Making a Good Thing Better — The Healthy Sport Index & Youth Sports

I have the great privilege of taking care of many outstanding young athletes in my sports medicine clinics

Youth sports is of special interest to me — I practice pediatric sports medicine at Nationwide Children’s Hospital, and perhaps 90% or more of the patients I see regularly participate in youth sports.

The topic is of great interest to this journal as well:  for example, CJSM will publish later this year a themed issue on topics in youth sports medicine, guest edited by my friend and colleague, pediatrician Alison Brooks M.D. of the American Medical Society for Sports Medicine (AMSSM).

Youth sports has long been recognized as a valuable activity for the individuals and families who choose to participate.  An abundance of evidence points to the health benefits — physical, mental, academic — that can be achieved by children and adolescents engaging in sports.

There has been growing concern over the last decade or two (or three), however, of the potential and possibly growing risks of youth sports.  The concerns range from early youth sports specialization and overuse injuries to early professionalism. The concerns include the youth sports culture itself – a culture manifest in nightmare form by the myriad incidents of abuse seen in USA Gymnastics or Swimming.

On April 12 2019, the AMSSM will be hosting a pre-conference prior to their annual meeting, entitled the Youth Early Sports Specialization Summit (YESSS!)   Among many of the subjects up for discussion is the “Healthy Sport Index (HSI),” an instrument developed by the Aspen Institute’s Project Play initiative and made public in October 2018. The HSI was designed to help kids and families answer the important question:  what sport is right for my child?  As a physician caring for thousands of these athletes a year, I can’t tell you how often I’m posed that question.  Now there is a tool to help.

One of the physicians who served on the Advisory Group for the development of the HSI was Michele LaBotz, M.D. She is a pediatrician and sports medicine physician in a large multi-specialty group in southern Maine, who serves on the American Academy of Pediatrics’ Council on Sports Medicine and Fitness (COSMF) and is a member of the AMSSM.  She kindly volunteered to give an overview on the HSI for the CJSM blog, and we’re delighted we can share her thoughts in the run up to YESSS!

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HEALTHY SPORT INDEX:  A UNIQUE TOOL FOR YOUTH SPORTS

Michele LaBotz MD FAAP

As health care providers, we rightfully emphasize safety and injury risk when discussing sport participation in young athletes.  We recognize the potential risks of sports that are contact vs. non-contact, or those that are high impact vs. low impact.   But, sport selection and participation is about more than just injury risk, and there is under-recognition that different sports exert a variety of influences on young athletes.  The Healthy Sport Index (HSI) presents this information in an appealing format and is a valuable resource for families and other stakeholders when considering sport-related issues in children and adolescents

HSI aggregates evidence-based data on physical activity, psychosocial effects, and safety on the 10 most popular high school sports for boys and girls in the U.S. Read more of this post

PRiSM 2017 — Dallas

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Dr. Jim Andrews, one of the pioneers of pediatric sports medicine, gives the keynote address at PRiSM 2017, Dallas photo: Kevin Ford

The last time we wrote about the Pediatric Research in Sports Medicine Society (PRiSM) we were in sunny San Diego.  This year’s annual meeting took place in another sunny, albeit slightly cooler, locale:  Dallas.

PRiSM is a relatively young society, but one which is up and coming.  There were 250+ attendees at this year’s meeting, the 4th annual gathering.  What makes this organization special is its focus and membership:  1) its focus is pediatric sports medicine research; 2) its membership is multidisciplinary, drawing from physicians, surgeons, physical therapists, athletic trainers and radiologists.  One of the speakers this year, in fact, came from the world of veterinary medicine: Cathy Carlson of the Univ. of Minnesota gave several interesting talks on aspects of osteochondritis dissecans (OCD), focusing on the animal models (swine, caprine) she uses in her research.  Her insights into the early development of OCD were among the most powerful, I thought, of the conference.

The keynote conference was delivered by a true pioneer in the field:  the world-renowned Dr. Jim Andrews, from the Andrews Sports Institute.  He bemoaned the epidemic of pediatric sports injuries and spent time identifying many of the factors contributing to this important public health issue.  At the same time, he described some of the success stories out there — models for how we can improve injury prevention in our young athletes.  These include the @safekids initiative he is involved with.  I would add MomsTeam Institute to any list of such safety initiatives.  This is the non-profit youth sports safety group I am involved with.

[on a side note — I am presenting research that MomsTeam has done, along with Executive Director Brooke de Lench, at the IOC World Conference on Prevention of Injury & Illness in Sport in Monaco in March — expect posts a plenty coming from that conference]

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David Howell, of Boston Children’s Sports Medicine, wins the best scientific poster of PRiSM 2017. Photo: Greg Myer

The faculty at PRiSM 2017 was simply stellar, including several who have graced the pages of our journal and our blog: Read more of this post

Boxing in the Olympics

 

Rio de Janeiro - Robson Conceição derrotou na tarde deste domingo o cubano Lázaro Álvarez e vai a final do boxe categoria peso ligeiro. (Fernando Frazão/Agência Brasil)

The new look to Olympic Men’s Boxing  (photo: Fernando Frazão/Agência Brasil)

With summer holidays and work, I will be honest — I have not been watching too much of the Olympics on the television.  I have made a point to watch Michael Phelps’ last (possibly?) Olympic swim and Usain Bolt’s historic 100m gold medal performance.  I am a former track and field athlete myself, and so I also have witnessed Jamaica’s Elaine Thompson win the women’s 100m and South Africa’s Wade van Niekerk set the 400m world record.  I catch up on news in the newspaper when I wake up (for instance, the story of Anna Sofia Botha is possibly the most heartwarming of these Games).  But watching live TV?  Not so much.

Between the track events, I have caught some of the men’s boxing and I, like possibly many of you CJSM blog readers, have been struck by the absence of head protection.  Our world of sports medicine is big, and I’ll confess I had not been aware of the rules changes going into these Olympics regarding the non-use of this protective equipment for men’s boxing:  since the 1984 Los Angeles Olympics, mandatory headgear has been in place for boxers until now, in Rio.

There has been some controversy over this issue — both when it was introduced as a safety measure, and now in 2016 when it has been removed, also for stated safety reasons:  the incidence of concussions is expected to decline without the headgear in place.  The International Boxing Association (AIBA) made this rule change since the Beijing Olympics, and International Olympic Committee (IOC) spokesman Mark Adams is quoted as saying, “AIBA provided medical and technical data that showed the number of concussions is lower without headgear. They have done a lot of research in the last three years. The rule will go ahead for Rio.”

Some of that research has been published in our journal, including this cross-sectional observational study on the use of head guards in AIBA boxing tournaments.   The results of this study show that referees had to stop matches for head injuries more often when boxers were wearing head gear than when they weren’t.  At the end of the day, after integrating all the available current evidence, it was understood that the headgear was not sufficiently protective to prevent concussions (no surprise there: the holy grail of contact sports may be effective, ‘concussion proof’ head protection), and, instead, promoted more frequent hits to the head — a good example of ‘risk compensation’ in injury prevention.

The CJSM study, authored by a group including lead author Michael Loosemore and senior author Julian Bailes, has already generated a fair amount of debate on social media and commentary in the media, including the New York Times.  We have been receiving a fair number of ‘letters to the editor’ regarding the study since these Olympics have begun, and we will be publishing both the letters and the authors’ responses soon.  A robust debate looking at the evidence, and pointing toward where research must head to resolve this issue — that is a ‘contest’ that will extend beyond Rio and into Tokyo, site of the 2020 summer games.  Stay tuned to the blog and to CJSM to stay abreast of this issue.

5 Questions with Brooke de Lench, MomsTEAM Institute of Youth Sports Safety

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I am pleased to have as our guest today Ms. Brooke de Lench, a pioneer and leader in the field of youth sports safety.  Brooke is founder and Executive Director of  MomsTEAM Institute of Youth Sports Safety, Producer of the PBS movie ‘The Smartest Team: Making High School Football Safer,” and author of Home Team Advantage:  The Critical Role of Mothers in Youth Sports.

Brooke has become a valued colleague, and someone I think of immediately when I’m asked what relevance social media has for a sports medicine clinician. I first ‘met’ Brooke on Twitter, and as our relationship has evolved, I now find I work with her on a weekly if not sometimes daily basis, addressing youth sports issues of mutual concern.  I am proud that I have become a member of the Board of Directors for the non-profit MomsTEAM Institute, a professional role I have written about in previous blog posts.

Much of the work MomsTEAM has done has been instrumental in advancing the cause of identifying, preventing, and managing concussions in youth sports, and there is a natural affiliation that has developed between this journal and MomsTEAM over the years, with the Institute authoring several blog posts on the research in youth concussions.  Those posts have frequently looked at work that CJSM has published.  Our November 2015 issue has, for instance, two pieces of original research that I suspect may end up in the pages of a MomsTEAM post: Register-Mihalik’s ‘Characteristics of Pediatric and Adolescent Concussion Clinic Patients with Post-concussion Amnesia,’ and  Schmidt’s ‘Does Visual Performance Influence Head Impact Severity Among High School Football Athletes?’

With MomsTEAM gearing up for a collaboration with Sony Pictures‘ Concussion (the movie)–an event that I think will impact all clinicians caring for youth athletes–I thought it was time to interview Brooke on our regularly recurring “Five Questions with CJSM” feature.

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1) CJSM: How old is MomsTeam Institute and how did you found it?

BD: I established MomsTEAM Institute in 1999 and we launched our first website and workshops in August of 2000. I began writing the “Survival Guide for Youth Sports Parents” in 1998 when Random House offered to publish my book in three volumes over the subsequent five years because I had “so much information.” Instead, I turned to the limitless container of information – the new and emerging internet which was something much more exciting to me. Later in 2006, I did write a book that Harper Collins published.

In 2000, there was nowhere to find independent, objective well researched and well written information for sports parents, and so I brought together a team of experts in medicine, law, journalism, sports, and coaching who along with me as a writer-researcher, began the long journey of providing the very best information on how to keep student athletes safe:  physically, emotionally, psychologically and sexually.

Parents always seemed to turn to me with sports safety questions; my triplet sons called these regulars “Moms Team.” Hence the name. Read more of this post

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