CJSM Blog Journal Club — Brain Changes After a Single Season in Youth vs. High School Football

Attending to injured player, High School Football

The November 2019 Clinical Journal of Sport Medicine has just published, and as always the new edition is full of interesting and original research.

One of the studies that already is getting some buzz is one by a team of researchers (full disclosure: including myself) headed by Dr. Kim Barber-Foss entitled Relative Head Impact Exposure and Brain White Matter Alterations After a Single Season of Competitive Football: A Pilot Comparison of Youth Versus High School Football.

This is a perfect study for a journal club, as the subject of cumulative exposure to head impacts, most especially in our youngest athletes, has been a hot, hot topic in sports medicine for several years. The sport in question here is American gridiron football.

Our intrepid Blog Journal Club author and Junior Associate Editor Jason Zaremski MD leads the charge, as ever, in his most recent post.  Thanks Dr. Zaremski for your insightful analysis of this new research.

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Title: Barber Foss KD, et al. Relative Head Impact Exposure and Brain White Matter Alterations After a Single Season of Competitive Football: A Pilot Comparison of Youth Versus High School Football. Clin J Sport Med 2019;29:442–450.

Jr. Assoc. Editor and Blog Journal Club author Dr. Jason Zaremski (L) and CJSM Editor-in-Chief Dr. Chris Hughes (R)

Introduction:  The pre-holiday CJSM journal club brings you an innovative new study from expert researchers related to potential white matter changes in the brain in adolescent football players. As has been discussed in the CJSM journal club as well as throughout the media, there are many consequences to sustaining a sport related concussion (SRC). One question yet to be answered, with advances in neuroimaging techniques, can structural alterations of the brain be observed using magnetic resonance diffusion tensor imaging (DTI)? According to the authors, DTI can evaluate microscale white matter (WM) changes. This is potentially important as WM changes may be detected even without clinical signs of a SRC. More specifically, the measurable metrics include fractional anisotropy (FA), radial diffusivity (RD), axial diffusivity (AD), and mean diffusivity (MD). According to prior research, RD, AD, and MD are sensitive to detect WM changes in athletes participating in contact sports. Hence, we present “Relative Head Impact Exposure and Brain White Matter Alterations After a Single Season of Competitive Football: A Pilot Comparison of Youth Versus High School Football.”

Purpose: To determine preseason to postseason changes in WM integrity from repetitive head impacts for youth football (YFB) players compared with HS football players during a competitive football season.

Hypothesis(es): The magnitude of WM changes would be greater for YFB than for HS football players.

Methods/Design:  Prospective study with IRB approval and consent and assent obtained. Read more of this post

What to do about heading?

Heading the ball — photo courtesy of Wikimedia

I have been meaning to write a blog post for over a week, since a bit of breaking sports medicine news occurred with the publication of some research in the New England Journal of Medicine (NEJM).

It took a Tweet this morning to rouse me to action.  I promise it hasn’t been sloth on my part that has slowed my hand, but pleading “I’m busy” to the group of folks who usually will be reading CJSM media is not going to gain much sympathy.

And yes, with fall sports, I sure have been busy.  But I am sure you have too.

I hope, however, not too busy to have missed this piece of research from NEJM: “Neurodegenerative Disease Mortality Among Former Professional Soccer Players.”  There was an accompanying editorial to this study, a piece that is most definitely worth a read too. “Soccer and Mortality — Good News and Bad News”

The published research was a large retrospective cohort study looking at former professional Scottish football (soccer) players: 7676 cases were identified from databases of Scottish football players and 23,028 controls (3:1) from the ‘general population’ were identified using a Scottish ‘Community Health Index.’ Controls were matched to players on the basis of sex, age, and degree of social deprivation.  Of note, all the participants in this study were male.The researchers looked at two dependent outcome variables:  i) cause of death as noted on death certificates and ii) dispensed medications, information for which was obtained from the Scottish national Prescribing Information System.  Follow up information for study participants was for a median of 18 years (for each individual, “Age was used as the time covariate, with follow-up from age 40 years to the date of data censoring, which was either the date of death or the end of the follow up (December 31, 2016), whichever occurred first).”

The researchers report several important findings in this study, to note just a few:

Read more of this post

The CJSM podcast on the pediatric athlete — Guest Editor Dr. M. Alison Brooks

Dr. Alison Brooks, in a rare moment of repose — enjoying the sights from Table Mountain, Cape Town RSA

We have just published our September 2019 issue.  It is a special thematic issue focused on the pediatric and adolescent athlete, and we are grateful to Guest Editor Alison Brooks M.D., M.P.H. for the outstanding work she has done nurturing this issue from cradle to…..adulthood.

It’s been a long process watching this issue proceed from crawling to toddling to, now, standing on it’s own two feet marching off into the world!

Want to know more about pediatric sport specialization, concussion, nutrition, safe play?  Want to know more about the rigors and work involved with a guest editorship?  It’s time then to queue up your smart phones and listen to our newest podcast, where Dr. Brooks makes her debut as our guest.

I have known Dr. Brooks for several years and consider her a friend.  As a friend as well as a professional colleague, I am duly impressed with her career.  And you should be, too. An Assoc. Professor on the tenure track at the University of Wisconsin, she has published widely and can be found in the pages of CJSM as well as many other journals. A former member of the AMSSM’s Board of Directors, Dr. Brooks continues to influence youth athletic policy with her work for the AAP’s Council on Sports Medicine and Fitness.  And I know her best as the person I accompanied on the AMSSM’s Travelling Fellowship in South Africa in 2015.

Spend 20 minutes finding out more about the medical challenges facing our young athletes and learning a bit more about Dr. Brooks.  Go to our podcasts now at iTunes or our journal’s main web page.

Prescribed Exercise for Managing Concussions — the CJSM Blog Journal Club

Our Editor-in-Chief Chris Hughes (R) and Jr. Assoc. Editor Jason Zaremski (L) taking a brief spell from their busy lives.

Our fifth edition of the year went live at the beginning of September, and it’s a special one:  we have devoted the entire issue to the theme of pediatric athletes.

Our guest editor Alison Brooks M.D., M.P.H. has assembled an impressive line up of authors, including John Leddy M.D. of SUNY Buffalo who is the lead on an interesting new study demonstrating the benefits of prescribed aerobic exercise in the recovery of adolescent males from sport-related concussion.

Our Jr. Assoc. Editor Jason Zaremski M.D. has submitted another insightful journal club piece looking at the details of Dr. Leddy’s study.

As fall approaches in the Northern Hemisphere, and spring in the Southern, sports-related concussions will continue to show up in a variety of sports our young athletes play.  This work from Dr. Leddy et al. (including both this new study and his CJSM 2018 study) will be transformative in the way we manage our athletes.

Enjoy the original research paper itself (here) and the journal club article (below).

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Jason Zaremski M.D., Junior Associate Editor CJSM

Title:

Leddy JJ, et al. A Preliminary Study of the Effect of Early Aerobic Exercise Treatment for Sport-Related Concussion in Males. Clin J Sport Med 2019 29(5):353-360.

Introduction:  

As the temperature begins to change and we enter the fall season, millions of student-athletes have returned to school and sport. With such large participation numbers in sport inevitably comes a rise in injury. One of these injuries is sports related concussions (SRC). In recent years, our overall knowledge of how to diagnose, manage, and treat SRC has improved thanks to the ever-growing research in this area. However, one aspect that is continuing to evolve is the timing and intensity of physical activity after sustaining a SRC. While rest (cognitive and physical) has been a mainstay of treatment in the past, there is a growing body of research that indicates physical activity may accelerate recovery versus physical rest only. Thus, it is our pleasure to provide this month’s CJSM Journal Club by reviewing Leddy and colleagues’ new work on the effects of early aerobic exercise as a potential treatment for SRC in adolescent males.

Purpose/Hypothesis(es):

The primary purposes of this research is to compare early subthreshold aerobic exercise (STAE) versus prescribed rest and days to recovery from concussion for adolescent males. The authors hypothesized that STAE would reduce the days to recovery after treatment prescription. Read more of this post

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