May Day

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CJSM: bringing you clinical sports and exercise medicine research, from around the globe

Whether you are celebrating today as International Workers’ Day, running around a May pole, or watching Leicester City try to complete the 5000:1 shot of winning the Premiership, we are sure that today, May 1, can only be a good day:  our third issue of the year has just published.  And this May Day CJSM is full of offerings we’re sure will be of  interest to you.

Two of the articles have a special focus on physical activity as an intervention for medical conditions — one is a meta-analysis from Chinese colleagues finding a protective effect for physical activity against lung cancer, and the other is a prospective, single-blinded, randomized clinical trial looking at rock climbing as an intervention in the treatment of low back pain. This study is from Austria, and had positive findings for dependent measures of disability (the Oswestry Disability Index), a physical examination maneuver, and even the extent of disc protrusion on MRI.  We’re proud to publish these high quality studies from across the globe.

We are also proud to contribute to the growing body of literature on the effectiveness of “Exercise is Medicine.” Read more of this post

A Sharapova Moment

The world of sports medicine is never boring, but who knew things could get this interesting?

In the first weeks of March, there have been at least two major stories that have transcended the borders of ‘sports medicine’ and become topics of debate for the world at large — I speak of the proposed ban on tackling in schoolboy rugby (and the continued debate on tackling in American football) and Maria Sharapova’s admission that she failed a drug test at the recent Australian Open.  For both stories, the boundaries of the discussion have gone well beyond the lines of the playing fields and the walls of the academy.

Social media has seen these topics trending. The mainstream media have been profiling the issues as well.  The Economist weighed in on the debate about tackling. And this morning I found the New York Times prominently featuring Ms. Sharapova’s story, including articles on the drug meldonium [for which Sharapova tested positive] and on the issue of the World Anti-doping Agency’s (WADA) use of emails to notify individuals about changes on WADA’s banned substance list.

Many people have an opinion on the subjects.   We’ve been running a poll on this blog regarding the issue of tackling, while our friends at the British Journal of Sports Medicine (BJSM) have been running a Twitter poll on the Sharapova issue: who is responsible, the player or her support staff [currently the poll is 74%/26% stating it’s the athlete’s responsibility].

In the New York Times article and in the BBC, former WADA-president Dick Pound has stated his opinion that Sharapova’s failed drug test was ‘reckless beyond description.’

I must say I take issue with this and empathize with Ms. Sharapova, who stated that she received in December the WADA email noting that meldonium was now on the banned substance list, but “…I did not look at that list.”  Meldonium was a PED legal until 2016, when it was placed on the ‘banned substances list.’ As a professional inundated with emails, alerts, pronouncements, and more, I confess to a certain degree of information overload even when it comes even to items vital to my licensure and ability to practice.  Have I ever received an email from the Medical Board that I have deleted?  Have I ever received notification from my hospital staff office of some new change in policy which I glossed over?  Yes and yes.

Regarding the WADA emails, other athletes in the NY Times article have offered this opinion: “Some dismissed the messages as irrelevant to their own regimens or too complicated to be useful.”  That certainly resonates with me and my professional world.

I am not writing this to absolve Ms. Sharapova, and I applaud her for her prompt and open admission of personal responsibility. That stance is right and proper.  But I would hardly deem her action “reckless beyond description.”

In CJSM we have published over the years several studies on banned substances. One of the pieces of original research just published in our March CJSM sheds some further light on this issue, I think: Dietary Supplements: Knowledge and Adverse Event Reporting Among American Medical Society for Sports Medicine Physicians.  Read more of this post

CAS vs. IAAF — the Dutee Chand decision

The Court of Arbitration in Sport (CAS) made a major ruling yesterday with broad implications. Dutee Chand, an Indian sprinter, had been fighting the International Association of Athletics Federation (IAAF) policy which would have required her to undergo surgery, take medicine, and agree to other interventions if she were to compete as a female. Ms. Chand has naturally higher levels of testeosterone than most women; she had never identified in her life as anything but female.  She and her legal team fought the IAAF policy in the CAS, and won.

The CAS questioned the advantage of naturally high levels of testosterone in women’s sport, and ruled that Ms. Chand must be allowed by the IAAF to compete as a woman, essentially overturning the current IAAF policy. A New York Times article makes for fascinating reading.

This is a victory for Ms. Chand, and many would argue that it is a victory for women’s sport, and for sport in general. Nevertheless, many athletes, including marathoner Paula Radcliffe, supported the IAAF policy and worry that women’s sport may now be conducted on a less level playing field, if you will.

Issues of gender in society are front page news this summer in the USA. Sports, as a mirror of society at large, offer up a narrative within this larger story — the Dutee Chand story has been ongoing for well over a year, and we’ve discussed her story and the overall story of ‘Too Much T’ at different times here in the blog.

We thought we’d repost (below) a very popular commentary which includes discussion of this issue of testosterone in women’s sport: ‘The Sports Gene: How Olympians are made (or born).’ And we thought we’d include a poll on what you, the reader, think of this most recent CAS decision on IAAF policy. Vote, and let us know what you think!

Take Our Poll

Clinical Journal of Sport Medicine Blog

The venues at Sochi are still, it seems, a work in progress.  Nevertheless, before the week’s end, we will (should?) see the Winter Olympic games start up.  Soon, we’ll get to watch some of the finest athletes in the world compete at their sport.

There has been a lot of talk about the on-going construction at the most expensive games in Olympic history, as well as the issue of gay rights and cultural sensibilities in Russia;  and there have been worries about the potential for terrorism.  But soon, when the competitions begin, I hope the focus will justifiably be on the athletes on the snow and ice.

Or in Tweet speak: #LetGamesBegin

I’ve not been consciously preparing for this elite sporting event, but rather coincidentally recently picked up a book that highlights elite athletes and has received a great deal of positive ‘buzz’:  The Sports…

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The Nutcracker

Angelina_Sansone_dans_Casse-Noisette,_Kansas_City_Ballet,_-4_décembre_2013_a

Angelina Sansone, Kansas City Ballet

With the holiday season come a host of traditions. There are tree trimming and the lighting of the menorah; there are caroling and jingle bell runs. And there’s that new favorite: wearing tacky sweaters.

There is, as well, the Nutcracker.

My family and I will be watching this weekend at Columbus’ BalletMet production.  This will mark our fifth year in attendance, and I’ve been impressed with the dancers’ artistry and skill each time I’ve seen the show.

Truth be told, I never went to any ballet until I was an adult.  My affection for the Nutcracker derives not from my own childhood Christmas memories, but from the work I did as a sports medicine fellow, where I ‘covered’ the Boston Ballet for a year.  What a great experience that was!

‘Dance Medicine,’ as many of you know, is a special niche of sports medicine.  Like any sport, dance has its own language, it’s own mental and physical challenges, its own equipment, and its own injury patterns.  I have not managed too many cases of hallux rigidus, FHL tendonitis or posterolateral ankle impingement outside of the dance world.

I grew very fond of this field during my training, and I continue to seek out opportunities to participate in this world.  And so I took extra pleasure in our September 2014 editions, which offered two new pieces of original research in dance medicine: Body Mass Index, Nutritional Knowledge, and Eating Behaviors in Elite Student and Professional Ballet Dancers and a brief report, Early Signs of Osteoarthritis in Professional Ballet Dancers:  A Preliminary Study.  I commend both of them to you. Read more of this post

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