field athlete myself, and so I also have witnessed Jamaica’s Elaine Thompson win the women’s 100m and South Africa’s Wade van Niekerk set the 400m world record.  I catch up on news in the newspaper when I wake up (for instance, the story of Anna Sofia Botha is possibly the most heartwarming of these Games).  But watching live TV?  Not so much.

Between the track events, I have caught some of the men’s boxing and I, like possibly many of you CJSM blog readers, have been struck by the absence of head protection.  Our world of sports medicine is big, and I’ll confess I had not been aware of the rules changes going into these Olympics regarding the non-use of this protective equipment for men’s boxing:  since the 1984 Los Angeles Olympics, mandatory headgear has been in place for boxers until now, in Rio.

There has been some controversy over this issue — both when it was introduced as a safety measure, and now in 2016 when it has been removed, also for stated safety reasons:  the incidence of concussions is expected to decline without the headgear in place.  The International Boxing Association (AIBA) made this rule change since the Beijing Olympics, and International Olympic Committee (IOC) spokesman Mark Adams is quoted as saying, “AIBA provided medical and technical data that showed the number of concussions is lower without headgear. They have done a lot of research in the last three years. The rule will go ahead for Rio.”

Some of that research has been published in our journal, including this cross-sectional observational study on the use of head guards in AIBA boxing tournaments.   The results of this study show that referees had to stop matches for head injuries more often when boxers were wearing head gear than when they weren’t.  At the end of the day, after integrating all the available current evidence, it was understood that the headgear was not sufficiently protective to prevent concussions (no surprise there: the holy grail of contact sports may be effective, ‘concussion proof’ head protection), and, instead, promoted more frequent hits to the head — a good example of ‘risk compensation’ in injury prevention.

The CJSM study, authored by a group including lead author Michael Loosemore and senior author Julian Bailes, has already generated a fair amount of debate on social media and commentary in the media, including the New York Times.  We have been receiving a fair number of ‘letters to the editor’ regarding the study since these Olympics have begun, and we will be publishing both the letters and the authors’ responses soon.  A robust debate looking at the evidence, and pointing toward where research must head to resolve this issue — that is a ‘contest’ that will extend beyond Rio and into Tokyo, site of the 2020 summer games.  Stay tuned to the blog and to CJSM to stay abreast of this issue.

Dietary Supplements in Sports

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Texas — site of upcoming AMSSM annual meeting [Dallas, 4/15 – 4/20]

One of the studies in our March 2016 CJSM which has generated substantial interest is original research from the Department of Military and Emergency Medicine, Uniformed Services University of the USA: “Dietary Supplements: Knowledge and Adverse Event Reporting among American Medical Society for Sports Medicine (AMSSM) Physicians.

The AMSSM, one of our affiliated societies, is having its annual meeting coming up in Dallas April 15 – 20, and we’re looking forward to joining in those proceedings [the official hashtag of the meeting is #AMSSM16 — keep that in mind you Twitter folks].  The physician membership is not infrequently surveyed about a variety of matters of interest to practicing sports medicine clinicians; the results of these surveys often provide invaluable data to researchers who have published in the CJSM pages.

Examples of this include “Concussion Practice Management Patterns among Sports Medicine Physicians” and “Cardiovascular Preparticipation Screening Practices of College Team Physicians.” 

Regarding the study on dietary supplements (DS), the authors looked at a variety of issues.  Of note, they found that majority of survey respondents (71%) reported that athletes under their care had experienced an adverse event associated DS use.

Not all of us who read this blog or subscribe to the journal are AMSSM members, of course, and so I thought it might be time for a poll, asking this very question: have you ever taken care of an athlete who has experienced an adverse DS event?  Please, take the poll, and if you can, send us a comment on this blog identifying the DS, the adverse outcome, and possibly the sport in which your athlete was participating.

We hope to see you in Dallas!

A Sharapova Moment

The world of sports medicine is never boring, but who knew things could get this interesting?

In the first weeks of March, there have been at least two major stories that have transcended the borders of ‘sports medicine’ and become topics of debate for the world at large — I speak of the proposed ban on tackling in schoolboy rugby (and the continued debate on tackling in American football) and Maria Sharapova’s admission that she failed a drug test at the recent Australian Open.  For both stories, the boundaries of the discussion have gone well beyond the lines of the playing fields and the walls of the academy.

Social media has seen these topics trending. The mainstream media have been profiling the issues as well.  The Economist weighed in on the debate about tackling. And this morning I found the New York Times prominently featuring Ms. Sharapova’s story, including articles on the drug meldonium [for which Sharapova tested positive] and on the issue of the World Anti-doping Agency’s (WADA) use of emails to notify individuals about changes on WADA’s banned substance list.

Many people have an opinion on the subjects.   We’ve been running a poll on this blog regarding the issue of tackling, while our friends at the British Journal of Sports Medicine (BJSM) have been running a Twitter poll on the Sharapova issue: who is responsible, the player or her support staff [currently the poll is 74%/26% stating it’s the athlete’s responsibility].

In the New York Times article and in the BBC, former WADA-president Dick Pound has stated his opinion that Sharapova’s failed drug test was ‘reckless beyond description.’

I must say I take issue with this and empathize with Ms. Sharapova, who stated that she received in December the WADA email noting that meldonium was now on the banned substance list, but “…I did not look at that list.”  Meldonium was a PED legal until 2016, when it was placed on the ‘banned substances list.’ As a professional inundated with emails, alerts, pronouncements, and more, I confess to a certain degree of information overload even when it comes even to items vital to my licensure and ability to practice.  Have I ever received an email from the Medical Board that I have deleted?  Have I ever received notification from my hospital staff office of some new change in policy which I glossed over?  Yes and yes.

Regarding the WADA emails, other athletes in the NY Times article have offered this opinion: “Some dismissed the messages as irrelevant to their own regimens or too complicated to be useful.”  That certainly resonates with me and my professional world.

I am not writing this to absolve Ms. Sharapova, and I applaud her for her prompt and open admission of personal responsibility. That stance is right and proper.  But I would hardly deem her action “reckless beyond description.”

In CJSM we have published over the years several studies on banned substances. One of the pieces of original research just published in our March CJSM sheds some further light on this issue, I think: Dietary Supplements: Knowledge and Adverse Event Reporting Among American Medical Society for Sports Medicine Physicians.  Read more of this post

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