Super Bowl Blues

The 2018 – 19 NFL season has ended with a familiar conclusion:  the New England Patriots having won (their sixth such championship).

Are you among the people who watched the game and found it boring (‘worst ever’)*?  Did you forego viewing entirely? Are you among the majority (reportedly) of fans disappointed because those Patriots won?  Sad simply because the season is over?

February can be a slog for all of us in the Northern Hemisphere — sports like the NFL can keep us going, and so perhaps you, my dear reader, are a bit blue for any number of reasons?

Well, I do not have something to cheer you up per se — rather I have something, perhaps, that will make you more blue….but it is an issue of vital importance to our profession.  And we can’t turn our eyes askance.

Recently published ‘ahead of print’ is headline-making original research: Reasons for Prescription Opioid Use While Playing in the National Football League as Risk Factors for Current Use and Misuse Among Former Players.

Headlines indeed. Over the Super Bowl weekend the New York Times published an article profiling former NFL players and their struggle with chronic pain and opioid addiction. It referenced the CJSM study authored by Dr. Eugene Dunne of Brown University and his team of authors.  Some of the more important findings reported are that among “….retired NFL players with exposure to prescribed pain medication during their playing career 26.2% reported recent use of prescription opioids (past 30 days).”  Moreover, the authors found that the past may be midwife to the future: use of opioids to manage pain during their career was associated with a 30% increased risk of present-day use of opioids in retired NFL Players.

Opioid use and abuse is a public health crisis of unprecedented scale in the USA according to JAMA.  Sports are not untouched by this epidemic.  CJSM has always striven to publish important and relevant research which can be translated into practical use — we provide this platform for clinicians helping individual patient-athletes, and we provide this platform for public health advocates as well.  We devoted an entire issue (Sept 2018) recently to the oft-neglected subject of pain management in athletes.  Guest Editor Prof. Wayne Derman of Stellenbosch Univ., South Africa emphasized in our podcast with him that it is imperative that clinicians seek holistic methods of pain control and that researchers look more intentionally at the issue of analgesia in athletics. An over-reliance on pharmacology, most especially opioids, is a potential recipe for problems (to wit, the experience of former NFL players in this new CJSM study).

Join us in this work and the global conversation on issues of importance to athletes, clinicians, researchers and public health advocates by checking out some of these references and following us on Twitter. We’ll always keep you abreast of what’s new and breaking in our world of sport and exercise medicine.

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*P.S. I really enjoyed the Super Bowl. Though low scoring, I loved watching Pats’ defense flummox such a great Rams’ offense, and I thought the game was tense until the very end. How about you?

Berlin 2016: The 5th International Consensus Conference on Concussion in Sport

20161027_120311The 4th International Consensus Conference on Concussion in Sport is one of CJSM’s published pieces that gets referenced frequently. Reflecting work that took place at a conference in Zurich in 2012, it was time to have an update on the issue of sports-related concussions.  As many of you know, the 5th consensus conference just took place in Berlin.  I was sorry I could not attend, and I look forward to the publications that will emerge from this meeting.

Today’s blog post is both about the Berlin conference and the power of social media.  I have written about social media and its import in the world of contemporary sports medicine.  I have celebrated the ability of media such as Twitter to bring people from different parts of the globe together, essentially obliterating barriers of distance and time.  I have lectured frequently on the ability of social media to translate findings from research into clinical practice.

Today’s blog post is proof of that power.

CJSM is delighted to have today guest author Osman Ahmed, a lecturer in physiotherapy at Bournemouth University in the UK, a practicing sports physiotherapist for the Football Association, and a leader in the use of social media in our profession. He attended and presented a poster at the Berlin conference. I first ‘met’ Dr. Ahmed on Twitter, and we’ve begun a deepening collaboration drawing on our mutual research interests.  We continue to interact on Twitter and Google Drive, but I have yet to shake his hand! [there are some issues social media can’t resolve on its own…..yet]

Some day, I look forward to meeting Osman in person.  In the mean time, I hit him up to share with the CJSM readership his impressions from the consensus conference.   Thanks so much for taking the time, Osman.

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Impressions of a concussion consensus conference from a newbie: Berlin 2016  — Osman Ahmed

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The largest chandelier in the whole of Germany is present in the lobby of the Ritz-Carlton Hotel

Few in the sports medicine community would argue that a consensus meeting has been as eagerly anticipated as the 5th International Consensus Conference on Concussion in Sport in Berlin this October. Since the last consensus meeting in Zurich in 2012, there has been an ever-increasing focus on sports concussion in the mainstream press [1], the scientific literature [2], and also in popular culture [3]. Given the magnitude of this conference, the impressive Ritz-Carlton Hotel in Potzdamer Platz was a fitting setting.

With so much attention on concussion in sport, there was plenty for the organising committee to work towards ahead of the conference. Read more of this post

ECG for the PPE? A conversation with Dr. Jonathan Drezner

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Dr. Jonathan Drezner in South Africa. Photo courtesy Alison Brooks.

Highlighting the just-published issue of CJSM is the new American Medical Society for Sports Medicine (AMSSM) position statement on cardiovascular preparticipation screening in young athletes.  The position statement is an invaluable contribution to the ongoing discussion over the pros and cons of adding the ECG to the preparticipation evaluation/examination (PPE) to prevent sudden cardiac death/arrest (SCD/SCA).

Those familiar with this debate will be familiar as well with the lead author of the statement, Dr. Jonathan Drezner. Dr. Drezner is a Professor in the Department of Family Medicine at the University of Washington and a team physician for the Seattle Seahawks of the NFL.  Dr. Drezner has published frequently in our pages, most often on the subjects of the PPE and screening for SCD/SCA.

The debate over the role of ECG in the PPE is one of the more contentious in sports medicine.  We look forward to seeing how the AMSSM statement will contribute to the direction that debate will take.  jsm-podcast-bg-1

You can gain added perspective on the statement and the controversy by listening to our newest podcast — a conversation with Dr. Drezner himself.  You can access the podcast both on iTunes and you can find it on our CJSM website as well.

Enjoy the discussion, and be sure to check out the statement itself, freely available in the 2016 September CJSM.

 

5 Questions with Dr. Jane Thornton — what is the physical activity prescription?

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Jane Thornton MD, PhD (2nd from left) — Canadian Olympian and Lead Author of CASEM Position Statement

We are having a sit down with Jane Thornton, MD PhD today as part of our recurring  blog offering, ‘5 Questions with CJSM.’  Among many other things, Dr. Thornton is the lead author of the new Canadian Academy of Sport and Exercise Medicine (CASEM) Position Statement on the ‘Physical Activity Prescription.’  This article, published in our July 2016 issue, has already drawn an immense amount of interest — it is currently free, so do not hesitate to check it out and print out/download the PDF to fully appreciate its contents.

Dr. Thornton is an extraordinarily accomplished individual who is finishing up her family medicine/sport medicine training at the University of Western Ontario.  Besides a medical degree, she has earned a Masters and PhD, doing her studies CJSM Associate Editor Connie Lebrun while at the Fowler Kennedy Sports Medicine Clinic.

With the Rio Olympics set to begin in a few days, it is perfect timing to conduct this interview with Dr. Thornton.  While doing all of that academic work noted previously, she was also training for the Canadian national rowing team. She rowed in the 2008 Olympics in Beijing with the Canadian women’s eight.  She knows a thing or two about physical activity, no doubt. In addition to her authorship of the CJSM manuscript, Dr. Thornton has co-created along with Dr. Mike Evans a website about how to #MakeYourDayHarder, advancing the notion that our every day activities offer abundant opportunity to get in meaningful levels of physical activity.

At CJSM, we have had an abiding interest in research on various aspects of physical activity (e.g. check out our recent post on #PEPA16 and Ann Gates, another mentor of Dr. Thornton’s), and so it is with great pleasure that we share with you our ‘chat’ with Jane Thornton.

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1) CJSM: How effective is an ‘exercise prescription’?  What is the evidence for this intervention?

JT: It may sound like common sense that physical activity is good for us, but it has taken us a long time to understand just how important it really is as a component of treatment. When we understand that it can lead to improved clinical outcomes in over 30 different chronic diseases, and can be as effective as medication in many instances (hypertension, stroke, and mild-to-moderate depression, to name a few), then we can’t ignore the fact that it should be something we talk about with our patients.

To best illustrate its effectiveness, though, let’s compare exercise prescription with smoking cessation counseling.  When we examine the number needed to treat (NNT), studies tell us that we need to counsel 50-120 patients to see one patient successfully quit smoking. When it comes to getting one patient to meet the globally agreed upon physical activity guidelines (150 minutes per week of moderate-to-vigorous physical activity), however, that number drops to 12 – meaning we have an incredible opportunity to help patients make a life-changing adjustment in their lives. No one, including me, would argue that smoking cessation counseling is not incredibly important. But given the recent findings that being inactive is almost as bad for you as smoking, we really should be expanding the conversation at each clinical encounter to include exercise.

2) CJSM: What are the barriers to its use?  Why aren’t more physicians actively engaged in giving their patients an exercise prescription?

JT: The most oft-cited barriers are time constraints, lack of education and training, complex comorbidities… and the most honest among us will also bring up the point that we just don’t think patients are motivated enough or willing to change. Interestingly, if we demonstrate a belief in patients, they will usually rise to the challenge. It may also come as no surprise that doctors who are active themselves are also more likely to counsel their patients to be active. A big obstacle in many countries is, of course, remuneration. It’s hard for some to justify time spent counseling on exercise if there is no billing code they can tack on. That one is a tougher nut to crack. Policy makers should take comfort in the fact that the practice of exercise prescription is also cost-effective.

3) CJSM: You are active on Twitter – if you could compose a 140 character Tweet for the CASEM position statement, what would it be?  Read more of this post

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