When it sees you but you don’t see it

Do Not Miss!!!

All of us who practice clinical care — who actively treat athletes and other patients — are keenly aware of the perils of a medical missed diagnosis.  The issues of concern can range from the relatively obvious — an Achilles tendon rupture for instance — to the more subtle.  In the case of an Achilles tendon rupture [or a scaphoid fracture or slipped capital femoral epiphysis (SCFE)], the outcomes from a medical misdiagnosis can be severe for both the patient and clinician:  significant morbidity for the former, and a possible medical malpractice suit (most especially in our litigious United States) for the latter.

Early in my training it was hammered home to me that if I let a patient with an Achilles tendon rupture walk out of my room with some bland assurance that one should give his or her acute posterior ankle pain a couple of weeks of rest and ice, and a message of ‘come back and see me if you’re not feeling better in a few weeks,” well….I could say hello to a suit which I would most certainly have to settle out of court.

Don’t want to be ‘that guy’ who doesn’t see the Achilles tendon rupture when it sees me.

Cassidy Foley, D.O., lead author

But what of some relatively common issues that may have more benign consequences, even if not initially ‘seen?’  What of the issues where missed or delayed diagnosis can result in weeks to months to years of frustration and, perhaps, unnecessary workup and/or misguided and ineffective treatments?

With those thoughts in mind, I was delighted to read an excellent study on the “Diagnosis and Treatment of Slipping Rib Syndrome” in the January 2019 CJSM.  Read more of this post

SportsKongres 2019 — An Overview Courtesy of Dr. Sheree Bekker

SportsKongres 2019, Copenhagen Denmark

Readers of this blog may be familiar with one of CJSM’s recurring collaborators, Dr. Sheree Bekker.  Dr. Bekker is a researcher in injury prevention at the University of Bath, UK,. She is, as well, an outspoken advocate raising awareness of the challenges faced by women in the field of sport medicine.  Finally, Sheree is a friend, and someone who is very active on Twitter:  a definite follow if you are in sport & exercise medicine and are reading this post!

I was following closely her tweets from the recent sportskongres in Copenhagen — what sounds like a fantastic conference just wrapped, and the buzz is on already for #SportsKongres2020.  Dr. Bekker graciously accepted my invitation to share her thoughts on the recent conference.  Enjoy, and hope to see you in Copenhagen in 2020!

___________________________________________________________________________

Dr. Sheree Bekker

Sheree Bekker, PhD

The 2019 edition of the Scandinavian Sports Medicine Congress has wrapped. Colloquially known by just a single name (as all the most famous people are, see: Serena, LeBron), sportskongres has, time and again, been billed by the British Journal of Sports Medicine as one of the Big 5.

This was my first sportskongres (full disclosure: I was an invited speaker), and from afar my biggest impressions of this conference were that the social program is legendary (spoiler: this is true), and that the focus is on clinically-relevant presentations and workshops (also true). Knowing that the majority of delegates at sportskongres are clinicians, I found an audience eager to learn from different disciplines and areas, an audience hungry for new insights and understandings as to what they are seeing and experiencing in everyday practice, and – most of all – an audience highly engaged in doing better. Read more of this post

Gender Bias in Medicine — the CJSM podcast with Dr. Esther Choo

@choo_ek (a.k.a. Dr. Esther Choo) — a definite follow on Twitter!

We are excited to share the first CJSM podcast of 2019 with you.  Special guest Esther Choo M.D., M.P.H. joins us to discuss issues of gender bias in medicine:  “From Mansplaining to Bromotion — How We Can Move the Needle on Gender Bias in Sports Medicine.” 

For those not familiar with Dr. Choo’s work, I would direct you to a CJSM blog post from December 2018 where I shared with you some of my thoughts about one of her more recent commentaries published in the British Medical Journal (BMJ): “A Lexcion for Gender Bias in Academic Medicine.”

I would also direct you to her Twitter feed and heartily encourage you to follow her @choo_ek to continually learn from her, as I do on a nearly daily basis.  She argues strongly that issues of equality inform all our attempts to deliver high quality medicine; that issues of bias should be of interest to us all, because they affect not only our fellow professionals, but the patients we serve.

She also does this typically with a sense of humor, which has often put me in mind of Mark Twain’s quotation, “Against the assault of laughter nothing can stand.”  This work and this tone can be hard to achieve, because many of the issues Dr. Choo and others are tilting against can be dark.  In thinking of our own word of sports medicine, the complicated and horrific story of Larry Nassar and USA Gymnastics comes to mind.  I’m also mindful of stories like that of Eva Carneiro, former team physician of an English Premiership Club, whose summary dismissal was entwined with these issues of sexism.  Or the exceedingly common phenomenon of attending a sports medicine conference only to find that all the keynote speakers are male

The world we serve is rife with issues of gender bias.  On his recent retirement, Andy Murray was lauded as an all too rare light in men’s sport — a man who would publicly stand up for women’s issues, a #HeForShe.  Or what to make of the arena of NCAA Division I coaching, where the sight of a man coaching a women’s team is common (think Gino Auriemma of UConn Women’s Bball), but the reverse is an exceedingly uncommon phenomenon.

There is light in this darkness.  Dr. Choo and groups like Feminem.org are doing great work.  I am also mindful of the lead that the IOC 2020 Prevention Conference has taken on this — the organizers publicly stated their intention to assemble a gender balanced planning committee, and they got it right, I think, including many luminaries in our field including Margo Mountjoy, Kate Ackerman, Caroline Finch, and Christa Janse van Rensburg, among others. Bravo!

I hope you go to our podcast page on our main website, or subscribe to the podcast on iTunes, to listen to our conversation with Dr. Choo and sample all of our podcasts.  Please let us know what you think. Take the time if you can on our iTunes feed to give us your opinion on the podcast in general, as we always take feedback seriously and use it to ‘tweak’ our media to make it ever better for you.

 

It’s a New Year — CSJM Blog Journal Club 2019 Starts Now

Japan (and its iconic Mt. Fuji) will be one of the places on the globe that will be enjoying an exciting 2019 in the world of sport.

We here at CJSM hope all of our readers have enjoyed a festive and relaxing holiday season.  I am sure for most of us reading this post, ‘things’ have picked back up, because the global sports world never sleeps.  From Australian Open tennis to the NFL playoffs to the English Premiership, and beyond, the sports (and sports medicine) scenes have been ushered in with a bang.

2019 promises to be an exciting year in sports all over, but perhaps in no place quite like Japan, as it hosts the Rugby World Cup at year’s end and busily prepares for the 2020 Summer Olympic Games in Tokyo.  I just spent my holidays there and fell in love with the country.  I am looking forward to posting more about the upcoming global events Japan is hosting this year and next.

CJSM has entered the new year with a bang as well, as we begin our 29th year with an issue that is full of interesting offerings.

Among the pieces of original research we have just published in this January 2019 issue is this one: Head Impact Exposure in Youth Soccer and Variation by Age and Sex. This piece has already received a good deal of attention. The accompanying editorial arguing (relatively speaking) against a ban on heading in youth soccer has realized a comparable buzz.

Jason Zaremski MD, Junior Associate Editor CJSM

We thought this would be a particularly good study to ‘de-construct’ in the Journal Club, and so we contacted our regular correspondent Jason Zaremski MD to pen one of his ever popular, recurring posts.  Thanks Dr. Zaremski, as always.

______________________________________________________________________________

Title:

Chrisman SPD, Ebel BE, Stein E, Sarah J. Lowry SJ, Rivara FP. Head Impact Exposure in Youth Soccer and Variation by Age and Sex. Clin J Sport Med 2019;29:3–10. http://dx.doi.org/10.1097/JSM.0000000000000497

Introduction:  

The newest edition of the Journal Club commentary for the Clinical Journal of Sports Medicine (CJSM) will be a review of an original research manuscript highlighting a very interesting topic, heading in “soccer” (referred to as “football” outside the United States) and its effects on our youth athletes. As the authors note, there are more than ¼ of a billion soccer players worldwide. In the USA, there are approximately 24 million soccer players and more than 37% are youth players. In the past few years there have been growing concerns about heading in youth soccer and possible associations with concussions and sub-concussive head impact exposures (HIE). Due to these concerns, individuals and some leagues (from local levels to national) have suggested a ban of heading to limit body contact and potential HIE. However, prior research has suggested that the actual number of youth players heading a soccer ball as well as intentional impacts with head to ball are low and heading restrictions may not be indicated. (Comstock et al JAMA Ped 2015, Lynall et al MSSE 2016, Press and Rowson CJSM 2016). Therefore, in order to obtain more objective data, the authors of this study wanted to objectively measure HIE in males and females at the youth level.

Purpose/Specific Aim(s):

The purpose of this study was to measure HIE using adhesive-mounted accelerometers during 1 month of soccer. Read more of this post

%d bloggers like this: