Exercise as a prescription to address post-concussion syndrome: The CJSM Blog Journal Club

Sports like American football are taking place in the midst of COVID19 — concussions are sure to follow

Our September 2020 edition has just published, and this edition is a particularly compelling one, full of original research.  You have to check it out.

As ever our Jr. Associate Editor Jason Zaremski M.D. has just posted his newest submission to the CJSM journal club.

While COVID19 is wreaking havoc with sports schedules around the globe, there are enough high schools and youth sports programs active that concussions will continue to remain a challenge for clinicians to treat.  And post-concussion syndrome is one particularly challenging aspect to this injury.  Dr. Zaremski walks us through original research looking at an ‘exercise prescription’ to treat post-concussion syndrome.

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Jason Zaremski MD

Gauvin-Lepage J, Friedman D, Grilli L, Sufrategui M, De Matteo C, Iverson, GL, Gagnon I. Effectiveness of an Exercise-Based Active Rehabilitation Intervention for Youth Who Are Slow to Recover After Concussion, Clinical Journal of Sport Medicine: September 2020 – Volume 30 – Issue 5 – p 423-432 doi: 10.1097/JSM.0000000000000634

Introduction:  With the change of seasons, many of our readers return to covering pediatric and adolescent sport. In the Northern Hemisphere, summer vacation is over, and academics and school sports are commencing. Fall is the start of the gridiron football season and there is often a surge of concussed youth who need effective, evidence-based management.

This month the CJSM Journal Club has chosen to highlight original research on the effectiveness of exercise-based rehabilitation in 8-17 year youth who have sustained a concussion. In this age group, return to school is even more important than return to sport, and the lingering difficulties in intellectual ability, vestibular system function, memory, and/or attention can be particularly debilitating.  The authors in this new study report that between 20% and 30% of all concussed youth will endorse post-concussive symptoms (PCS) 1 month after injury. Further research into treatments and modalities aimed at reducing the frequency with which children and adolescents experience PCS is paramount.

Purpose: The authors state two aims:

1) To determine the impact of providing participants (aged 8 to 17 years) who are slow to recover after a concussion with an active rehabilitation intervention (ARI) compared to receiving standard care alone, at 2 and 6 weeks after the initiation of the ARI.

2) To investigate functional recovery 6 weeks after initiation of the ARI.

Setting: Tertiary care pediatric trauma center and associated community health care providers. Read more of this post

CJSM July Blog Post Journal Club — A Physical Activity Vital Sign

Our Jr. Associate Editor and Journal Club Author, Dr. Jason Zaremski, sporting the contemporary COVID-era look

Our July 2020 issue has just published, and it’s full of many important new position statements and original research publications.

Among the latter is an investigation of a physical activity ‘vital sign’ and its association with cardiometabolic disease.

As always, our Jr. Associate Editor Jason Zaremski, MD will walk us through the study in this edition of the CJSM Blog Post Journal Club.

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Jason Zaremski, MD — Jr. Associate Editor, CJSM

Title: Nelson VR, Masocol RV, Ewing JA, Johnston S, Hale A, Widederman M, Asif IM. Association Between a Physical Activity Vital Sign and Cardiometabolic Disease in High-Risk Patients. Clinical Journal of Sport Medicine: July 2020 – Volume 30 – Issue 4 – p 348-352. doi: 10.1097/JSM.0000000000000588.

Introduction:  The challenges posed by the COVID pandemic are legion.  A less publicized aspect of ‘stay home’ or ‘shelter-in-place’ orders has been the reduction in physical activity in all ages. This new publication by Nelson VR et al. examining a physical activity vital sign (PVS) arrives in the pages of CJSM at just the right time.

Physical inactivity is known to be associated with increased rates of cardiovascular disease, cancer, and increased mortality rates. The ability of physicians to potentially screen patients using efficient means during clinical encounters could be extremely helpful to improve measures of all cause morbidity and mortality of patients.

This month’s journal club focuses on this interesting new study assessing the use of a PAVS and its correlation with cardiometabolic markers and disease in medically complex patient population in a large family medicine clinic in South Carolina. Read more of this post

CJSM Journal Club — Nondisclosure of concussion symptoms by athletes

Jason Zaremski MD, au courant with medical clothing styles circa 2020. Go Gators!

Our May 2020 issue has recently published, and as ever our Jr. Assoc. Editor Dr. Jason Zaremski is ready to share his pick for the newest CJSM Blog Journal Club.

Concussion Symptom Underreporting Among Incoming National Collegiate Athletic Association Division I College Athletes is the subject for today’s blog post.

Dr. Zaremski is himself a physician at The University of Florida, well known for its Division 1 College Athletic program, the Florida Gators. Whether we treat collegiate athletes, pros, or children, we in sports medicine ALL have an interest in addressing the issue of concussion nondisclosure.

Thanks to the authors for this timely study, and thanks to Dr. Zaremski for your ongoing contributions in this journal club.

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Jason Zaremski, MD

Introduction:  As we enter the early stages of the summer and approach a “new normal” with regards to sports, it is incumbent upon sports medicine team physicians to be vigilant as we bring freshman athletes to college campuses with potentially different methods to screen and perform pre-participation physical examinations. While dealing with the new challenges COVID will pose, including the possibility of conducting assessments remotely, clinicians will need, as always, to obtain accurate historical information in order to care for our student-athletes. With that in mind, we present the May 2020 Journal Club on Concussion Symptom Underreporting Among Incoming National Collegiate Athletic Association Division I College Athletes by Dr Fiona Conway and colleagues.

Purpose: To examine concussion knowledge and the relationship of knowledge to reasons for concussion symptom nondisclosure in NCAA Division one incoming athletes. Read more of this post

Treatments for Achilles Tendinopathy — CJSM Blog Post Journal Club

We’re celebrating our 30th Anniversary!!! Take a look what’s beneath the new, sleek cover.

We are celebrating our 30th year of publication in 2020 and we could not be happier to ring this new year in than with the publication of our January 2020 issue, full of the sorts of offerings that make CJSM a special part of the sports medicine universe. From original research to systematic reviews to case reports, we have several new offerings that help clinicians bring the latest in evidence-based medicine to their patients on the pitch, in the training rooms, and in the clinics.

One of those studies reports research results reported by authors practicing in the UK and deals with a very common problem among athletes: Novel Inerventions for Recalcitrant Achilles Tendinopathy.

Dr. Zaremski & assistant take a break from their writing.

This prospective cohort study is the focus of our first blog post journal club of the year, with CJSM Associate Editor Jason Zaremski M.D. guiding us through the ins and outs of the study.  Take it away Dr. Zaremski!

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Introduction:  As we begin a new decade and say goodbye to 2019, the winter CJSM journal club will be focusing on an issue that is extremely common in all individuals, chronic Achilles tendon injury. As many individuals make New Year’s resolutions to exercise more and live healthier lifestyles, we as sports medicine and musculoskeletal experts must be prepared for an increase in overuse injuries such as tendinopathies.  These conditions can be difficult to treat, and new, novel approaches to these common conditions are always of interest. A new study by Wheeler and Tattersall is a timely publication to review in this new year: Novel Interventions for Recalcitrant Achilles Tendinopathy. Benefits Seen Following High-Volume Image-Guided Injection or Extracorporeal Shockwave Therapy—A Prospective Cohort Study.

Purpose: The authors of this study set out to compare the outcomes for patients with chronic non-insertional Achilles tendinopathy (CNIAT) following extracorporeal shockwave therapy (ESWT) versus high-volume image-guided injection (HVIGI). The results may provide practitioners greater information for patients and to improve patient care. Read more of this post

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