#AMSSM14

April 6, 2014 by

#AMSSM14 is the tag to follow on Twitter the next few days if you want to stay on top of what is topical in the world of sports medicine.  The American Medical Society for Sports Medicine (AMSSM) is having its 2014 annual meeting in New Orleans these next several days.  #AMSSM14 began Friday and is continuing through Wednesday.  It’s already been a rich experience, one we’ve been looking forward to for a while.

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Happy conference attendees, Drs. Jane Sando and Natalie Stork.

Among the speakers who have already graced the podium:  David Epstein, a journalist and author of The Sports Gene, gave a great keynote speech Sunday on some of the factors that go into the ‘making’ of an elite athlete.  He presented a compelling argument for avoiding early sport specialization, allowing the youth athlete to sample and perhaps find the sport that ‘fits’ his or her unique physical attributes.  The talk was the perfect prelude to the afternoon’s sessions, ‘From Best Practices to Burnout,’ a series of lectures on how sports medicine clinicians might best guide youth athletes and families as they work their way through the North American sport system.

Dr. John DiFiori, the outgoing AMSSM president and lead author on the statement on youth sport specialization and burnout we published in January, spoke at length about the findings of that systematic review.  In case you missed the lecture and/or are elsewhere than New Orleans this weekend, take a look at our ‘5 Questions with CJSM’ interview with Dr. DiFiori.  Dr. Tracy Ray discussed ‘Patient Centered Care’ of the collegiate athlete that I particularly enjoyed.   The focus was the InterAssociation Consensus Statement on Best Practices for Sports Medicine Management for Secondary Schools and Colleges.

I already have my eye on a series of ‘point/counterpoint’ discussions tomorrow morning:  contact sport: should it be embraced or avoided? Spondylolysis:  to brace or not to brace? And vitamin D:  to screen and treat or not?  I’ll be there and I’ll be sure to be tweeting the high points of those sessions.

I think it’s a testament to the quality of the sessions that I am sitting in a large auditorium at 5 pm on a weekend day here in New Orleans…..and it’s nearly full!  Great to see folks want to hear about positive and negative likelihood ratios rather than enjoying the temptations of Bourbon street…..well, at least for an hour more perhaps!

Follow us on @cjsmonline, follow the AMSSM on @TheAMSSM, and follow the hashtag #AMSSM14 for all the info coming hot off the press from this conference!!

Filed under Evidence-based Medicine in SEM, 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

The Effectiveness of Ankle Taping

February 22, 2014 by 6 Comments

gail taping ankle

ATC Gail Swisher, Bexley High School
and Nationwide Children’s Hospital,
demonstrating her art

To tape or not to tape, that is the question.

And the answer is of interest to a lot of folks out there.

“Residual Mechanical Effectiveness of External Ankle Tape Before and After Competitive Professional Soccer Performance,” published in our January issue, has been our most emailed study so far this year.  On our twitter feed, @csjmonline, I can also tell you that the posts I’ve been making have been getting a lot of traffic.

There is a great deal of interest in this most utilitarian of subjects. It’s original research coming from a group out of Germany:  Best, Mauch, Böhle et al., and currently on the CJSM website it’s FREE!  It’s time to check it out!

All of us in clinical sports medicine can attest to the ubiquity of ankle injuries.  The authors of this study note, for instance, that aside from muscle strains, ankle ‘distortions” are the most frequent injuries seen in professional soccer, accounting for about 20% of all injuries.  They further note that bracing and adhesive taping of the ankle are commonly used to prevent and treat these injuries, though “….the effect of adhesive ankle tape remains inconclusive, in comparison to semirigid orthoses and braces….”

There is considerable debate over the residual effectiveness of taping over the course of a prolonged sporting session.  The issue is of practical significance, as the author’s note that during soccer matches, a disproportionately high number of injuries occur during the last third of each halftime.  To date, there have been few studies that have evaluated the mechanical, protective properties of tape beyond 30 minutes of exercise.

It is in this context, then, that the authors’ developed what amounts to their research hypothesis:  “…during realistic competitive soccer performance reflecting a halftime of 45 minutes–ankle tape might lose most of its assumed initial mechanical effectiveness to reliably prevent ankle distortions.”  They set out to test just that. Read more of this post

Filed under Elite sport, Evidence-based Medicine in SEM, General Interest, Injury Prevention Tagged with

Articular Cartilage Pathology: What to do?

January 12, 2014 by 2 Comments

A syringe delivering PRP:
A silver bullet for osteoarthritis?

My fall was so busy, I’m finally getting back to doing a sequel of a post I wrote in early October:  Osteoarthritis Part I.

I’m finally writing “Part II.”

The proximal impetus for finally attending to this item on my personal ‘to do’ list?  The new, January 2014 edition of the Clinical Journal of Sports Medicine has a couple of very fine articles on the treatment of articular cartilage pathology. One of the studies, “Treatment of Cartilage Defects of the Knee: Expanding on the Existing Algorithm,” is a general review I hope to post about in the near future.  The study that is in my line of fire today explores the uses of platelet-rich plasma (PRP) in the treatment of osteoarthritis and cartilage defects: “Platelet-rich Plasma in the Management of Articular Cartilage Pathology:  A Systematic Review.”

I found this review to be incredibly helpful.  It begins with an overview of articular cartilage pathology and a reminder of the frustrations in treating a tissue that has a limited inherent healing capacity.   Rarely can articular cartilage repair itself.  And when injury penetrates subchondral bone, underlying marrow cells can be stimulated to provide some repair, but inevitably the fibrocartilage that results is a biomechanically inferior substitute for native, articular hyaline cartilage.

ocd for blog 2

OCD of the medial femoral condyle:
what will this joint look like in 2044?

The review notes the increasing incidence of chondral and osteochondral lesions, something as a pediatric sports medicine specialist I can attest to.  The 10 year old with knee OCD I am treating today:  I often wonder what their knee will be like in 30 years?

The authors note:   “Several treatment modalities are available, including microfracture, autologous chondrocyte transplatation, and autograft and allograft osteochondral transplantation.  However, the reported resulst with these procedures have been variable and are not guaranteed to prevent symptomatic degenerative disease at long-term follow up.”

In other words, the hunt is on for an effective, definitive treatment of articular cartilage injury.  Might PRP be the answer?

The brief answer:  we need to learn much, much more about PRP, and probably about articular cartilage, too.

Let’s start with the limitations.  Read more of this post

Filed under Evidence-based Medicine in SEM, General Interest, Patient Outcome Measures Tagged with , ,

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