Beantown & the MomsTeam Summit

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With the illustrious Brooke de Lench, Executive Director of MomsTeam. Friend and fellow traveller in the quest to make youth sports safer.

I’m flying to Boston today, and it feels like going home.

As I’ve shared with readers of this blog, I spent many of my formative years of education and medical training in ‘Beantown.’  I’ve experienced both sports (university track and cross-country) and sports medicine (fellowship training, coverage of the Boston marathon, and more) in ‘the Hub.’

This morning I head to Boston in advance of attending and speaking at a very special gathering taking place on Monday:  a ‘Youth Sports Summit’ taking place at Harvard Medical School.  The summit will focus on evidence-based best practices to address almost every facet of #YouthSportsSafety:  concussion prevention, sound nutrition, screening for sudden cardiac death, prevention of sexual abuse, to name a few topics.  I am one of several speakers and I’ll be speaking on injury prevention in youth athletes.

The host for the “Smart Teams Play Safe” summit is MomsTEAM  an especially influential organization addressing #YouthSportsSafety concerns. I serve on the Board of Advisors for the non-profit MomsTEAM Institute.  The Board is full of authors who have published in CJSM:  Tracey Covassin, Neeru Jayanthi, Dawn Comstock, Johnana Register-Mihalik……it’s a veritable ‘Who’s Who’ of sports medicine.  Most of the Board will be in attendance, and many will be speaking.

As I prepare for my talk, I find myself so frequently turning to the pages of CJSM to find the evidence for best practices in this area.  I will be relying heavily on studies ranging from the AMSSM position statement on youth overuse injuries, published in January 2014; to the CASEM position statement on neuromuscular training for ACL injury prevention; to some of the compelling research regarding the benefits of postponing body checking in youth hockey.

I’ll be blogging and tweeting from Boston, so look to these pages and to our twitter feed for updates on the proceedings.

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Spoiler Alert (will be mentioning this in my talk):  if there is any group that is going to begin solving the epidemic of youth sports injuries, it is a determined group of mothers like those involved in MomsTeam.  From the Playground Movement of the late 19th century, to the push by MADD to address the public health crisis of drunk driving, motivated mothers have made major impacts on societal health.  I have no doubt that in the arena of #YouthSportsSafety, the same will hold true.

On Call and Evidence Based Medicine

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Calling Dr. MacDonald…..

When I am ‘on-call’ for my sports medicine clinic practice I receive a mixed bag of phone calls.  The calls come in from patients we take care of, to emergency physicians looking for help triaging patients, to community physicians looking for consultation. Because I do non-operative, primary care sports medicine, I’m rarely involved in an emergency when ‘on-call’; any urgent or emergent issue I need to manage typically occurs when I am on a sideline and not nominally ‘on-call.’

Last week, I received an interesting query about muscle pain in a high school runner who had been doing some intense pre-season training.  The physician seeking my advice had felt obliged to check the patient’s creatine kinase (CK) and told me the level was 1400 U/L.  He had already obtained a urine for myoglobinuria (negative), and he was asking if he should be clearing the patient to return to sport.

Most of my clinical work involves taking care of fractures or concussions, spondylolysis or osteochondritis dissecans.  As with a lot of clinicians, I suspect, for the conditions I treat in high volume I have the facts usually at the tip of my tongue.  Though I have manged the condition, I don’t routinely treat patients where rhabdomyolysis is in the differential.  And so, with this specific phone consultation, I assured the physician the patient was in no imminent danger, but I wanted to get back to him later that day after I had done a literature search.

Though I did not think about this explicitly at the time, I later realized that this little vignette represents an example of “Evidence Based Medicine” (EBM) in use.  As Sackett et al. state in 1996, “Evidence-based medicine is the conscientious explicit and judicious use of current best evidence in making decisions about the care of individual patients.”

In this particular case, I wanted to find some of the primary research done on CK levels in athletes in this age group.  Among the articles I pulled were two from CJSM:  “A Cluster of Exertional Rhabdomyolysis Affecting a Division I Football Team” , which was published in 2013; and a ‘Brief Report’ that was available only on-line until it was just published with the new, September CJSM, “Creatine Kinase Levels During Preseason Camp in National Collegiate Athletic Association Division-I Football Athletes.”

The former study I have actually profiled in these blog pages before.

There can be limits to the application of EBM in making decisions about ‘individual patients.’ Read more of this post

CJSM Podcast 3

jsm-podcast-bg-1It’s hard to believe it is already July 1:  summer is in full swing in the northern hemisphere; the World Cup is half way done; Wimbledon, too; and, I’ve actually seen ‘back to school’ advertisements in newspapers.  Time flies!

One of the great joys of reaching this day, the mid-point of the year, is that we get to publish the fourth CJSM issue of 2014, and it’s a good one.  Be sure to check out what’s on offer here.

In some ways, however, we publish continuously.  In recognition of the great content that has already passed the rigors of peer review and are in the queue for full, print publication, we have a “Published Ahead of Print (PAP)” feature on the main website page.  These are citeable studies, ready to read…..and ready for listening!

Yes, listen:  today’s podcast profiles just one of those PAP studies.  I got to interview William Meehan, the lead author of the new publication:  “Risk of athletes with Chiari malformations suffering catastrophic injuries during sports participation is low.”

Bill has contributed a tremendous amount of original research to the pages of CJSM. Today, sit back and hear what he has to say about the relative safety of Chiari malformations.  And remember:  you can listen to the podcasts here on the blog, at the CJSM main website, and you can subscribe to the podcast stream on iTunes. However you lay your ears on the podcast, so to speak, you’ll be happy!

 

CJSM Podcast 2

JSM-Podcast-BG (1)The May CJSM has been out for a little more than a week, and we hope you have been able to begin looking it over.

I had a chance to talk with Dr. James Carson of Canada, one of the authors of the new Canadian Academy of Sports and Exercise Medicine (CASEM) position statement highlighted in the new journal:  Neuromuscular Training Programs can Decrease Anterior Cruciate Ligament Injuries in Youth Soccer Players.

Neuromuscular training programs are gaining favor as cost-effective interventions for ACL injury; witness a recent article profiling their impact at a cost of only $1.25 per player!

It’s a wonderful paper, and I hope you get both a chance to read it and listen to the new podcast. Let us know what you think, by commenting here or tweeting us @cjsmonline.

 

(music:  Jeff Manning)

 

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