Sports Medicine from South Africa — SASMA biennial congress begins this week!

Dr. Pierre Viviers, President of SASMA

It’s been a while since we have invited a sports medicine colleague to a “Five Questions with CJSM” interview.

What better time to catch up with the current President of the South African Medical Association (SASMA) than on the eve of SASMA’s biennial Congress?

My dear friend Dr. Pierre Viviers of Stellenbosch University is a very busy man right now as he places the final touches on what is sure to be one of the premier events of this year’s sports medicine calendar.  Having attended SASMA in 2015  in Johannesburg, I can attest to what an exciting and stimulating event this Congress is.

True to form, Dr. Viviers did not hesitate to volunteer for this interview when I reached out to him, despite his busy schedule.  I hope you enjoy our conversation and that it whets your appetite for what is coming later this week from Cape Town.  If you can’t be there, be sure to follow #SASMA2019 on social media.

And now….Dr. Viviers!

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  1. CJSM: The biennial Congress of SASMA is taking place 10 – 13 October 2019 in Cape Town, the “Mother City.” It is a joint Congress with SASMA and BRICSCESS.  Can you tell us about what you see as the highlights of the program, and for the readers unfamiliar with BRICSCESS can you tell us about that organization?

Pierre Viviers (PV): It is a joint congress which also includes the 6th Annual Congress on Medicine and Science in Ultra-Endurance Sport which will definitely be a highlight. The pre-congress workshops are always popular and well attended. This will include 2 full-day workshops presented by ‘Exercise is Medicine South Africa” (EIM SA) and SAIDS (SA Institute for Drug-free Sport), as well as a half-day workshop by the S.A Sport-Physiotherapy group.

A highlight for me personally, is the integrated participation between scientists and medical professionals throughout the program.

Opening the narrative of social justice and the role which sport can play, especially in a country like S.A, will be one of our most influential South Africans, Prof Thuli Madonsela, activist for social justice and human rights, previous public protector and advocate in the High Court of S.A.  This is definitely a session not to be missed.

The prestigious Noble lecture will be presented by a good friend and colleague, Cheri Blauwet from Harvard Medical School & Spaulding Rehab Hospital, Boston. Cheri’s journey in injury and illness prevention in the elite Paralympic athlete will be a certain highlight. A symposium later in the conference will be another highlight, focusing on “innovations in athletes with disability.”

The sport nutrition colloquium led by Louise Burke (Australia) and other prominent South Africans in the field is another highlight.

The featured science session on player welfare in rugby union as well as the featured clinical symposium on Sport Related Concussion will reveal interesting concepts in injury prevention and management in this popular South African collision sport.

The session on mental health in athletes presented by two leaders in the field will also give new insight in prevalent mental health issues which may influence athlete welfare and performance.

The BRICES countries are Brasilia, Russia, India, China and South Africa and BRICSCESS is the Council of Exercise and Sport Science founded to specifically look into health and wellness of people within these counties. However, this is there second international congress. The council also strives to bring communication together between the BRICS countries on issues influencing health and wellness through universities and other platforms. The Council is also dedicated to leadership development in young scientists within the field.

 

  1. CJSM: You are winding down your term as President of SASMA. What are the fondest memories of your past two years of service?  Who is the incoming President?

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It’s July, and the new CJSM issue has published

July is already here and it’s the moment for a new issue of CJSM.

I wanted to take this moment both to share our Editor-in-Chief’s thoughts on the new issue, as well as republish a very popular journal club posting on one of the highlighted studies in the new issue: LIPUS in the treatment of spondylolysis.

Whether it’s summer or winter where you currently live, we at CJSM hope you are well and will enjoy and learn from the July 2019 issue.

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Editor-in-Chief Chris Hughes

It’s difficult to believe that we’re already half-way through the year, but here we are already with our fourth Issue of the Clinical Journal of Sport Medicine in 2019. 

We start this month with an interesting systematic review by DiSilvestro and colleagues examining the outcomes of anterior cruciate ligament (ACL) reconstruction amongst obese and overweight patients, in studies with a minimum of 1-year follow-up data. 

Several factors were examined in this review including mechanism of injury, post-reconstruction rates of arthritis, IKDC scores, risks of requirement for revision surgery, and risks of contralateral ACL tears. A consistent association between overweight status and the subsequent development of arthritis post-ACL reconstruction was found. However, patient-reported outcome measures were similar for both sets of patients apart from IKDC scores, with lower IKDC scores being found amongst the overweight and obese population. The authors conclude that more research is required to be able to appropriately counsel patients undergoing primary ACL reconstruction surgery with specific relation to weight optimisation prior to surgery. 

Tsukada and Colleagues present an interesting case-control study of the effect of low-intensity pulsed ultrasound (LIPUS) for early-stage lumbar spondylolysis amongst a cohort of 82 active sports participants aged between 10-18 years old, with the vast majority of these subjects playing baseball. Time required for return to previous sports activities with standard conservative treatment (including thoracolumbar bracing, activity modification and therapeutic exercises) were compared with a similar group also receiving LIPUS treatment. Amongst this cohort, median time for return to previous sports activities for the conservative treatment plus LIPUS group was 61 days, compared with 167 days for the conservative tretatment-alone group. The authors suggest that LIPUS combined with conservative treatment may be a useful therapy for shortening return to sport times. 

Highlights amongst our other Original Research articles this month include the clinical utility of oculomotor and electrophysiological measures in identifying concussion history, the effects of long-term diving on the morphology and growth of the distal radial epiphyseal plate of young divers as assessed by MRI, and a prospective randomized-controlled trial pilot study comparing conservative treatment with trunk stabilisation exercises to standard hip muscle exercises for treating femoroacetabular impingement. 

We also bring you a Brief Report on the effect of a commercially available footwear insole on biomechanical variables associated with common running injuries, and a Case Report on the clinical outcome following lateral ulnar collateral ligament reconstruction in an adolescent baseball player. 

Finally this month, we pay tribute in respect of the passing of our esteemed Editorial Board Member, Dr Bill Garrett Jr, on May 4th, 2019. As Director of Duke Health, Bill was a much-loved and valued member of the Orthopedic team there for over 40 years. As a Specialist in Sports Medicine, he worked as the Medical Director for the US Soccer Federation and as Team Physician for the US National Men and Women’s Teams, as well as for many Duke teams. A consummate clinician, researcher and teacher, he served as former President of the American Orthopaedic Society for Sports Medicine and the Herodicus Society, and was also a Board Member of the American Board of Orthopaedic Surgeons, the American Academy of Orthopaedic Surgeons, and the American College of Sports Medicine. 

Bill will be sadly missed by all of us at the Clinical Journal of Sport Medicine, and by the many colleagues, juniors, and patients who owe their thanks to him for his contribution to Medicine in his many roles over the years. 

Best Wishes, 

Chris

Christopher Hughes MBBS MSc

Editor-in-Chief 

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Clinical Journal of Sport Medicine Blog

Spondylolysis in the adolescent athlete — what to do?

Symptomatic isthmic spondylolysis in the adolescent athlete — for many of us in the world of primary care sports medicine who have a large pediatric/adolescent patient base, this is one of the more common clinical entities we treat.

I’ve written previously about some of the controversies surrounding this condition, and I have had the pleasure of seeing some of the spondylolysis research I’ve conducted published in the pages of CJSM.

Recently published “On Line first” in CJSM is research coming from a Japanese center renowned for its work in this area:  Low-intensity Pulsed Ultrasound (LIPUS)for Early-stage Lumbar Spondylolysis in Young Athletes.

I’m delighted to introduce again our Junior Associate Editor, Jason Zaremski, M.D., who is pioneering our on-line CJSM journal club.  He’ll take us through this new study and help us decide:  LIPUS — should we…

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Sports Med Garnering Headlines — the Ugly Way

Our profession’s shame — headlining the newspapers this past weekend

I woke up Saturday to local news that had a national profile and an international impact:  the front page of ‘my’ local newspaper, The Columbus Dispatch announced in a headline A Failure to act by OSU and went on to describe in the first few lines the essence of the story:

“Over his 20-year career, Strauss would go on to abuse at least 177 male students at Ohio State. For years, nobody stopped him.”

Nobody stopped him.

Dr. Richard Strauss was a team physician for Ohio State (OSU) athletics, taking care of wrestlers and football players.  He was as well a founding member of the American Medical Society for Sports Medicine (AMSSM), one of the premier professional bodies in our profession (I am also a member of the AMSSM).

If you have not read this story, I encourage you to take a look. In brief, one year ago Ohio State announced an independent investigation into allegations of sexual abuse against Dr. Richard Strauss that had emerged at that time.  Dr. Strauss was a team physician at OSU from the period of 1978 to 1998. He died in 2005 when he committed suicide.  During his tenure the report reveals he abused at least 177 athletes.

There have been multiple media reports, but you may not have had the ability yet to see the full report, which has been released by OSU can can be found here.

I honestly find myself at a loss for words here. That is, I don’t have much in the way of commentary.  I want more than anything with this post to bear witness to the victims and to air this news as widely as possible; it may be that some of the readers of this blog are international and possibly have not heard this news yet.

Our profession of sports medicine has earned these headlines before — the Larry Nassar story still plays out, with USA Gymnastics in shambles a)nd the lives of hundreds of young women forever altered.  Our sports and top institutions have earned these ugly headlines far too often:  from the story Jerry Sandusky and Penn State in the USA to Barry Bennell and youth football in the UK.

“Nobody stopped him.”  The subtext of each one of these ugly, headline-making stories.

I think if the story of abuse in the Church (as told in ‘Spotlight’ and other movies) teaches us anything, it is that the last ugly story we have heard will not be the last ugly story we hear.  There are a Richard Strauss and a Larry Nassar alive and practicing in our profession right now.

Bear witness. Open our eyes to the possibility that this is occurring in your institution, your school, your community. Be willing to speak out and act. Look at resources such as the UN’s initiative on safeguarding in sport (particularly useful for youth sports). The IOC likewise has a ‘toolkit’ — Safeguarding Athletes from Abuse and Harassment in Sport. 

More than anything in a post like this, I would look to you the sports medicine community to share back with me what your thoughts are about this, what resources you are aware of to make these headlines go away.

The Mental Health Podcast and CASEMCON2019

I hope readers of this blog, and listeners of the podcast, have been following #CASEMCON2019 on their social media feeds this week. The Canadian Academy of Sport and Exercise Medicine (CASEM) has been conducting its annual meeting in Vancouver these past several days, and is scheduled to wrap up today, May 18.  I have learned so much from following this #, as well as following the feeds of CJSM Twitter friends including Drs. Jane Thornton  Margo Mountjoy and Laura Cruz.

The topic of mental health in sport has figured prominently in the CASEM proceedings:  for instance, Clint Malarchuk, a retired NHL player, is scheduled to talk today about the stigma of mental health in sport.

And so one of our more recent publications and our most recent podcast could not be timelier (published in our May 2019 journal): The Canadian Centre for Mental Health and Sport (CCMHS) Position Statement: Principles of Mental Health in Competitive and High-Performance Sport

Krista Van Slingerland, of CCMHS and the University of Ottawa

The CCMHS is a relatively new organization and, along with a similar group in Sweden, represents one of the first such initiatives on the planet.  The co-founder of CCMHS, Ms. Krista Van Slingerland of the University of Ottawa, is the lead author of the position statement. She graciously met me on Skype (she, in Ottawa, and I in Columbus) to conduct a podcast exploring the issue of mental health in sport and the work CCMHS is doing to bring further attention to this issue and begin treating individual athletes for the problems they are facing.

CJSM is committed to providing a platform for this important issue, one which has been relatively neglected for too long in our world of sport and exercise medicine.  In my training — and I would suspect in yours, too — the focus was primarily on musculoskeletal medicine,  Medical issues such as managing diabetes or exercise-induced asthma, screening for cardiac disease, etc. would demand our attention at times.  The issue of concussion and its sequelae have of course become central to our athletes’ lives and our practice.  But identifying and helping our athletes cope with anxiety, depression, suicidality — I received little to no training in sports medicine about this, and have heretofore relied on my training in family medicine to help.

The new position statement as well as the CJSM CME Module we have created will help clinicians, including myself, learn more about the importance of mental health in the athletes we serve, and will help us be better able to identify and address the issues uncovered.  High profile and tragic stories like that of the life and death by suicide of Olympic cyclist Kelly Catlin underscore the vital importance of improving our care.

Besides the timeliness of #CASEMCON2019 wrapping up today in Vancouver with Clint Malarchuk’s talk, there is a bit of additional serendipity to the publication date for the CCMHS statement and this podcast, as well, for May is #MentalHealthAwarenessMonth!

And so…..your action items for this weekend

  1. Follow #CASEMCON2019 on your social media feeds
  2. Listen to the podcast, which can be found on our journal web page and on our iTunes feed
  3. Read the position statement — one of the Editor’s picks for this month
  4. Check out the CME module CJSM has produced on the topic of mental health in sport
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