CJSM Podcast with Kim Barber Foss and Greg Myer

We’re excited to ring in 2020 (and our 30th year of the journal) with both the publication of our January issue and a podcast with two special guests:  Kim Barber Foss MS, ATC and Greg Myer PhD from Cincinnati Children’s hospital, the lead and senior author on a study published in our November 2019 issue, Relative Head Impact Exposure and Brain White Matter Alterations After a Single Season of Competitive Football.

Kim Barber Foss MS, ATC

Kim and Greg are prolific researchers and have published widely. For instance, Kim published one of the seminal papers on youth sports concussion over 20 years ago in JAMA: Traumatic Brain Injury in High School Athletes. Do you remember those hoary days of the late 90’s, a prelapsarian world before iTunes and Twitter????  And Greg has published widely on subjects from ACL injury to concussion.  He has been a frequent contributor to CJSM and a major force in advancing evidence-based sports medicine.

With good friend and frequent CJSM contributor, Greg Myer PhD

I hope you get the chance both to read the study and listen to the podcast.  As ever, the podcast conversation can be an illuminating way to understand the author’s interpretation of their own work — conclusions which can be quite different from those which an individual reader may draw from the same study.  This is most especially true when the underlying subject — brain injury in youth contact sports — is such a controversial one.

As ever, you can find and subscribe to our podcasts on iTunes or at the CJSM website. If you have feedback to give us about the podcasts in general, please take the time to rate CJSM at iTunes.  And if you want to comment on this particular podcast and this particular study, please do so on this blog’s moderated comment section.

Enjoy the January 2020 issue and Happy New Year!

What to do about heading?

Heading the ball — photo courtesy of Wikimedia

I have been meaning to write a blog post for over a week, since a bit of breaking sports medicine news occurred with the publication of some research in the New England Journal of Medicine (NEJM).

It took a Tweet this morning to rouse me to action.  I promise it hasn’t been sloth on my part that has slowed my hand, but pleading “I’m busy” to the group of folks who usually will be reading CJSM media is not going to gain much sympathy.

And yes, with fall sports, I sure have been busy.  But I am sure you have too.

I hope, however, not too busy to have missed this piece of research from NEJM: “Neurodegenerative Disease Mortality Among Former Professional Soccer Players.”  There was an accompanying editorial to this study, a piece that is most definitely worth a read too. “Soccer and Mortality — Good News and Bad News”

The published research was a large retrospective cohort study looking at former professional Scottish football (soccer) players: 7676 cases were identified from databases of Scottish football players and 23,028 controls (3:1) from the ‘general population’ were identified using a Scottish ‘Community Health Index.’ Controls were matched to players on the basis of sex, age, and degree of social deprivation.  Of note, all the participants in this study were male.The researchers looked at two dependent outcome variables:  i) cause of death as noted on death certificates and ii) dispensed medications, information for which was obtained from the Scottish national Prescribing Information System.  Follow up information for study participants was for a median of 18 years (for each individual, “Age was used as the time covariate, with follow-up from age 40 years to the date of data censoring, which was either the date of death or the end of the follow up (December 31, 2016), whichever occurred first).”

The researchers report several important findings in this study, to note just a few:

Read more of this post

Bread and Butter

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Bread, butter……and food for thought!

Fall sports in the USA  — sometimes in my clinics at this time of year I feel like I am swamped in concussions.  There will be stretches in a morning that I go from room to room, each one a different variant of this all-too-common injury.

But overall, in truth, the bulk of my patient encounters this time of year are of the musculoskeletal (MSK) variety.  It may not ‘feel’ that way, but when my hospital ‘numbers gal’ crunches the data, we’re still running at > 50 % MSK for patient visits.

And ankle sprains are definitely in that mix.

Ankle injuries, like knee injuries, concussions, and fractures, are part of the ‘bread and butter’ of my practice at the Division of Sports Medicine at Nationwide Children’s Hospital (NCH).  And one of the things I love about the Clinical Journal of Sport Medicine are the multiple original research articles the journal publishes that give me insight into the management of these common injuries.

I recently wrote a blog post about the four original research articles focused on concussion in our just-published September 2016 issue.  In this current post, I want to draw your attention to some more original research being published ‘ahead of print’: “Current Trends in the Management of Lateral Ankle Sprains in the United States.”

I found this to be a very interesting read using a “Big Data” approach to look at how this common injury, lateral ankle sprain (LAS), is managed in the USA.  The authors queried a database of national health insurance records for 2007 to 2011 and identified 825,718 patients with the diagnosis of LAS.  After applying select exclusion criteria (e.g. those with associated fractures,), they analyzed 725,927 isolated patients with LAS.

The authors found that 36% of all LAS occurred in patients < 20 years old (my patient mix at NCH), and that the number of patients with LAS decreased ‘exponentially’ with age (the 60+ crowd represented < 5% of the total).  Some of the more notable findings:  fully 2/3 (67.8%) received radiographs, and for treatment — 9% received a brace, and only 6.8% received physical therapy (PT) within 30 days of their diagnosis.

the end

Ankle bracing was looked at in the study, but not taping.

I think these two findings in particular should challenge us as clinicians.

First, though we cannot know in detail what the physical examination status was for the 700K LAS patients at time of initial evaluation, it strains credulity, I think, to consider that 67.8% of them met Ottawa Ankle Rules criteria.  Talk about a knowledge translation gap!  I believe the rules have been around for a good 20+ years [I did a Google scholar search on that, anyone is welcome to comment on this and let me know what they consider to be the first, the ‘Ur’ reference for the rules].  The rules have a very high sensitivity (approaching 100%).  Does anyone remember the mnemonic SnOUT? [ SnOUT = a negative finding in a highly sensitive test rules ‘out’ the problem].  I think this result reinforces for me what I need to be thinking about in my evaluations of LAS on the sideline and in the training room — apply those rules, and I’ll surely minimize my use of radiographs, saving cost and radiation exposure.

Second, the authors make a great case for the residual functional deficits that can linger for some time after a LAS. They specifically mention the evidence “…that patients with LAS are less physically active throughout their lifetime and (have) decreased health-related quality of life.”  LAS are not the benign injury we may always think them to be, and it is arguable they need some form of rehab.  I would note, again, that we cannot know in detail what access these patients had to PT, but to think that less than 7% received PT within the first month of injury……

In my own clinics, we often prescribe home rehab, and do a brief tutorial and give a handout to patients with LAS; we also prescribe PT to many.  I am not so sure how compliant my patients are with their home rehab, and I know that I get a lot of ‘no-shows’ for my prescribed PT.  Perhaps if I ‘put the hammer down’ a bit as a clinician–emphasized a bit more of the consequences of a poorly rehabbed LAS–I might get more patient ‘buy in’ to the concept of the necessity for PT/rehab to achieve a fully recovery.

LAS — bread and butter injuries, no doubt.  And this new research article — food for thought, indeed.

 

May Day

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CJSM: bringing you clinical sports and exercise medicine research, from around the globe

Whether you are celebrating today as International Workers’ Day, running around a May pole, or watching Leicester City try to complete the 5000:1 shot of winning the Premiership, we are sure that today, May 1, can only be a good day:  our third issue of the year has just published.  And this May Day CJSM is full of offerings we’re sure will be of  interest to you.

Two of the articles have a special focus on physical activity as an intervention for medical conditions — one is a meta-analysis from Chinese colleagues finding a protective effect for physical activity against lung cancer, and the other is a prospective, single-blinded, randomized clinical trial looking at rock climbing as an intervention in the treatment of low back pain. This study is from Austria, and had positive findings for dependent measures of disability (the Oswestry Disability Index), a physical examination maneuver, and even the extent of disc protrusion on MRI.  We’re proud to publish these high quality studies from across the globe.

We are also proud to contribute to the growing body of literature on the effectiveness of “Exercise is Medicine.” Read more of this post

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