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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CJSM Podcast 10: Exercise-associated Hyponatremia, the 2015 Consensus Statement

jsm-podcast-bg-1#DrinkToThirst is the hashtag that needs to trend in the sports medicine world!

Exercise-associated hyponatremia (EAH), a preventable and treatable but potentially life-threatening condition that can affect athletes under our care, is the topic of our tenth podcast.  And #DrinkToThirst is one of the chief themes to be found therein.

We’re proud to publish the 3rd international consensus statement on EAH in our July 2015 CJSM, and we’re delighted to have the lead author as our guest on the associated podcast.

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Dr. Hew-Butler and friend.

Dr Tamara Hew-Butler is an associate professor of Exercise Science at Oakland University in Rochester, MI. She obtained her: BS in Kinesiology at the University of California at Los Angeles, CA; Doctor of Podiatric Medicine (DPM) at Temple University in Philadelphia, PA; Residency and Fellowship at the Harris County Podiatric Surgical Residency Program, Houston, TX; and Philosophy Doctor (PhD) at the University of Cape Town, South Africa. Dr Hew-Butler is a Fellow of the American College of Sports Medicine (FACSM) and specializes in both sports medicine and exercise physiology. Her expertise is in exercise-associated hyponatremia and the endocrine regulation of fluid balance during exercise. She trained under Timothy D. Noakes MD, DSc and Joseph G. Verbalis MD and has published ~50 papers on the topic.

Join us in the rousing conversation, and learn i) why athletes should #DrinkToThirst; ii) why sidelines should have hypertonic saline as well as AEDs and access to cold-water immersion therapies; iii) and so much more.

There Be Monsters

“In like a lion, out like a lamb,” that’s what they say about March.

To the extent that expression applies to the weather this month and to this blog, I think 2014 may be the exception that proves the rule!  We may be going out like a lion in both areas.

The east coast of North America is ready for spring, but this month that opened up with winter is ending the same way.  If there was an outdoor lacrosse game in Buffalo, New York this weekend, the players were dealing with snow!

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More like a lion than a lamb: an NHL body check.

As for this blog, we opened the month with a post that had both sound and teeth, like the proverbial carnivore itself:  our first podcast was a discussion with Drs. Neil Craton and Oliver Leslie, the authors of the March 2014 CJSM lead editorial, Time to Re-Think the Zurich Guidelines: a Critique on the Consensus Statement on Concussion in Sport.  I continue to hear about this editorial, on social media, on the American Medical Society for Sports Medicine email ListServ, and most recently at a symposium on concussions held at Ohio State University (OSU).  It has stirred a tremendous amount of interest.  And so I thought it would be fitting to end the month where we started, with the subject of concussion in sport.

The featured speaker of the OSU symposium was Kevin Guskiewicz, who spoke about “Sports concussions: paranoia or legitimate concern?”  Both he and Dr. Jim Borchers, the Ohio State Team Physician, mentioned the editorial critique in their respective talks.

If you follow the literature on sport-related concussions, you most certainly will come across Dr. Guskiewicz’s name.  He has contributed mightily to the research on several dimensions of this injury.  And so it was a pleasure to hear him speak for an hour on the subject.

As the title of his talk would indicate, Dr. Guskiewicz took as his theme the fear surrounding sport-related concussion.  Dr. Guskiewicz did an admirable job underscoring the importance of both the injury (concussion) and the need to avoid throwing out the baby with the bathwater:  eliminating collision sports such as American football out of possibly misplaced concern over short- and long-term deleterious effects on the brain.  The high points of his talk focused on the various aspects of sport amenable to change which can minimize injury risk and maximize participation.

I especially enjoyed his approach because, in many respects, it is the work that he and a few others have done (amplified by the media) that has helped unleash the beast of “concussion fear.” Read more of this post

The November CJSM: A Discussion on the Mandatory Use of Bicycle Helmets

The November issue of CJSM has been out for a week, and I hope you’ve had a chance to look at our latest offering.  It is also our last offering for 2013 (CJSM is a bimonthly, publishing 6 times a year).  The next time the journal will hit your mailboxes and inboxes will be January 2014.

FIMS 2014

Quebec City, site of the XXXIII FIMS
World Congress of Sports Medicine
CJSM will be there: will you?

2014 promises to be a big year in sports and sports medicine.  The Winter Olympics take place in Sochi, Russia; the FIFA World Cup is in Brazil; and the Commonwealth Games are in Glasgow, Scotland.   On the sports medicine front, the Canadian Academy of Sports and Exercise Medicine (CASEM) hosts the FIMS 2014 World Congress of Sports Medicine in Quebec City, and earlier in the spring the AMSSM annual meeting takes place in the Big Easy.  And this brief listing, of course, merely scratches the surface of what is to come.

But before I get ahead of myself, best to hold on to the mantra, “Be Here Now,” and share with you a little of what’s in store when you delve into this month’s CJSM.

Headlining the November issue is CASEM’s position statement on the mandatory use of bicycle helmets.  This document is a revision of a previous statement made in 2002, and incorporates the medical evidence in support of such use that has accumulated over the last 10+ years.  There is an associated lead editorial by Murray Maitland, PhD that is definitely worth a read as well.

I was particularly interested in the CASEM offering at least in part because I am a regular bicycle commuter here in Columbus, Ohio who recently had his interest in such matters piqued after reading a provocative article in the NY Times:  “Is it OK to Kill Cyclists?”

That’s a rhetorical question mind you!

First having ensured the life insurance policy had been paid up, I then read through the CASEM statement, which packs a lot in two pages.  The statement surveys the field of what is known about the use of bicycle helmets and injury prevention, and then makes recommendations.  Some of the salient points I walked away with: 1) wearing a properly fitted helmet decreases head injuries by 63% to 88% in all ages of bicyclists; 2) introduction of legislation (i.e. not merely relying on education campaigns) is associated with a decreased injury rate and has not been shown to decrease ridership (importantly, as we seek to increase physical activity in our sedentary population); 3) youth populations are more likely to wear helmets where there is legislation that applies to riders of all ages as opposed to only 18 years and younger; 4) youth are more likely to wear helmets when cycling with an adult wearing a helmet (95%) than when cycling with an adult not wearing a helmet (41%).

The CASEM statement draws several conclusions from these data, but most importantly recommends “That all Provincial and Territorial governments should enact comprehensive legislation mandating that bicyclists of all ages wear helmets.”

I would concur with those recommendations, and I would love to hear your thoughts after reading the CASEM statement, either here in the comments section or on twitter @cjsmonline.  The CJSM executive editor, Chris Hughes, has written about this subject in a 2011 blog post, and notes that the associated poll of the readership taken at that time got more traffic than any other.  I’m hoping this month’s articles on the subject, and this blog post, encourages that same sort of commentary.

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My trusty steed has been known to fail me;
I’m happy to have a helmet on when riding it

My position on the matter (pro) is uncomplicated.  I think the data are clear and in favor of mandatory use of bicycle helmets:  mandatory legislation reduces serious injury; it encourages the most vulnerable (children) in the use of an injury prevention device; and it has not been shown to decrease ridership. Read more of this post

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