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

November…….already

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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!

Team Physicians: On your mark, get set….go!

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The sidelines–where so many of us like to be.

It’s still full-on summer in North America. The temps can exceed 40 C (104 F) in some parts, and the geese haven’t flown anywhere…..but fall is in the air, as team sports are in the midst of two-a-days and the hitting has begun! My clinics have shown an uptick in patient numbers, as the injured are trickling in. I have yet to stand on a sideline, but will do so in two weeks. It’s a good time to review the Team Physician Consensus Statement (see below) published a couple of years ago.

From the challenges of making real-time, sideline decisions regarding our athletes to the development of emergency action plans, those of us in clinical sports medicine will find a lot to help us in this statement.  In CJSM we have published over the years several manuscripts of great importance to the team doc.  We have explored whether return to play decisions are the responsibility ultimately of the team physician to variation in physician practice in those return to play decisions to more.  On this blog, we’ve covered the spectrum with interviews of team physicians from the Ohio State Buckeyes (Jim Borchers) to the Michigan Wolverines (Bruce Miller)…….

The health and welfare of our athletes is our primary obligation; in keeping our eye on this ‘ball’ there are several others we need to juggle–the needs of the team, the decisions of coaches and managers, the desires of parents if we are taking care of youth athletes……As our seasons progress, be sure to follow us here on the blog and on twitter @cjsmonline. And stay tuned to cjsportmed.com for studies released ahead of print, our ever-growing body of podcasts. We will try to help you navigate this juggling act.  All the best!

Clinical Journal of Sport Medicine Blog

Earlier this week, several sports medicine organizations released a statement with which all sports medicine clinicians should familiarize themselves:  the “Team Physician Consensus Statement:  2013 Update.”

The Statement represents, in its own words, “…an ongoing project-based alliance” of the major professional associations associated with sports medicine  in the United States.  These include the American Academy of FamilyPhysicians (AAFP), the American Academy of Orthopaedic Surgons (AAOS), the American College of Sports Medicine (ACSM), the American Orthopaedic Society for Sports Medicine (AOSSM), the American Osteopathic Academy of Sports Medicine (AOASM), and this journal’s affiliated professional group, the American Medical Society for Sports Medicine (AMSSM).

This is an update of a statement first published in 2000.  It includes sections which define the role of ‘team physician’;  describe the requisite education and qualifications; enumerate the medical and adminstrative duties and responsibilities; and explore the relevant ethical and medicolegal issues.

The entire statement is worth a read, but I find…

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