Transitions: November in the USA.

Really?  Can it be that November is here?

I just covered my last high school football game of the fall, a loss in the playoffs. A season which began in the heat and humidity of August [with its attendant muscle cramps and concerns of exertional heat illness & exercise-associated hyponatremia] is now over, and injuries sustained on wrestling mats and in basketball gymnasia are beginning to show up in my clinic.  Before you know it, the skiiers and snowboarders will be filling out the waiting room.

November also brings with it the publication of our last CJSM of 2015, and it is a good one.  We have profiled two offerings in particular, both of which currently are freely available on line:  original research looking at potential limitations of American Heart Association recommendations for pre-participation cardiac screening in youth athletes; and a provocative editorial [and just right for the change of seasons] arguing for adult autonomy in deciding whether or not to wear helmets when skiing.

Both subjects are among the more controversial in sports medicine.  Whether or not to consider pre-participation screening with ECG when taking care of our younger athletes–well, that’s a question whose answer can vary depending on what side of the Atlantic one is on, or what part of the United States you may live in.  It’s a question whose answers may lie in much of the research we publish in our journal, with luminaries such as Jonathan Drezner and William Roberts weighing in.

Whenever we publish research or commentary on the question of mandatory personal protective equipment, I sometimes feel as if we have entered the ‘blood sport’ arena of sports medicine.  This issue’s editorial  on the ‘Ethics of Head Protection While Skiing’ has already generated some buzz on our twitter feed. Two years ago, we published the Canadian Academy of Sport and Exercise Medicine (CASEM) Position Statement on the Mandatory Use of Bicycle Helmets, and our social media feeds erupted.  I have never seen so much discussion on the blog site.

There is much more to be read carefully in this November 2015 issue.  A very interesting piece of original research, from one of our more prolific authors (Dr. Irfan Asif), looks at the potential psychological stressors of undergoing pre-participation cardiovascular screening.  As a pediatric sports medicine specialist, I’ll be reading with great interest a study on the potential prognostic implications of post-injury amnesia in pediatric and adolescent concussed athletes–lead author Johna Register-Mihalik continues to make major contributions to our understanding of that injury in that population.

So, enjoy this issue.  And brace yourself–2016 is on its way.  It will be here before you know it!

The @MomsTeam Summit in Boston #PlaySmart

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Dr. Brian Hainline, Chief Medical Officer for the NCAA, discussing how to ensure the physical and mental health of youth athletes.

It truly was inspiring being part of a special day of talk and action that took place on Monday.  As I wrap up my work week (condensed into a few busy days after flying back home to Columbus, OH from Boston, MA) I now have the time to reflect a bit on the day.

MomsTeam Institute hosted a summit at Harvard Medical School, “SmartTeams Play Safe™: Protecting the Health & Safety of the Whole Child In Youth Sports By Implementing Best Practices,” and I was honored to be one of the speakers.

I’ve written about MomsTeam, a non-profit organization implementing best practices in youth sport safety, before; but I don’t believe I’ve ever shared with you what a strong band of clinicians and researchers comprise the group.  Monday, many of my fellow speakers formed a veritable ‘Who’s Who’ of sports medicine, and to a person they gave some wonderfully memorable talks:  ranging from Doug Casa speaking broadly about the subject of heat injury prevention in youth sports  to Brian Hainline, the NCAA’s Chief Medical Officer, to Holly Silvers-Granelli who spoke about ACL prevention in female youth athletes, emphasizing neuromuscular training programs (a subject which is central to one of our CJSM podcasts), and Tracey Covassin who spoke about gender differences in concussions.

A particularly poignant moment came when Dr. Hainline had us watch the video from Designed to Move, a “Physical Activity Action Agenda.”   Read more of this post

Computerized Neurocognitive Testing in the Management of Concussions, Part 2


Concussion management for football,
c. 1930

I woke up this morning to my usual Sunday routine:  the New York Times Sports page and coffee.

Today’s sports section–and I don’t think the Times is alone in this regard–is devoted to the subject of the forthcoming American college football season.  The first games of the season will take place this Thursday, August 29.  As the Times puts it, “The nation’s annual rite of mayhem and pageantry known as the college football season begins this week…..”

When I’m not doing work with the Clinical Journal of Sports Medicine, I’m taking care of youth, high school and college athletes; for my colleagues and me, the football season has already begun, with the various teams we cover already having had weeks of steady, increasingly intense practices and scrimmages.  And we’re seeing the injury results of the sport, including an increase in volume of concussions.

I’ve mentioned this in my blog posts for this month, where the theme has been ‘concussions.’  Last week I wrote about the special set of CJSM concussion research articles we have made freely available for a limited time.  At the beginning of the month, I authored a post on the subject of computerized neurocognitive testing (e.g. ANAM4, CNS-Vital Signs, AxonSports,  ImPACT, etc.) and their use in managing concussions.  I want to return to that subject in today’s post.

axon sport macdonald

The author’s baseline AxonSport report

A recent article from the Archives of Clinical Neuropscyhology was especially interesting, I thought. The authors looked at a military population while evaluating the test-retest reliability of four computerized neurocognitive assessment tools (NCATs):  Automated Neuropsychological Assessment Metrics 4 (ANAM4), CNS-Vital Signs, CogState (available now in the U.S. as ‘Axon Sports’), and ImPACT).  I’m familiar with these products, but most especially ‘know’ CogState, as this is the NCAT we use in our clinic.

The authors correctly assert that test-retest reliability is one of the “…fundamental psychometric characteristics that should be established in each NCAT,” and that “….reliability should be established before making conclusions about a test’s validity,” which is the psychometric construct that can indicate whether a test measures what one is truly trying to measure (for instance, ‘reaction time,’ or ‘memory’).  Reliability, is the “…extent to which the test produces consistent results across multiple administrations to the same individual.”

In this study of 215 individuals (mean age 34, range 19 to 59), Read more of this post

Risk Factors for Injury in Elite Youth Ice Hockey

I had planned today on writing a sequel to my weekend post on spondylolysis, and I will definitely do so later this week.  But I have hockey on my mind this morning.

Our local team, the Columbus Blue Jackets, fought valiantly this shortened NHL season, and came within a whisker of the playoffs.  The team I grew up with, the Detroit Red Wings, have moved on to the Conference semi-finals, and so if I have any skin left in the game, it is with the Wings.

But I was captivated last night, as I’m sure some of the blog’s readership was, with an extraordinary Game 7 between the Toronto Maple Leafs and the Boston Bruins which brought to mind Jim McKay’s famous line from the “Wide World of Sports”:  “the thrill of victory, and the agony of defeat.


Patrice Bergeron scored the goals at end of regulation and in OT to send Bruins to victory


The Maple Leafs: deflated at the end of a heartbreaking game.

Somehow, the Maple Leafs went from leading 4-1 to losing 5-4 in overtime, as the Bruins, playing at home in Boston, achieved one of the more memorable comebacks in NHL playoff history.

As this was happening, my Twitter feed exploded with #bruins and #leafs posts, as two cities were collectively either shouting with joy or gnashing their teeth.  If you’ve never ‘watched’ a sporting event via Twitter, I commend the experience to you: it’s a bit like tapping into the collective consciousness of whatever group your following. Read more of this post

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