The Mental Health Podcast and CASEMCON2019

I hope readers of this blog, and listeners of the podcast, have been following #CASEMCON2019 on their social media feeds this week. The Canadian Academy of Sport and Exercise Medicine (CASEM) has been conducting its annual meeting in Vancouver these past several days, and is scheduled to wrap up today, May 18.  I have learned so much from following this #, as well as following the feeds of CJSM Twitter friends including Drs. Jane Thornton  Margo Mountjoy and Laura Cruz.

The topic of mental health in sport has figured prominently in the CASEM proceedings:  for instance, Clint Malarchuk, a retired NHL player, is scheduled to talk today about the stigma of mental health in sport.

And so one of our more recent publications and our most recent podcast could not be timelier (published in our May 2019 journal): The Canadian Centre for Mental Health and Sport (CCMHS) Position Statement: Principles of Mental Health in Competitive and High-Performance Sport

Krista Van Slingerland, of CCMHS and the University of Ottawa

The CCMHS is a relatively new organization and, along with a similar group in Sweden, represents one of the first such initiatives on the planet.  The co-founder of CCMHS, Ms. Krista Van Slingerland of the University of Ottawa, is the lead author of the position statement. She graciously met me on Skype (she, in Ottawa, and I in Columbus) to conduct a podcast exploring the issue of mental health in sport and the work CCMHS is doing to bring further attention to this issue and begin treating individual athletes for the problems they are facing.

CJSM is committed to providing a platform for this important issue, one which has been relatively neglected for too long in our world of sport and exercise medicine.  In my training — and I would suspect in yours, too — the focus was primarily on musculoskeletal medicine,  Medical issues such as managing diabetes or exercise-induced asthma, screening for cardiac disease, etc. would demand our attention at times.  The issue of concussion and its sequelae have of course become central to our athletes’ lives and our practice.  But identifying and helping our athletes cope with anxiety, depression, suicidality — I received little to no training in sports medicine about this, and have heretofore relied on my training in family medicine to help.

The new position statement as well as the CJSM CME Module we have created will help clinicians, including myself, learn more about the importance of mental health in the athletes we serve, and will help us be better able to identify and address the issues uncovered.  High profile and tragic stories like that of the life and death by suicide of Olympic cyclist Kelly Catlin underscore the vital importance of improving our care.

Besides the timeliness of #CASEMCON2019 wrapping up today in Vancouver with Clint Malarchuk’s talk, there is a bit of additional serendipity to the publication date for the CCMHS statement and this podcast, as well, for May is #MentalHealthAwarenessMonth!

And so…..your action items for this weekend

  1. Follow #CASEMCON2019 on your social media feeds
  2. Listen to the podcast, which can be found on our journal web page and on our iTunes feed
  3. Read the position statement — one of the Editor’s picks for this month
  4. Check out the CME module CJSM has produced on the topic of mental health in sport

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.

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